Identifying Pre-operative Factors for Successful Micro-dissection Testicular Sperm Extraction in Non-Obstructive Azoospermia

Identifying Pre-operative Factors for Successful Micro-dissection Testicular Sperm Extraction in Non-Obstructive Azoospermia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Identifying Pre-operative Factors for Successful Micro-dissection Testicular Sperm Extraction in Non-Obstructive Azoospermia Omar Mohamed, Hafez Badawi, Osama Mohamed, Gamal A.Alsagheer, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6678763/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background About half of all infertility cases among couples globally are caused by male infertility. Azoospermia, in which no sperm are detected in the ejaculate, affects around 1% of the male population and 10–15% of males who experience infertility. There are two kinds, obstructive and non-obstructive, and the reasons for and methods of treating each are different. To solve this problem, in vitro fertilization (IVF) can be used to harvest sperm. Although there are many methods for sperm retrieval, micro-testicular sperm extraction (Micro-TESE) allows for the most accurate retrieval with the least amount of tissue injury. Aim This study aims to enhance results and decrease treatment costs by identifying predictive characteristics of successful micro-TESE in NOA patients. Methods This prospective study (May 2022–May 2024, Qena University Hospital) included NOA patients, including those undergoing redo procedures or with a single testis. Exclusion criteria covered obstructive causes, surgeries, infections, or genetic issues. All underwent detailed hormonal, clinical, and imaging assessments, and micro-TESE was performed using magnification to preserve tissue. Outcomes assessed included sperm retrieval, histopathology (Juhanson Score), complications, and pregnancy rates. Results Mean male age was 38.83 ± 9.91 years; 60.67% were smokers. Mean wife age was 30.03 ± 6.03 years; infertility duration averaged 6.76 ± 5.59 years. Successful micro-TESE was associated with older age, larger testicular size, prior treatment, lower FSH, LH, E2, and prolactin, and higher testosterone (p < 0.05). Juhanson score, testicular side, and sperm concentration also predicted success. ROC analysis showed strong predictors: age < 34.5 years (67.4% sensitivity), testis size 4.765 ng/mL (90.6% sensitivity), and Juhanson score < 1.5 (97.2% sensitivity, 72.7% specificity). Conclusion Key predictors of micro-TESE success in NOA include hormone levels, testicular size, prior treatment, and histopathology score, aiding in better case selection and outcome prediction. Micro-TESE Non-obstructive azoospermia Male infertility Figures Figure 1 Introduction Male infertility is defined as the inability of a male to achieve pregnancy in a fertile female after 12 months of regular, unprotected intercourse. ( Agarwal A, et al 2015 ) Approximately 7–12% of the world's male population experiences infertility, and couples experiencing male infertility make up around half of all infertility cases. Male infertility can be affected with several factors such as genetic defects, hormonal disturbance, evidence of varicocele, infections, and lifestyle such as obesity and smoking . The diagnosis of azoospermia is made after centrifugation and examination under a 400 X power microscope when neither of the two consecutive ejaculates contain sperm. ( Tharakan et al., 2021 ) It affects 10–15% of males who are unable to conceive and approximately 1% of all men. The azoospermia can be classified into two primary groups: obstructive and non-obstructive. Obstructive azoospermia can be caused by a number of different things, such as blockage of the ejacturatory duct, injuries, infections, vasectomy, and congenital bilateral absence of vas or lack of vas at birth. ( Jarow, J. P et al., 1989) The main cause of non-obstructive azoospermia is a defect or failure of the testes to produce sperm. The most common reasons include problems with hormones, infections, genetics, and testicular failure. ( Tournaye, H.,et al., 2017 ) Early evaluation and accurate classification of azoospermia enhance the likelihood of successful fertility management. Under the microscope Using a microscope, micro-TESE locates seminiferous tubules that are rich in sperm and extracts them. The technique enhances sperm retrieval with minimal harm to testicular tissue and danger of increasing testosterone insufficiency by extracting small tissue fragments instead of big biopsies. ( Achermann et al., 2021 ; Esteves & Verza, 2012 ) . Finding predictive markers of efficient micro-TESE in patients with non-obstructive azoospermia was the goal of this study, which aimed to optimize outcomes, reduce costs, and maximize pregnancy rates. Patients and methods This prospective clinical study was conducted at the Urology Department of University Hospital between May 2022 and May 2024 to evaluate predictive factors for successful micro testicular sperm extraction (micro-TESE) in patients with non-obstructive azoospermia (NOA). A total of 600 patients completed follow-up during the study period. The data used to compute the sample size came from Kalsi et al. ( 2015 ), who reported a retrieval success rate of 46.55%. An odds ratio of 1.115, 95% confidence, 80% power, and 5% margin of error were determined by the algorithm to require 600 samples when utilizing Epi Info: n = [DEFF*Np(1-p)]/ [(d 2 /Z 2 1−α/2 *(N-1) + p*(1-p)] "The ethics committee of [………….] approved this study (Approval No.: [401], Date: [22-5-2025]). All subjects provided written (or verbal) informed consent for inclusion in the study/for undergoing the procedures described. The procedures adhered to the ethical guidelines of the Declaration of Helsinki and its amendments. The authors confirm the availability of, and access to, all original data reported in this study." the authors declare to have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Each author made substantial contributions to the Manuscript Dr OM and Dr OM designed the work and interpreted the patient data Dr AH was a major contributor in writing the manuscript Dr GA wrote the discussion Dr HB had drafted the work and revised it All authors read and approved the final manuscript. Ethical code : SVU MED URO016 2 22 5 401 Ethical committee, south valley university, Egypt In this investigation, males with a NOA diagnosis were the focus. Patients with non-obstructive azoospermia, those having a single testicle, or those having redo micro-TESE surgeries were all considered for inclusion. The following conditions were not considered for inclusion: obstructive azoospermia, vas deferens absence on both sides, genital infection history, vasectomy or surgery in the past, and hereditary anomalies. Consent Form for participation and publication A written consent from the responsible person on the selected patient before conducting the research . Consent name:: age: address: Date: I am who signed on this paper. I agree completely on my participation in this research project That will predict the factors affecting sperm retrieval techniques in non-obstructive Azoospermia that caused male infertility as I was diagnosed. and Dr, ………… explained to me obviously all benefits and hazards of participation in this research project by taking some laboratory investigations from me and then perform sperm retrevial techniques. I also agree that the results of this project can be published in International scientific journals Signature All patients underwent thorough preparation, including detailed history taking, physical examination, and both laboratory and radiological investigations. The preoperative evaluation involved data collection from patient records, covering infertility complaints, duration, time and consummation of marriage (defined by willful vaginal penetration), frequency and timing of sexual intercourse, contraceptive use, and any history of erectile dysfunction or premature ejaculation. Medical and surgical histories were reviewed, including previous procedures such as varicocelectomy, micro-TESE, hernia repair, or orchiopexy, as well as any relevant family history. General evaluation for gynecomastia, hair distribution, and body mass index were all part of the thorough physical examination. Local genital examination included testicular volume measured by orchidometer and penile and meatal morphology, presence of epididymal cysts, assessment of vas deferens (bilateral absence led to exclusion), varicocele grading, and digital rectal examination to rule out prostatic cysts or seminal vesicle abnormalities. Investigations included semen analysis (per WHO 2010 guidelines, two samples), scrotal Doppler ultrasound to assess testicular volume and varicocele, and hormonal assays (FSH, LH, prolactin, total testosterone). Karyotyping and Y-chromosome microdeletion tests were done when needed, especially in suspected Klinefelter syndrome cases. Microdissection testicular sperm extraction (micro-TESE) involved wide equatorial incision of the testis to expose seminiferous tubules while preserving intratesticular blood flow. Under ×2 and ×6 magnification, tubules were dissected between fine septae and centrifugal vessels, avoiding disruption of the subtunical vessels beneath the tunica albuginea, which are highly prone to bleeding. Success in minimizing testicular trauma depended heavily on meticulous hemostasis, as bleeding is the main cause of adverse outcomes like fibrosis. Microdissection was extended to explore all tubules due to the heterogeneous distribution of spermatogenesis; larger and opaque tubules often indicated active sperm production. Postoperatively, outcomes included success rates in each attempt, histopathology results of biopsies using Johanson Score for both positive and negative findings, complication rates (bleeding, hematoma, failure, fibrosis), and pregnancy rates confirmed by gestational sac detection. We conducted the statistical analysis using IBM SPSS Statistics for Windows, Version 28, which is produced by IBM Corp. in Armonk, NY, USA. Means, standard deviations, minimums, and maximums—indices of central tendency and dispersion—characterized the quantitative variables. To summarize the categorical variables, percentages and frequencies were utilized. For the statistical study, we utilized IBM SPSS Statistics for Windows, Version 28, which is produced by IBM Corp. in Armonk, NY, USA. Standard deviations, minimums, and maximums—indices of central tendency and dispersion—characterized the quantitative variables. In order to summarize the categorical variables, percentages and frequencies were considered. Results Table (1): General evaluation among included subjects Value (N =600) Age (Years) 38.83 ± 9.91 Smoking 364 (60.67%) Wife age (Year) 30.03 ± 6.03 Infertility duration (years) 6.76 ± 5.59 Mean male age was 38.83 ± 9.91 years; 60.67% were smokers. Mean wife age was 30.03 ± 6.03 years. Infertility duration averaged 6.76 ± 5.59 years. Table (2): Comparison between cases with positive and failed negative micro TESE regarding general and clinical evaluations Positive Micro-TESE group (N = 376) Negative Micro-TESE group (N = 224) P. Value Age (Years 39.39 ± 9.35 37.88 ± 10.73 0.0154* [MWU] Smoker 248 (65.96%) 116 (51.79%) 0.015* [X] Wife age (Year) 30.6 ± 6.03 29.09 ± 5.91 0.0327* [MWU] Infertility duration 6.4 ± 4 7.36 ± 7.51 0.5029 [MWU] Clinical Evaluation Right testicular size 8.75 ± 2.75 6.79 ± 3.05 <0.0001* [MWU] Left testicular size 8.71 ± 2.93 6.74 ± 3.03 <0.0001* [MWU] Varicocele 108 (28.72%) 68 (30.36%) 0.7646 [X] Treatment before TESE 252 (67.02%) 120 (53.57%) 0.0202* [X] Mean age, wife age, and smoking rate were significantly higher in the positive micro-TESE group (p = 0.0154, 0.0327, and 0.015, respectively). Right and left testicular sizes were significantly larger in the positive group (p < 0.0001). Prior treatment was also more common in the positive group (67.02% vs. 53.57%, p = 0.0202). Varicocele incidence (p = 0.7646) and infertility duration (p = 0.5029) did not differ significantly. Table (3): Comparison between cases with positive and failed negative micro TESE regarding lab. data and histopathology Positive Micro-TESE group (N = 367) Negative Micro-TESE group (N = 224) P. Value Labs. FSH 13.16 ± 11.25 21.69 ± 17.53 <0.0001* [MWU] LH 8.09 ± 4.58 11.93 ± 10.35 0.0056* [MWU] Testosterone 7.81 ± 2.42 4.11 ± 0.84 <0.0001* [MWU] Estradiol E2 34.74 ± 16.85 70.9 ± 51.28 <0.0001* [MWU] Prolactin 10.36 ± 4.86 17.23 ± 11.98 <0.0001* [MWU] Histopathology Juhanson score for histopathology 9.93 ± 1.52 2.14 ± 0.61 <0.0001* [MWU] Micro TESE testicular site Right 208 (55.32%) 28 (12.5%) <0.0001* [X] Left 140 (37.23%) 32 (14.29%) <0.0001* [X] Bilateral 28 (7.45%) 164 (73.21%) <0.0001* [X] Sperm concertation Good 120 (31.91%) 0 (0%) <0.0001* [f] Moderate 104 (27.66%) 0 (0%) <0.0001* [f] Low 152 (40.43%) 224 (100%) <0.0001* [X] Both the duration of infertility (p = 0.5029) and the incidence of varicocele (p = 0.7646) did not show any significant differences. Significantly higher histopathology (Juhanson) scores were seen in the positive group (p < 0.0001). The prevalence of right- or left-sided micro-TESE was higher in positive instances, but bilateral TESE was more common in negative cases (p < 0.0001). There were no good or moderate instances in the negative group, while positive cases exhibited significantly higher sperm concentration (p < 0.0001). Table (4): Comparison between cases with successful and failed pregnancy regarding general and clinical evaluations Success pregnancy group (N = 200) Failed pregnancy group (N = 400) P. Value Age (Years) 38.78 ± 9.02 38.85 ± 10.33 0.6562 [MWU] Smoking 136 (68%) 228 (57%) 0.0663 [X] Wife age (Year) 29.95 ± 5.54 30.08 ± 6.26 0.826 [MWU] Infertility duration (years) 5.88 ± 3.9 7.2 ± 6.23 0.2148 [MWU] Clinical Evaluation Right testicular size 9.11 ± 2.58 7.44 ± 3.08 <0.0001* [MWU] Left testicular size 9.03 ± 2.96 7.45 ± 3.06 0.0003* [MWU] Varicocele 24 (24%) 128 (32%) 0.1524 [X] Treatment before TESE 140 (70%) 232 (58%) 0.0437* [X] There were no significant differences between the groups that had successful pregnancies and those that did not in terms of age, wife age, smoking, or length of infertility (all p > 0.05). The right and left testicular diameters were significantly larger in the successful group (p < 0.0001 and p = 0.0003, respectively). Cases that were effective had a higher frequency of pre-TESE treatment (p = 0.0437). There was no discernible change in the incidence of varicocele (p = 0.1524). Table (5): Comparison between cases with successful and failed pregnancy regarding Lab data and histopathology Success pregnancy group (N = 200) Failed pregnancy group (N = 400) P. Value Labs FSH 12.52 ± 10.28 18.25 ± 15.9 0.0089* [MWU] LH 7.8 ± 4.42 10.39 ± 8.54 0.0367* [MWU] Testosterone 9.37 ± 2.01 4.96 ± 1.47 <0.0001* [MWU] Estradiol E2 33.56 ± 13.42 55.57 ± 44.12 <0.0001* [MWU] Prolactin 11.12 ± 4.58 13.83 ± 10.3 0.3751 [MWU] Histopathology Juhanson score for histopathology 10.18 ± 0.64 5.44 ± 3.99 <0.0001* [MWU] Micro TESE testicular site Right 116 (58%) 120 (30%) <0.0001* [X] Left 76 (38%) 96 (24%) 0.0114* [X] Bilateral 8 (4%) 184 (46%) <0.0001* [X] Sperm concertation Good 116 (58%) 4 (1%) <0.0001* [X] Moderate 76 (38%) 28 (7%) <0.0001* [X] Low 8 (4%) 368 (92%) <0.0001* [X] Results from successful pregnancies showed significantly reduced levels of FSH (p = 0.0089), LH (p = 0.0367), and estradiol (p < 0.0001), and significantly higher levels of testosterone (p < 0.0001). A statistical analysis revealed no significant difference in prolactin levels (p = 0.3751). A higher frequency of bilateral TESE (p < 0.0001) was observed in the failure group, in contrast to the success group's higher frequency of Juhanson score (p < 0.0001), right (p < 0.0001), and left testicular locations (p = 0.0114). Good and moderate sperm concentrations were significantly higher in success cases; low concentration predominated in failures (all p < 0.0001). Table (6): Regression analysis between Micro-TESE and other parameters Unstandardized Coefficients B OR Test Value P. Value 95.0% Confidence Interval for B Lower Bound Upper Bound (Constant) -0.1341 -2.0847 0.038* -0.2607 -0.0075 Age -0.001 0.999 -0.7641 0.4455 -0.0035 0.0015 Smoker 0.0322 1.0327 1.7148 0.0875 -0.0048 0.0691 Wife age -0.0001 0.9999 -0.0416 0.9668 -0.0039 0.0038 Infertility duration 0.0025 1.0025 1.2434 0.2148 -0.0015 0.0066 Right testicular size 0.0082 1.0082 1.3156 0.1894 -0.0041 0.0205 Left testicular size -0.0012 0.9988 -0.1902 0.8493 -0.0131 0.0108 Varicocele 0.0309 1.0314 1.5093 0.1324 -0.0094 0.0712 Treatment before TESE 0.0292 1.0296 1.4628 0.1446 -0.0101 0.0684 FSH -0.0005 0.9995 -0.5011 0.6167 -0.0023 0.0014 LH 0.0001 1.0001 0.058 0.9538 -0.0035 0.0037 Testosterone 0.0062 1.0063 1.3329 0.1837 -0.003 0.0155 Estradiol E2 -0.0009 0.9991 -3.5054 0.0005* -0.0015 -0.0004 Prolactin -0.003 0.997 -2.5217 0.0122* -0.0054 -0.0007 Juhanson score for histopathology 0.1041 1.1097 29.864 <0.0001* 0.0973 0.111 Estradiol E2 and Prolactin both showed significant negative association with Micro TESE (P<0.05). Only Juhanson score for histopathology showed significant positive association with micro TESE (P<0.0001). Table (7): ROC curve between micro TESE and other parameters: Test Result Variable(s) Cut off AUC Sensitivity Specificity Accuracy P. Value Husband Age (Years) < 34.5 0.5857 67.40% 51.90% 39% 0.0142* Wife Age (Years) <29.5 0.5704 55.80% 52.80% 55% 0.0439* Right Testicular size < 7.45 0.6687 74.60% 51.90% 64.67% <0.0001* Left Testicular size < 7.55 0.6649 72.40% 54.60% 65% <0.0001* FSH < 7.7 0.3458 65.20% 26.40% 51% <0.0001* LH < 6.05 0.4043 60.20% 35.50% 50.67% 0.0062* Testosterone <4.765 0.9396 90.60% 69.10% 80% <0.0001* Estradiol (E2) < 35.45 0.2152 36.50% 20.90% 30.1% <0.0001* Prolactin < 10.15 0.3401 51.40% 33.60% 44.82% <0.0001* Juhanson score for histopathology <1.5 0.9817 97.20% 72.70% 67% <0.0001* Significant associations were observed between micro-TESE outcomes and multiple parameters based on ROC analysis. At a cut-off value <34.5 years, husband age was significantly associated with micro-TESE (p = 0.0142), showing 67.4% sensitivity and 51.9% specificity. Wife age at a cut-off <29.5 years was also significant (p = 0.0439) with 55.8% sensitivity and 52.8% specificity. Right and left testicular sizes showed strong associations at cut-offs <7.45 cm and <7.55 cm (both p < 0.0001), with sensitivities of 74.6% and 72.4% respectively. FSH and LH were significant at <7.7 and <6.05 mIU/mL (p < 0.0001 and p = 0.0062), with FSH showing lower specificity (26.4%) despite 65.2% sensitivity. Testosterone had the highest diagnostic performance at a cut-off <4.765 ng/mL (p < 0.0001), achieving 90.6% sensitivity and 69.1% specificity with 80% accuracy. Estradiol (E2) and prolactin were also significantly associated (p < 0.0001), though with lower diagnostic accuracy (30.1% and 44.82%, respectively). The strongest association was observed with the Juhanson histopathology score at a cut-off <1.5 (p < 0.0001), demonstrating 97.2% sensitivity and 72.7% specificity. Discussion Our study included men with a mean age of 38.82 ± 10.04 years, with 60.67% being smokers. Their wives had a mean age of 30.05 ± 6.09 years. The mean infertility duration was 6.75 ± 5.56 years. Right and left testicular volumes were 8 ± 3.03 mL and 7.99 ± 3.13 mL, respectively. Varicocele was present in 29.33% of patients, and 62% had a history of prior infertility treatment. Hormonal evaluation showed FSH of 16.33 ± 14.46 mIU/mL, LH 9.53 ± 7.53 mIU/mL, testosterone 6.42 ± 2.67 ng/mL, estradiol 48.14 ± 38.23 pg/mL, and prolactin 12.92 ± 8.88 ng/mL. Our study showed a 62.67% micro-TESE success rate, with 62% undergoing ICSI and 33.33% achieving pregnancy. Micro-TESE was done on the right testis in 39.33%, left in 28.67%, and bilaterally in 32%. Sperm concentration was low in 62.67%, moderate in 17.33%, and good in 20%. The mean Juhanson histopathology score was 7.03 ± 3.98. Our study findings showed higher micro-TESE success in older males (39.4 vs. 37.84 years, P = 0.0005), smokers (65.96% vs. 51.79%, P = 0.0006), and with older wives (30.57 vs. 29.18 years, P = 0.0051), while infertility duration showed no significant association ( P = 0.3641). These findings align with Liu et al. (2018), who reported a 62% success rate in micro-TESE among NOA patients with secondary testicular injury, and with Zhao et al. (2019), who reported 42.7% success in 472 NOA patients with mean age 31 years, testicular volume 10 mL, and FSH 15.4 IU/L. Our hormonal and volume profiles are comparable to those of Ghalayini et al. (2011), who noted testicular volume of 11.8 ± 4.1 mL and varicocele in 15.4%. Bernie et al. (2015) showing an average patient age of 34.4 years, FSH levels of 20.5 mIU/mL, testosterone levels of 373 ng/dL, and a testicular volume of 13.5 mL lend credence to our studies. Our study also agrees with PP et al. (2021), who reported micro-TESE sperm retrieval rates (SRR) of 46.6% in NOA, ranging from 18.4–70.8%, with ICSI fertilization rates ~57%, clinical pregnancy 39%, and live birth 24%. Morris et al. (2018) discovered that following a failed cTESE or TESA, salvage micro-TESE was effective in 39% of instances, and following a previous successful micro-TESE, it was success rate 100%. Our findings align with Yücel et al. (2018) in confirming infertility duration as a non-significant predictor of success. However, our results differ from Franco et al. (2016), who found no significant age difference between successful and failed micro-TESE outcomes. Our study findings revealed that successful micro-TESE cases had significantly larger testicular volumes (right: 8.73 vs. 6.78 mL; left: 8.72 vs. 6.76 mL; P < 0.0001), and more frequent prior infertility treatment (67.02% vs. 53.57%, P = 0.001). There was no significant change in the prevalence of varicocele (P = 0.6714). This contradicts the findings of Amer et al. (2019), who found no statistically significant variations in testicular volume between the groups who had positive and negative micro-TESE outcomes. Our study demonstrated significantly lower levels of FSH (13.16 vs. 21.65 mIU/mL), LH (8.09 vs. 11.94 mIU/mL), estradiol (34.72 vs. 70.62 pg/mL), and prolactin (10.36 vs. 17.21 ng/mL), and higher testosterone (7.79 vs. 4.11 ng/mL) in successful cases, with all differences reaching P < 0.0001. These findings are in line with Kalsi et al. (2015), who found significantly higher testosterone levels in successful cases, though they found no difference in FSH. Conversely, Yücel et al. (2018) reported higher FSH in successful cases but no significant differences in testosterone, LH, estradiol, or prolactin. Histopathology also supported our outcomes. Our study found significantly higher Juhanson scores in successful micro-TESE cases (9.94 vs. 2.14, P < 0.0001). Unilateral TESE was more frequent in successful cases (right: 55.32%, left: 37.23%), while failed cases more often had bilateral TESE (73.21%, P < 0.0001). Sperm concentration in successful cases was better (good: 31.91%, moderate: 27.66%, low: 40.43%) compared to 100% low in failed cases ( P < 0.0001). Pregnancy outcomes were not significantly affected by male or wife age or infertility duration, but were linked to higher smoking prevalence (68% vs. 57%, P = 0.0093). These results agree with Poullis et al. (2016), discovered that neither the age of the mother nor the father was a predictor of gestational age or term birth. Nonetheless, we found evidence that Johnsen score and histology were not predictive, which goes against their conclusions. Our study confirmed that pregnancy success was associated with favorable testicular size, prior treatment, and improved hormonal profiles—lower FSH, LH, estradiol, and prolactin, and higher testosterone (all P < 0.0001). These findings align with Casarini et al. (2020), Hart et al. (2015), Ismael et al. (2017), and Simoni et al. (2020), discovered no correlation between the sexes' ages and the likelihood of becoming pregnant or having a live birth. We found the opposite to be true, though; they concluded that histology and the Johnsen score were not predictive.. This opposes Poullis et al. (2016), who found no predictive value for Johnsen score. Regression analysis in our study showed estradiol and prolactin had significant negative associations with micro-TESE success ( P < 0.05), while Juhanson score had a strong positive association ( P < 0.0001). Testosterone < 4.765 ng/mL was the strongest ROC predictor (sensitivity 90.6%, specificity 69.1%, accuracy 80%). Other key predictors included Juhanson score < 1.5 (sensitivity 97.2%, specificity 72.7%), and testicular sizes < 7.45 mL (right) and < 7.55 mL (left). Hormonal markers (FSH, LH, prolactin) showed lower sensitivity and accuracy. These findings are supported by Jahromi et al. (2020), who demonstrated an increase in FSH levels in unsuccessful instances (P < 0.001) using a threshold of 14.6 mIU/mL to forecast results with an accuracy of 83.5% and a specificity of 80.3%. Additionally, Li et al. (2018) noted that FSH, testicular volume, and histopathological subtypes like HS had variable predictive value, with testicular volume showing limited utility (AUSROC 0.6389), while histology (HS) had stronger predictive power (DOR 16.49, specificity 0.98). Our study provides more evidence that histology, hormone indicators, and testicular size can be used to predict micro-TESE and pregnancy outcomes. Conclusion The probability of a micro-TESE procedure's success for patients with non-obstructive azoospermia (NOA) is dependent on various factors. In addition to lower levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and estrogen (E2), elevated testosterone levels, smoking, testicular size, and past therapy all increase the risk of tuberculosis endometritis (TSE). Additionally, a higher Juhanson histopathology score and certain testicular micro-TESE sites were linked to positive results. Declarations Funding : not applicable References Achermann AP, Pereira TA, Esteves SC. (2021). Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: summary of current literature. International Urology and Nephrology , 53(11): 2193–2210. 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Jahromi BN, Zeyghami S, Parsanezhad ME, Ghaemmaghami P, Zarei A, Kutenaee MA, et al. (2020). Determining an optimal cut-off value for follicle-stimulating hormone to predict microsurgical testicular sperm extraction outcome in patients with non-obstructive azoospermia. Archives of Endocrinology and Metabolism , 64(2): 165–170. Jarow, J. P et al., 1989 Evaluation of the azoospermic patient. The Journal of Urology, 142(1), 62–65. https://doi.org/10.1016/S0022-5347(17)38648-6 Kalsi JS, Shah P, Thum Y, Muneer A, Ralph DJ, Minhas S (2015). Salvage micro‐dissection testicular sperm extraction; outcome in men with non‐obstructive azoospermia with previous failed sperm retrievals. BJU international, 116(3): 460-465.‏ Krausz C, Cioppi F. (2021). Genetic factors of non-obstructive azoospermia: consequences on patients’ and offspring health. Journal of Clinical Medicine , 10(17): 4009. Li H, Chen L-P, Yang J, Li M-C, Chen R-B, Lan R-Z, et al. (2018). Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian Journal of Andrology , 20(1): 30–36. Liu G-H, Zhang J, Sun G-H, Pang J-H, Wang Y, Fang C, et al. (2018). Micro-dissection testicular sperm extraction for non-obstructive azoospermia patients with the history of secondary testicular injury. Zhonghua Nan Ke Xue = National Journal of Andrology , 24(8): 681–685. Morris S, Yap T, Alkematy K, Bhandari C, Sangster P, Shabbir M, et al. (2018). Is there a role for salvage or redo micro-dissection testicular sperm extraction in non-obstructive azoospermia?: PD01-08. Journal of Urology , 199(4): e62–e63. Poullis C, Abumelha S, Al Mashat F, Rushwan N, Yap T, Thum MY, et al. (2016). Live birth rates in men with non-obstructive azoospermia (NOA) undergoing microdissection testicular sperm extraction (mTESE): PD05-08. Journal of Urology , 195(4): e171–e172. Qi L, Liu YP, Zhang NN, Su YC. (2021). Predictors of testicular sperm retrieval in patients with non-obstructive azoospermia: a review. Journal of International Medical Research , 49(4): 03000605211002703. Simoni M, Brigante G, Rochira V, Santi D, Casarini L. (2020). Prospects for FSH treatment of male infertility. The Journal of Clinical Endocrinology & Metabolism , 105(7): 2105–2118. Tharakan T, Luo R, Jayasena CN, Minhas S. (2021). Non-obstructive azoospermia: current and future perspectives. Faculty Reviews , 10: 1–13. Tournaye, H., Krausz, C., & Oates, R. D. (2017) . Novel concepts in the aetiology of male reproductive impairment. The Lancet Diabetes & Endocrinology , 5(7), 544–553. https://doi.org/10.1016/S2213-8587(16)30300-7 Yücel C, Budak S, Keskin MZ, Kisa E, Kozacioglu Z. (2018). Predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed mTESE in patients with non-obstructive azoospermia: long-term experience at a single institute. Archivio Italiano di Urologia e Andrologia , 90(2): 136–140. Zhao LM, Jiang H, Hong K, Lin HC, Tang WH, Liu DF, et al. (2019). Analysis of intratesticular condition in micro-dissection testicular sperm extraction era. Journal of Peking University. Health Sciences , 51(4): 632–635. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6678763","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471614375,"identity":"87db39e4-f757-49ce-9782-1b6bc64757c4","order_by":0,"name":"Omar Mohamed","email":"","orcid":"","institution":"South Valley University","correspondingAuthor":false,"prefix":"","firstName":"Omar","middleName":"","lastName":"Mohamed","suffix":""},{"id":471614376,"identity":"e2337af2-38c2-4f4e-92bb-4618e2bbdf08","order_by":1,"name":"Hafez Badawi","email":"data:image/png;base64,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","orcid":"","institution":"South Valley University","correspondingAuthor":true,"prefix":"","firstName":"Hafez","middleName":"","lastName":"Badawi","suffix":""},{"id":471614377,"identity":"427b23c8-9fd4-4f98-968c-cf8d2d8e952a","order_by":2,"name":"Osama Mohamed","email":"","orcid":"","institution":"South Valley University","correspondingAuthor":false,"prefix":"","firstName":"Osama","middleName":"","lastName":"Mohamed","suffix":""},{"id":471614378,"identity":"d4325f99-c612-447e-ab76-7405ab89b1da","order_by":3,"name":"Gamal A.Alsagheer","email":"","orcid":"","institution":"South Valley University","correspondingAuthor":false,"prefix":"","firstName":"Gamal","middleName":"","lastName":"A.Alsagheer","suffix":""},{"id":471614379,"identity":"2292fdbc-889d-433b-a755-706d9d73f30b","order_by":4,"name":"Ahmed hasan","email":"","orcid":"","institution":"South Valley University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"hasan","suffix":""}],"badges":[],"createdAt":"2025-05-16 08:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6678763/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6678763/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85068940,"identity":"def5b71a-d6e4-4855-9383-17bf6e97d27e","added_by":"auto","created_at":"2025-06-20 15:26:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92187,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve analysis of between micro TESE and other parameters.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6678763/v1/1935d08ebbcb1a9d83763276.png"},{"id":86297714,"identity":"e9e2bfc9-9fb8-4866-adae-22fe04e0e27f","added_by":"auto","created_at":"2025-07-09 05:46:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1528384,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6678763/v1/db3825e8-fc9d-4cd0-a3e2-84a3969c4cd0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Identifying Pre-operative Factors for Successful Micro-dissection Testicular Sperm Extraction in Non-Obstructive Azoospermia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMale infertility is defined as the inability of a male to achieve pregnancy in a fertile female after 12 months of regular, unprotected intercourse.\u003cb\u003e(\u003c/b\u003e Agarwal A, et al \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eApproximately 7\u0026ndash;12% of the world's male population experiences infertility, and couples experiencing male infertility make up around half of all infertility cases.\u003c/p\u003e \u003cp\u003eMale infertility can be affected with several factors such as genetic defects, hormonal disturbance, evidence of varicocele, infections, and lifestyle such as obesity and smoking .\u003c/p\u003e \u003cp\u003eThe diagnosis of azoospermia is made after centrifugation and examination under a 400 X power microscope when neither of the two consecutive ejaculates contain sperm. \u003cb\u003e(\u003c/b\u003eTharakan et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIt affects 10\u0026ndash;15% of males who are unable to conceive and approximately 1% of all men.\u003c/p\u003e \u003cp\u003eThe azoospermia can be classified into two primary groups: obstructive and non-obstructive.\u003c/p\u003e \u003cp\u003eObstructive azoospermia can be caused by a number of different things, such as blockage of the ejacturatory duct, injuries, infections, vasectomy, and congenital bilateral absence of vas or lack of vas at birth. \u003cb\u003e( Jarow, J. P et al., 1989)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe main cause of non-obstructive azoospermia is a defect or failure of the testes to produce sperm. The most common reasons include problems with hormones, infections, genetics, and testicular failure. \u003cb\u003e(\u003c/b\u003eTournaye, H.,et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eEarly evaluation and accurate classification of azoospermia enhance the likelihood of successful fertility management.\u003c/p\u003e \u003cp\u003eUnder the microscope Using a microscope, micro-TESE locates seminiferous tubules that are rich in sperm and extracts them. The technique enhances sperm retrieval with minimal harm to testicular tissue and danger of increasing testosterone insufficiency by extracting small tissue fragments instead of big biopsies. \u003cb\u003e(\u003c/b\u003eAchermann et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Esteves \u0026amp; Verza, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2012\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eFinding predictive markers of efficient micro-TESE in patients with non-obstructive azoospermia was the goal of this study, which aimed to optimize outcomes, reduce costs, and maximize pregnancy rates.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003eThis prospective clinical study was conducted at the Urology Department of University Hospital between May 2022 and May 2024 to evaluate predictive factors for successful micro testicular sperm extraction (micro-TESE) in patients with non-obstructive azoospermia (NOA). A total of 600 patients completed follow-up during the study period.\u003c/p\u003e \u003cp\u003eThe data used to compute the sample size came from Kalsi et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), who reported a retrieval success rate of 46.55%. An odds ratio of 1.115, 95% confidence, 80% power, and 5% margin of error were determined by the algorithm to require 600 samples when utilizing Epi Info:\u003c/p\u003e \u003cp\u003e \u003cb\u003en\u003c/b\u003e \u003cb\u003e= [DEFF*Np(1-p)]/ [(d\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/Z\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003csub\u003e\u003cb\u003e1\u0026minus;α/2\u003c/b\u003e\u003c/sub\u003e\u003cb\u003e*(N-1)\u0026thinsp;+\u0026thinsp;p*(1-p)]\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\"The ethics committee of [\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.] approved this study (Approval No.: [401], Date: [22-5-2025]). All subjects provided written (or verbal) informed consent for inclusion in the study/for undergoing the procedures described. The procedures adhered to the ethical guidelines of the Declaration of Helsinki and its amendments. The authors confirm the availability of, and access to, all original data reported in this study.\"\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ethe authors declare to have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/b\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEach author made substantial contributions to the Manuscript\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eDr OM and Dr OM designed the work and interpreted the patient data\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section4\"\u003e \u003ch2\u003eDr AH was a major contributor in writing the manuscript\u003c/h2\u003e \u003cp\u003e \u003cb\u003eDr GA wrote the discussion\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eDr HB had drafted the work and revised it\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eAll authors read and approved the final manuscript.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eEthical code\u003c/span\u003e : \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSVU MED URO016 2 22 5 401 Ethical committee, south valley university, Egypt\u003c/span\u003e\u003c/p\u003e \u003cp\u003eIn this investigation, males with a NOA diagnosis were the focus. Patients with non-obstructive azoospermia, those having a single testicle, or those having redo micro-TESE surgeries were all considered for inclusion. The following conditions were not considered for inclusion: obstructive azoospermia, vas deferens absence on both sides, genital infection history, vasectomy or surgery in the past, and hereditary anomalies.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eConsent Form for participation and publication\u003c/h2\u003e \u003cp\u003e \u003cb\u003eA written consent from the responsible person on the selected patient before conducting the research\u003c/b\u003e .\u003c/p\u003e \u003cp\u003eConsent name:: age: address: Date:\u003c/p\u003e \u003cp\u003eI am who signed on this paper. I agree completely on my participation in this research project\u003c/p\u003e \u003cp\u003eThat will predict the factors affecting sperm retrieval techniques in non-obstructive Azoospermia that caused male infertility as I was diagnosed.\u003c/p\u003e \u003cp\u003eand \u003cb\u003eDr, \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/b\u003e explained to me obviously all benefits and hazards of participation in this research project by taking some laboratory investigations from me and then perform sperm retrevial techniques.\u003c/p\u003e \u003cp\u003e \u003cb\u003eI also agree that the results of this\u003c/b\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eproject can be published in International scientific journals\u003c/span\u003e\u003c/p\u003e \u003cp\u003eSignature\u003c/p\u003e \u003cp\u003eAll patients underwent thorough preparation, including detailed history taking, physical examination, and both laboratory and radiological investigations. The preoperative evaluation involved data collection from patient records, covering infertility complaints, duration, time and consummation of marriage (defined by willful vaginal penetration), frequency and timing of sexual intercourse, contraceptive use, and any history of erectile dysfunction or premature ejaculation. Medical and surgical histories were reviewed, including previous procedures such as varicocelectomy, micro-TESE, hernia repair, or orchiopexy, as well as any relevant family history.\u003c/p\u003e \u003cp\u003eGeneral evaluation for gynecomastia, hair distribution, and body mass index were all part of the thorough physical examination. Local genital examination included testicular volume measured by orchidometer and penile and meatal morphology, presence of epididymal cysts, assessment of vas deferens (bilateral absence led to exclusion), varicocele grading, and digital rectal examination to rule out prostatic cysts or seminal vesicle abnormalities.\u003c/p\u003e \u003cp\u003eInvestigations included semen analysis (per WHO 2010 guidelines, two samples), scrotal Doppler ultrasound to assess testicular volume and varicocele, and hormonal assays (FSH, LH, prolactin, total testosterone). Karyotyping and Y-chromosome microdeletion tests were done when needed, especially in suspected Klinefelter syndrome cases.\u003c/p\u003e \u003cp\u003eMicrodissection testicular sperm extraction (micro-TESE) involved wide equatorial incision of the testis to expose seminiferous tubules while preserving intratesticular blood flow. Under \u0026times;2 and \u0026times;6 magnification, tubules were dissected between fine septae and centrifugal vessels, avoiding disruption of the subtunical vessels beneath the tunica albuginea, which are highly prone to bleeding. Success in minimizing testicular trauma depended heavily on meticulous hemostasis, as bleeding is the main cause of adverse outcomes like fibrosis. Microdissection was extended to explore all tubules due to the heterogeneous distribution of spermatogenesis; larger and opaque tubules often indicated active sperm production.\u003c/p\u003e \u003cp\u003ePostoperatively, outcomes included success rates in each attempt, histopathology results of biopsies using Johanson Score for both positive and negative findings, complication rates (bleeding, hematoma, failure, fibrosis), and pregnancy rates confirmed by gestational sac detection.\u003c/p\u003e \u003cp\u003eWe conducted the statistical analysis using IBM SPSS Statistics for Windows, Version 28, which is produced by IBM Corp. in Armonk, NY, USA. Means, standard deviations, minimums, and maximums\u0026mdash;indices of central tendency and dispersion\u0026mdash;characterized the quantitative variables. To summarize the categorical variables, percentages and frequencies were utilized. For the statistical study, we utilized IBM SPSS Statistics for Windows, Version 28, which is produced by IBM Corp. in Armonk, NY, USA. Standard deviations, minimums, and maximums\u0026mdash;indices of central tendency and dispersion\u0026mdash;characterized the quantitative variables. In order to summarize the categorical variables, percentages and frequencies were considered.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable (1): General evaluation among included subjects\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eValue (N =600)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eAge (Years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003e38.83 \u0026plusmn; 9.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003e364 (60.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eWife age (Year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003e30.03 \u0026plusmn; 6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eInfertility duration (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003e6.76 \u0026plusmn; 5.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Mean male age was 38.83 \u0026plusmn; 9.91 years; 60.67% were smokers. Mean wife age was 30.03 \u0026plusmn; 6.03 years. Infertility duration averaged 6.76 \u0026plusmn; 5.59 years.\u003c/p\u003e\n\u003cp\u003eTable (2): Comparison between cases with positive and failed negative micro TESE regarding general and clinical evaluations\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"108%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003ePositive Micro-TESE\u0026nbsp;\u003cbr\u003e\u0026nbsp;group (N = 376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003eNegative Micro-TESE\u0026nbsp;\u003cbr\u003e\u0026nbsp;group (N = 224)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eP. Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eAge (Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e39.39 \u0026plusmn; 9.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e37.88 \u0026plusmn; 10.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.0154*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSmoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e248 (65.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e116 (51.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.015*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eWife age (Year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e30.6 \u0026plusmn; 6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e29.09 \u0026plusmn; 5.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.0327*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eInfertility duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e6.4 \u0026plusmn; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e7.36 \u0026plusmn; 7.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.5029\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Evaluation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eRight testicular size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e8.75 \u0026plusmn; 2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e6.79 \u0026plusmn; 3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLeft testicular size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e8.71 \u0026plusmn; 2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e6.74 \u0026plusmn; 3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eVaricocele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e108 (28.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e68 (30.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.7646\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eTreatment before TESE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e252 (67.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e120 (53.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.0202*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Mean age, wife age, and smoking rate were significantly higher in the positive micro-TESE group (p = 0.0154, 0.0327, and 0.015, respectively). Right and left testicular sizes were significantly larger in the positive group (p \u0026lt; 0.0001). Prior treatment was also more common in the positive group (67.02% vs. 53.57%, p = 0.0202). Varicocele incidence (p = 0.7646) and infertility duration (p = 0.5029) did not differ significantly.\u003c/p\u003e\n\u003cp\u003eTable (3): Comparison between cases with positive and failed negative micro TESE regarding lab. data and\u0026nbsp;histopathology\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"120%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003ePositive Micro-TESE\u0026nbsp;\u003cbr\u003e\u0026nbsp;group (N = 367)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eNegative Micro-TESE\u0026nbsp;\u003cbr\u003e\u0026nbsp;group (N = 224)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eP. Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLabs.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eFSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e13.16 \u0026plusmn; 11.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e21.69 \u0026plusmn; 17.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eLH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e8.09 \u0026plusmn; 4.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e11.93 \u0026plusmn; 10.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0.0056*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23px;\"\u003e\n \u003cp\u003e7.81 \u0026plusmn; 2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4.11 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eEstradiol E2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e34.74 \u0026plusmn; 16.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e70.9 \u0026plusmn; 51.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eProlactin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e10.36 \u0026plusmn; 4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e17.23 \u0026plusmn; 11.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistopathology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eJuhanson score for histopathology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e9.93 \u0026plusmn; 1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2.14 \u0026plusmn; 0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicro TESE \u0026nbsp;testicular site\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e208 (55.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e28 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e140 (37.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e32 (14.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e28 (7.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e164 (73.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSperm concertation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e120 (31.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[f]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e104 (27.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[f]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e152 (40.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e224 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Both the duration of infertility (p = 0.5029) and the incidence of varicocele (p = 0.7646) did not show any significant differences. Significantly higher histopathology (Juhanson) scores were seen in the positive group (p \u0026lt; 0.0001). The prevalence of right- or left-sided micro-TESE was higher in positive instances, but bilateral TESE was more common in negative cases (p \u0026lt; 0.0001). There were no good or moderate instances in the negative group, while positive cases exhibited significantly higher sperm concentration (p \u0026lt; 0.0001).\u003c/p\u003e\n\u003cp\u003eTable (4): Comparison between cases with successful and failed pregnancy regarding general and clinical evaluations\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"673\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eSuccess pregnancy\u0026nbsp;\u003cbr\u003e\u0026nbsp;group (N = 200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eFailed pregnancy\u0026nbsp;\u003cbr\u003e\u0026nbsp;group (N = 400)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003eP. Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eAge (Years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e38.78 \u0026plusmn; 9.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e38.85 \u0026plusmn; 10.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.6562\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e136 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e228 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.0663\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eWife age (Year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e29.95 \u0026plusmn; 5.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e30.08 \u0026plusmn; 6.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.826\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eInfertility duration (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e5.88 \u0026plusmn; 3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e7.2 \u0026plusmn; 6.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.2148\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Evaluation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eRight testicular size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e9.11 \u0026plusmn; 2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e7.44 \u0026plusmn; 3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLeft testicular size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e9.03 \u0026plusmn; 2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e7.45 \u0026plusmn; 3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.0003*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eVaricocele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e24 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e128 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.1524\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eTreatment before TESE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e140 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e232 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.0437*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThere were no significant differences between the groups that had successful pregnancies and those that did not in terms of age, wife age, smoking, or length of infertility (all p \u0026gt; 0.05). The right and left testicular diameters were significantly larger in the successful group (p \u0026lt; 0.0001 and p = 0.0003, respectively). Cases that were effective had a higher frequency of pre-TESE treatment (p = 0.0437). There was no discernible change in the incidence of varicocele (p = 0.1524).\u003c/p\u003e\n\u003cp\u003eTable (5): Comparison between cases with successful and failed pregnancy regarding Lab data and\u0026nbsp;histopathology\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"673\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eSuccess pregnancy\u0026nbsp;\u003cbr\u003e\u0026nbsp;group (N = 200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eFailed pregnancy\u0026nbsp;\u003cbr\u003e\u0026nbsp;group (N = 400)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003eP. Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLabs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eFSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e12.52 \u0026plusmn; 10.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e18.25 \u0026plusmn; 15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.0089*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e10.39 \u0026plusmn; 8.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.0367*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e9.37 \u0026plusmn; 2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 158px;\"\u003e\n \u003cp\u003e4.96 \u0026plusmn; 1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eEstradiol E2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e33.56 \u0026plusmn; 13.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e55.57 \u0026plusmn; 44.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eProlactin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e11.12 \u0026plusmn; 4.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e13.83 \u0026plusmn; 10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.3751\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistopathology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eJuhanson score for histopathology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e10.18 \u0026plusmn; 0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e5.44 \u0026plusmn; 3.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[MWU]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicro TESE \u0026nbsp;testicular site\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e116 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e120 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e76 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e96 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.0114*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e8 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e184 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSperm concertation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e116 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e4 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e76 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e28 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e8 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e368 (92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003csup\u003e[X]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults from successful pregnancies showed significantly reduced levels of FSH (p = 0.0089), LH (p = 0.0367), and estradiol (p \u0026lt; 0.0001), and significantly higher levels of testosterone (p \u0026lt; 0.0001). A statistical analysis revealed no significant difference in prolactin levels (p = 0.3751). A higher frequency of bilateral TESE (p \u0026lt; 0.0001) was observed in the failure group, in contrast to the success group\u0026apos;s higher frequency of Juhanson score (p \u0026lt; 0.0001), right (p \u0026lt; 0.0001), and left testicular locations (p = 0.0114). Good and moderate sperm concentrations were significantly higher in success cases; low concentration predominated in failures (all p \u0026lt; 0.0001).\u003c/p\u003e\n\u003cp\u003eTable (6): Regression analysis between Micro-TESE and other parameters\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"125%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eUnstandardized\u0026nbsp;\u003cbr\u003e\u0026nbsp;Coefficients B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eTest Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eP. Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003e95.0% Confidence Interval for B\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eUpper Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.1341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-2.0847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.038*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.2607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.7641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.4455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eSmoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.0322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.7148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.0875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eWife age\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.9999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.9668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eInfertility duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.0025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.2434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.2148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;Right testicular size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.0082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.3156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.1894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eLeft testicular size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.0012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.9988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.1902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.8493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eVaricocele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.0309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.5093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.1324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0712\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eTreatment before TESE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.0292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.4628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.1446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0684\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eFSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.9995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.5011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.6167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eLH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.9538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.0062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.0063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.3329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.1837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eEstradiol E2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.0009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.9991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-3.5054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.0005*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eProlactin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-2.5217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.0122*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.0007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eJuhanson score for histopathology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.1041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.1097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e29.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.0973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEstradiol E2 and Prolactin both showed significant negative association with Micro TESE (P\u0026lt;0.05). \u0026nbsp;Only Juhanson score for histopathology showed significant positive association with micro TESE (P\u0026lt;0.0001).\u003c/p\u003e\n\u003cp\u003eTable (7): ROC curve between micro TESE and other parameters:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"102%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eTest Result Variable(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003eCut off\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003eAccuracy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003eP. Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eHusband Age (Years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt; 34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.5857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e67.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e51.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e0.0142*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eWife Age (Years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt;29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.5704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e55.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e52.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e0.0439*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eRight Testicular size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt; 7.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.6687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e74.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e51.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e64.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eLeft Testicular size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt; 7.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.6649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e72.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e54.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eFSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt; 7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.3458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e65.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e26.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eLH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt; 6.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.4043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e60.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e35.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e50.67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e0.0062*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt;4.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.9396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e90.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e69.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eEstradiol (E2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt; 35.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.2152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e36.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e20.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e30.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eProlactin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt; 10.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.3401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e51.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e33.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e44.82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3075%;\"\u003e\n \u003cp\u003eJuhanson score for histopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1695%;\"\u003e\n \u003cp\u003e\u0026lt;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.9274%;\"\u003e\n \u003cp\u003e0.9817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3753%;\"\u003e\n \u003cp\u003e97.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.6174%;\"\u003e\n \u003cp\u003e72.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8015%;\"\u003e\n \u003cp\u003e\u0026lt;0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSignificant associations were observed between micro-TESE outcomes and multiple parameters based on ROC analysis. At a cut-off value \u0026lt;34.5 years, husband age was significantly associated with micro-TESE (p = 0.0142), showing 67.4% sensitivity and 51.9% specificity. Wife age at a cut-off \u0026lt;29.5 years was also significant (p = 0.0439) with 55.8% sensitivity and 52.8% specificity. Right and left testicular sizes showed strong associations at cut-offs \u0026lt;7.45 cm and \u0026lt;7.55 cm (both p \u0026lt; 0.0001), with sensitivities of 74.6% and 72.4% respectively. FSH and LH were significant at \u0026lt;7.7 and \u0026lt;6.05 mIU/mL (p \u0026lt; 0.0001 and p = 0.0062), with FSH showing lower specificity (26.4%) despite 65.2% sensitivity. Testosterone had the highest diagnostic performance at a cut-off \u0026lt;4.765 ng/mL (p \u0026lt; 0.0001), achieving 90.6% sensitivity and 69.1% specificity with 80% accuracy. Estradiol (E2) and prolactin were also significantly associated (p \u0026lt; 0.0001), though with lower diagnostic accuracy (30.1% and 44.82%, respectively). The strongest association was observed with the Juhanson histopathology score at a cut-off \u0026lt;1.5 (p \u0026lt; 0.0001), demonstrating 97.2% sensitivity and 72.7% specificity.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study included men with a mean age of 38.82 ± 10.04 years, with 60.67% being smokers. Their wives had a mean age of 30.05 ± 6.09 years. The mean infertility duration was 6.75 ± 5.56 years. Right and left testicular volumes were 8 ± 3.03 mL and 7.99 ± 3.13 mL, respectively. Varicocele was present in 29.33% of patients, and 62% had a history of prior infertility treatment. Hormonal evaluation showed FSH of 16.33 ± 14.46 mIU/mL, LH 9.53 ± 7.53 mIU/mL, testosterone 6.42 ± 2.67 ng/mL, estradiol 48.14 ± 38.23 pg/mL, and prolactin 12.92 ± 8.88 ng/mL. Our study showed a 62.67% micro-TESE success rate, with 62% undergoing ICSI and 33.33% achieving pregnancy. Micro-TESE was done on the right testis in 39.33%, left in 28.67%, and bilaterally in 32%. Sperm concentration was low in 62.67%, moderate in 17.33%, and good in 20%. The mean Juhanson histopathology score was 7.03 ± 3.98.\u003c/p\u003e\n\u003cp\u003eOur study findings showed higher micro-TESE success in older males (39.4 vs. 37.84 years, \u003cem\u003eP\u003c/em\u003e = 0.0005), smokers (65.96% vs. 51.79%, \u003cem\u003eP\u003c/em\u003e = 0.0006), and with older wives (30.57 vs. 29.18 years, \u003cem\u003eP\u003c/em\u003e = 0.0051), while infertility duration showed no significant association (\u003cem\u003eP\u003c/em\u003e = 0.3641). These findings align with Liu et al. (2018), who reported a 62% success rate in micro-TESE among NOA patients with secondary testicular injury, and with Zhao et al. (2019), who reported 42.7% success in 472 NOA patients with mean age 31 years, testicular volume 10 mL, and FSH 15.4 IU/L. Our hormonal and volume profiles are comparable to those of Ghalayini et al. (2011), who noted testicular volume of 11.8 ± 4.1 mL and varicocele in 15.4%. Bernie et al. (2015) showing an average patient age of 34.4 years, FSH levels of 20.5 mIU/mL, testosterone levels of 373 ng/dL, and a testicular volume of 13.5 mL lend credence to our studies.\u003c/p\u003e\n\u003cp\u003eOur study also agrees with PP et al. (2021), who reported micro-TESE sperm retrieval rates (SRR) of 46.6% in NOA, ranging from 18.4–70.8%, with ICSI fertilization rates ~57%, clinical pregnancy 39%, and live birth 24%. Morris et al. (2018) discovered that following a failed cTESE or TESA, salvage micro-TESE was effective in 39% of instances, and following a previous successful micro-TESE, it was success rate 100%. Our findings align with Yücel et al. (2018) in confirming infertility duration as a non-significant predictor of success. However, our results differ from Franco et al. (2016), who found no significant age difference between successful and failed micro-TESE outcomes.\u003c/p\u003e\n\u003cp\u003eOur study findings revealed that successful micro-TESE cases had significantly larger testicular volumes (right: 8.73 vs. 6.78 mL; left: 8.72 vs. 6.76 mL; \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001), and more frequent prior infertility treatment (67.02% vs. 53.57%, \u003cem\u003eP\u003c/em\u003e = 0.001). There was no significant change in the prevalence of varicocele (P = 0.6714). This contradicts the findings of Amer et al. (2019), who found no statistically significant variations in testicular volume between the groups who had positive and negative micro-TESE outcomes.\u003c/p\u003e\n\u003cp\u003eOur study demonstrated significantly lower levels of FSH (13.16 vs. 21.65 mIU/mL), LH (8.09 vs. 11.94 mIU/mL), estradiol (34.72 vs. 70.62 pg/mL), and prolactin (10.36 vs. 17.21 ng/mL), and higher testosterone (7.79 vs. 4.11 ng/mL) in successful cases, with all differences reaching \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001. These findings are in line with Kalsi et al. (2015), who found significantly higher testosterone levels in successful cases, though they found no difference in FSH. Conversely, Yücel et al. (2018) reported higher FSH in successful cases but no significant differences in testosterone, LH, estradiol, or prolactin.\u003c/p\u003e\n\u003cp\u003eHistopathology also supported our outcomes. Our study found significantly higher Juhanson scores in successful micro-TESE cases (9.94 vs. 2.14, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001). Unilateral TESE was more frequent in successful cases (right: 55.32%, left: 37.23%), while failed cases more often had bilateral TESE (73.21%, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001). Sperm concentration in successful cases was better (good: 31.91%, moderate: 27.66%, low: 40.43%) compared to 100% low in failed cases (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001). Pregnancy outcomes were not significantly affected by male or wife age or infertility duration, but were linked to higher smoking prevalence (68% vs. 57%, \u003cem\u003eP\u003c/em\u003e = 0.0093). These results agree with Poullis et al. (2016), discovered that neither the age of the mother nor the father was a predictor of gestational age or term birth. Nonetheless, we found evidence that Johnsen score and histology were not predictive, which goes against their conclusions.\u003c/p\u003e\n\u003cp\u003eOur study confirmed that pregnancy success was associated with favorable testicular size, prior treatment, and improved hormonal profiles—lower FSH, LH, estradiol, and prolactin, and higher testosterone (all \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001). These findings align with Casarini et al. (2020), Hart et al. (2015), Ismael et al. (2017), and Simoni et al. (2020), discovered no correlation between the sexes' ages and the likelihood of becoming pregnant or having a live birth. We found the opposite to be true, though; they concluded that histology and the Johnsen score were not predictive.. This opposes Poullis et al. (2016), who found no predictive value for Johnsen score.\u003c/p\u003e\n\u003cp\u003eRegression analysis in our study showed estradiol and prolactin had significant negative associations with micro-TESE success (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), while Juhanson score had a strong positive association (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001). Testosterone \u0026lt; 4.765 ng/mL was the strongest ROC predictor (sensitivity 90.6%, specificity 69.1%, accuracy 80%). Other key predictors included Juhanson score \u0026lt; 1.5 (sensitivity 97.2%, specificity 72.7%), and testicular sizes \u0026lt; 7.45 mL (right) and \u0026lt; 7.55 mL (left). Hormonal markers (FSH, LH, prolactin) showed lower sensitivity and accuracy.\u003c/p\u003e\n\u003cp\u003eThese findings are supported by Jahromi et al. (2020), who demonstrated an increase in FSH levels in unsuccessful instances (P \u0026lt; 0.001) using a threshold of 14.6 mIU/mL to forecast results with an accuracy of 83.5% and a specificity of 80.3%. Additionally, Li et al. (2018) noted that FSH, testicular volume, and histopathological subtypes like HS had variable predictive value, with testicular volume showing limited utility (AUSROC 0.6389), while histology (HS) had stronger predictive power (DOR 16.49, specificity 0.98). Our study provides more evidence that histology, hormone indicators, and testicular size can be used to predict micro-TESE and pregnancy outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe probability of a micro-TESE procedure's success for patients with non-obstructive azoospermia (NOA) is dependent on various factors. In addition to lower levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and estrogen (E2), elevated testosterone levels, smoking, testicular size, and past therapy all increase the risk of tuberculosis endometritis (TSE). Additionally, a higher Juhanson histopathology score and certain testicular micro-TESE sites were linked to positive results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFunding : not applicable\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eAchermann AP, Pereira TA, Esteves SC. (2021).\u003c/strong\u003e Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: summary of current literature. \u003cem\u003eInternational Urology and Nephrology\u003c/em\u003e, 53(11): 2193\u0026ndash;2210.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAgarwal A, Mulgund A, Hamada A, Chyatte MR. (2015).\u0026nbsp;\u003c/strong\u003eA unique view on male infertility around the globe. \u003cem\u003eReproductive Biology and Endocrinology\u003c/em\u003e, 13(1), 37. https://doi.org/10.1186/s12958-015-0032-1\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAmer MK, Ahmed AR, Abdel Hamid AA, GamalEl Din SF. 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(2021).\u003c/strong\u003e Non-obstructive azoospermia: current and future perspectives. \u003cem\u003eFaculty Reviews\u003c/em\u003e, 10: 1\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTournaye, H., Krausz, C., \u0026amp; Oates, R. D. (2017)\u003c/strong\u003e. Novel concepts in the aetiology of male reproductive impairment. \u003cem\u003eThe Lancet Diabetes \u0026amp; Endocrinology\u003c/em\u003e, 5(7), 544\u0026ndash;553. https://doi.org/10.1016/S2213-8587(16)30300-7\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eY\u0026uuml;cel C, Budak S, Keskin MZ, Kisa E, Kozacioglu Z. (2018).\u003c/strong\u003e Predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed mTESE in patients with non-obstructive azoospermia: long-term experience at a single institute. \u003cem\u003eArchivio Italiano di Urologia e Andrologia\u003c/em\u003e, 90(2): 136\u0026ndash;140.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eZhao LM, Jiang H, Hong K, Lin HC, Tang WH, Liu DF, et al. (2019).\u003c/strong\u003e Analysis of intratesticular condition in micro-dissection testicular sperm extraction era. \u003cem\u003eJournal of Peking University. Health Sciences\u003c/em\u003e, 51(4): 632\u0026ndash;635.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Micro-TESE, Non-obstructive azoospermia, Male infertility","lastPublishedDoi":"10.21203/rs.3.rs-6678763/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6678763/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAbout half of all infertility cases among couples globally are caused by male infertility. Azoospermia, in which no sperm are detected in the ejaculate, affects around 1% of the male population and 10\u0026ndash;15% of males who experience infertility. There are two kinds, obstructive and non-obstructive, and the reasons for and methods of treating each are different. To solve this problem, in vitro fertilization (IVF) can be used to harvest sperm. Although there are many methods for sperm retrieval, micro-testicular sperm extraction (Micro-TESE) allows for the most accurate retrieval with the least amount of tissue injury.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAim\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aims to enhance results and decrease treatment costs by identifying predictive characteristics of successful micro-TESE in NOA patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis prospective study (May 2022\u0026ndash;May 2024, Qena University Hospital) included NOA patients, including those undergoing redo procedures or with a single testis. Exclusion criteria covered obstructive causes, surgeries, infections, or genetic issues. All underwent detailed hormonal, clinical, and imaging assessments, and micro-TESE was performed using magnification to preserve tissue. Outcomes assessed included sperm retrieval, histopathology (Juhanson Score), complications, and pregnancy rates.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMean male age was 38.83\u0026thinsp;\u0026plusmn;\u0026thinsp;9.91 years; 60.67% were smokers. Mean wife age was 30.03\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03 years; infertility duration averaged 6.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59 years. Successful micro-TESE was associated with older age, larger testicular size, prior treatment, lower FSH, LH, E2, and prolactin, and higher testosterone (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Juhanson score, testicular side, and sperm concentration also predicted success. ROC analysis showed strong predictors: age\u0026thinsp;\u0026lt;\u0026thinsp;34.5 years (67.4% sensitivity), testis size\u0026thinsp;\u0026lt;\u0026thinsp;7.5 cm (\u0026ge;\u0026thinsp;72% sensitivity), testosterone\u0026thinsp;\u0026gt;\u0026thinsp;4.765 ng/mL (90.6% sensitivity), and Juhanson score\u0026thinsp;\u0026lt;\u0026thinsp;1.5 (97.2% sensitivity, 72.7% specificity).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eKey predictors of micro-TESE success in NOA include hormone levels, testicular size, prior treatment, and histopathology score, aiding in better case selection and outcome prediction.\u003c/p\u003e","manuscriptTitle":"Identifying Pre-operative Factors for Successful Micro-dissection Testicular Sperm Extraction in Non-Obstructive Azoospermia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-20 15:26:02","doi":"10.21203/rs.3.rs-6678763/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88a4bc78-a438-4659-9ad7-adaf53010035","owner":[],"postedDate":"June 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-09T05:38:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-20 15:26:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6678763","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6678763","identity":"rs-6678763","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}