الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Infertility is becoming a major public health concern with major psychological and economic impacts. Globally, up to 15% of couples suffer from infertility, in which almost a quarter of the cases are due to the male factor. Azoospermia refers to the complete lack of spermatozoa in the ejaculate, affecting 1% of all males and up to 15% of the infertile male population. Azoospermia can be categorized into obstructive azoospermia (OA); that is due to blockage along the male reproductive tract and non-obstructive azoospermia (NOA): that is due to dysfunctional spermatogenesis affecting about 60% of azoospermic men. Both cases of NOA and OA can benefit from testicular sperm extraction (TESE).
In cases of NOA, micro-TESE has improved the chances of sperm retrieval by identifying foci of spermatogenesis in the testis with a success rate of 40-60%. To improve this outcome, it is necessary to have a reliable predictor of sperm retrieval. Several clinical parameters such as semen analysis, testicular size, FSH levels, inhibin B, and histopathology are among predictive factors for successful sperm retrieval in men with dysfunctional azoospermia. However, no accurate predictors have been identified.
In view of the scarcity of studies on SPEM1 in predicting sperm retrieval in the literature and the lack of studies in our ethnic population, there is an unmet need to determine its value in this set-up. Thus, the present study aimed to analyze SPEM1 in testicular samples and serum inhibin B in patients undertaking micro-TESE for ICSI and their correlation with sperm retrieval.
Forty patients were recruited from the Andrology outpatient clinic of the Main University Hospital, Faculty of Medicine, University of Alexandria, 30 NOA patients with verified azoospermia as per the WHO 5th edition, normal seminal fructose and alpha-glucosidase levels, and no evidence of obstructive causes of azoospermia in history or physical examination were included. Patients with evidence of obstruction, anejaculation, and retrograde ejaculation were excluded from the study. Ten out of the 40 recruited patients had obstructive azoospermia (OA) and served as controls. The serum levels of FSH, inhibin B, testosterone, and LH were analyzed in all patients. The study was approved by the Alexandria faculty of medicine research ethics committee.
All patients underwent micro-TESE, the microdissected samples were placed in Petri dishes containing culture media (Ham`s F10) and wet smear assessment was performed by inverted phase-contrast microscope for the presence of sperm. Retrieved viable sperm were directly utilized for ICSI or cryopreserved at -4°C in liquid nitrogen. Two extra pieces of testicular tissue were taken and fixed in Bouin`s fixative solution for quantitative assessment of histopathological pattern, and RNA stabilization reagent for quantitative expression of SPEM1.
Serum inhibin B was significantly lower in the NOA patients than in OA controls (P<0.001). In the NOA patients, the level of serum inhibin B was statistically significantly higher in cases with positive micro-TESE outcome compared to cases with negative outcome (p=0.002). Serum level of inhibin B was highest in hypospermatogenesis and lowest in tubular hyalinization. Serum FSH and inhibin B had a significant negative correlation (r = -0.596, p=0.001) whereas, SPEM1 relative expression had a significant positive correlation wi