الفهرس 
Introduction and Aim of workOnly 14 pages are availabe for public view
 |  | from | 176 |  |  |
| | | from | 176 | | |
Abstract
This study was performed, on 1970 patients who underwent either 1st time or repeated micro-TESE. Men with non-obstructive azoospermia (NOA) who underwent micro-surgical sperm retrieval between January 2010 and December 2015 were included and categorized into one of four groups [based on the number of prior unsuccessful TESE attempts] as follows: 1st time micro-TESE group (n: 1560); 2nd time micro-TESE group (n: 344); 3rd time micro-TESE group (n: 51); or 4th time micro-TESE group (n: 15). Patients were recruited from men attending the Andrology clinic of a specialized IVF center (Adam international hospital, Giza, Egypt).
The aim of this study was to report a six-year experience of repeat micro-TESE sperm retrieval rate in a large group of men with NOA and poor prognosis for sperm retrieval in comparison to those undergoing first microsurgical extraction attempt, as well as to compare between the testicular histological pattern of the initial and subsequent sperm retrieval specimens. Prior to undergoing micro-TESE, each patient was thoroughly evaluated by a comprehensive history, full clinical examination, 2 semen analyses with centrifugation, basal hormonal evaluation, revising the histopathological diagnoses of the former testicular biopsy, in addition to karyotype and Yq microdeletion analyses.
After statistical analysis, the results were as follows:
Approximately 78% had small testicular volume, 10% had clinical varicocele. 92.3% had normal karyotype, and 1.43% of men with normal karyotype had AZF-c micro-deletions.
Patients who underwent no prior biopsies and 1 prior biopsy had lower mean duration of infertility and lower frequencies of Klinefelter syndrome (KS) than those who underwent 2 to 3 prior biopsies, but the four groups were comparable regarding the mean age, testicular volume, frequency of varicocele, reproductive hormonal levels, and frequencies of AZFc micro-deletions.
The overall sperm retrieval rate (SRR) was 31.7%, and the success of sperm retrieval in the group with no prior biopsies (35.6%) was significantly higher than those who underwent repetitive TESE (16.8 %).
Patients who underwent 1 to 2 prior biopsies, had significant success rates of sperm retrieval (17.7% and 15.7%, respectively) compared to the 0% retrieval rate reported in patients with 3 prior unsuccessful biopsies.
Patients with prior three negative m-TESE had unsuccessful sperm retrieval during the fourth trial.
The proportions of histological patterns observed in the group with no prior biopsies were comparable to those observed in patients with repetitive TESE (P> 0.05).
Sertoli cell only (SCO) and arrest at primary spermatocyte were the most common patterns observed in patients with repetitive TESE.
The differences regarding histopathological patterns of the prior failed TESE and the current m-TESE was statistically insignificant,
Mature spermatozoa were retrieved more frequently in patients with SCO and primary spermatocytes arrest who had no prior biopsies (SRR: 32.1%and 25.7%, respectively) than those with the same histological patterns who had prior failed biopsies (SRR: 12.04% for SCO, and 12.6% for primary spermatocyte arrest).
Various characteristics of the study populations were comparable among patients with successful (n: 625) or unsuccessful (n: 1345) sperm retrieval, however the proportions of patients with KS were significantly higher (9.96%) among those with sperm negative TESE than those with sperm positive TESE (2.9%), P<0.05.