Erkekte Radyasyon ve İnfertilite
Özet
Radyasyon maruziyeti, tıbbi tanı ve tedavi yöntemlerinin, çevresel faktörlerin ve mesleki çalışmaların artmasıyla birlikte erkek üreme sağlığı üzerinde ciddi bir tehdit oluşturmaktadır. Vücuttaki en radyosensitif organlardan biri olan testisler, iyonize radyasyona doğrudan veya dolaylı olarak maruz kaldığında hücresel düzeyde ciddi hasarlar görmektedir. Bu maruziyet, su moleküllerinin iyonlaşması sonucu ortaya çıkan reaktif oksijer türleri nedeniyle oksidatif strese, germ hücrelerinde apopitoza, Leydig hücresi disfonksiyonuna ve Y kromozomundaki AZF bölgelerinde genomik kararsızlıklara yol açarak sperm kalitesini ve sayısını düşürmektedir. Düşük dozlar bile spermatogenezi baskılayabilirken, 2 Gray ve üzeri dozlar kalıcı azoospermi ve sterilete ile ilişkilendirilmektedir. Bu riskleri en aza indirmek adına, radyoloji pratiğinde ALARA (olası en az) ilkesi altın standart kabul edilerek zaman, mesafe ve kurşun bariyer kullanımı gibi bedensel korunma teknikleri ile gonadal koruyucu ekipmanların kullanımı kritik önem taşımaktadır. Nedeni tam açıklanamayan idiyopatik infertilite olgularında ve radyasyon kaynaklı hasarlarda ise yaşam tarzı değişiklikleri, antioksidan tedavileri ile IUI, IVF ve ICSI gibi yardımcı üreme teknolojileri gebelik şansını artırmak için sıklıkla tercih edilen tedavi stratejileridir.
Radiation exposure poses a severe threat to male reproductive health due to the expansion of medical diagnostic and therapeutic procedures, environmental factors, and occupational activities. The testes, being among the most radiosensitive organs in the human body, suffer significant cellular damage when exposed to ionizing radiation directly or indirectly. This exposure triggers oxidative stress through the formation of reactive oxygen species from water molecule ionization, leading to germ cell apoptosis, Leydig cell dysfunction, and genomic instability in the AZF regions of the Y chromosome, which ultimately reduces sperm count and quality. Even low radiation doses can suppress spermatogenesis, while doses of 2 Gray and above are strongly associated with permanent azoospermia and sterility. To mitigate these risks, the ALARA (As Low As Reasonably Achievable) principle is accepted as the gold standard in radiology practice, making radiation protection techniques such as time, distance, shielding, and gonad protective equipment highly critical. For cases of unexplained idiopathic infertility or radiation-induced impairment, lifestyle modifications, antioxidant therapies, and assisted reproductive technologies like IUI, IVF, and ICSI are widely utilized strategies to enhance the chances of achieving pregnancy.
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