Prof.Dr. Kaan AYDOS
Genelde uygulanan üremeye yardımcı teknik yöntemleri IUI, IVF-ET ve ICSI’dir. Uygulanacak metod spermiyogram bulguları ve sperm fonksiyon testleri sonuçlarına göre seçilmelidir. 36 yaş altındaki kadınlarda 3 siklus uygulanımını takiben IUI’un başarısı >%40 dır (30). Swim up ile ejakulatın hazırlanmasını takiben >10×106/ml spermatozoa ve >%40 motilite içeren olgularda IUI ile başarılı sonuçlar alınabilir (31). Ancak, motil sperm sayısı <106 olduğu zaman gebelik oranı %3’ün altına düşmektedir. IVF için kullanılacak spermlerin ise >%30 ileri motilite ve >%30 normal morfoloji gösteren >5×106/ml spermatozoa içermesi önerilir (32). İnseminasyon dropleti içinde ise oosit başına 2×104 – 1×105/ml motil spermatozoa eklenmesi yeterlidir. Spermin kalitesine göre (immotil, aglütine, anormal spermlerde) bu sayı 5×105/ml’ye kadar yükseltilebilir (33).
ICSI için ise sperm sayısında bir kriter yoktur. Azoospermik olgularda bile testislerden elde edilen spermatozoalar, hatta spermatid kullanılarak 
gebelik elde edilebilmektedir. Bütün bu uygulamalarda başarılı olmanın en önemli koşullarından biri sperm hücresinin canlı olmasıdır. Oositi fertilize edebilecek kalitede bir spermi ayırt etmenin en iyi yöntemi sperm motilitesinin ve sperm membran bütünlüğünün hipoosmotik ortamda şişme (HOS) testi veya eozin- Y vitalite boyama testi ile gösterilmiş olmasıdır. Motil olmayan spermlerin canlı oldukları ortaya konmuşsa bunların kullanılması ile sağlıklı ICSI gebelikleri elde edilebilir. Oysa immotil spermlerin IUI ya da IVF gibi diğer ÜYT’de kullanılması başarılı olmayacaktır. Bu nedenle, ÜYT uygulanması kararı verilmiş olgularda, taze ejakulatın ve hastanın kliniğine göre en uygun sperm hazırlama yönteminin seçilmesi hastayı takip eden doktorun özellikle üzerinde durması gereken bir koşuldur. Örneğin, seminal parametreleri orta derecede ve ileri derecede bozulmuş erkeklerde gradiyent sistemi ile sperm hazırlanıp ÜYT uygulandığında siklus başına gebelik oranları sırasıyla %43.5 ve %7.1 bulunurken (34), swim up ile hazırlanmış örneklerde gebelik oranları ise orta kalite ejakulatlarda %5.9’da kalmaktadır. Demek ki, sperm hazırlama yöntemleri spermin kalitesine göre seçilmelidir.
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