الفهرس 
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Abstract
Summary
zoospermia, defined as the absence of spermatozoa in the ejaculate, is classified as obstructive azoospermia and non obstructive azoospermia (NOA). NOA represents decreased sperm production within the testes.
Aim of the work:
This prospective comparative study encompassed 118 infertile men with clinical and laboratory data indicating NOA, who were referred to the Andrology clinic of a specialized IVF center (Adam International Hospital, Giza, Egypt) for surgical retrieval of sperm cells, starting from. The study was conducted between July 2021 and February 2023.
All the patients were subjected to the following:
1. Demographic and clinical characteristics (including full fertility history and genital examination).
2. At least two semen analyses: done according to WHO (2010) guidelines.
3. Hormonal profile.
4. Cytogenetic evaluation.
5. Sperm retrieval by micro-dissection techniques (under local or spinal anesthesia):
For all participants (n: 118), initial retrieval was attempted by means of mini-incision m-TESE with limited unilateral micro-dissection (Alrabeeah et al., 2016; Almajed et al., 2020). If several (≥5) motile spermatozoa were identified during the preliminary assessment of the first
5 specimen extracted from the superficial parenchyma of the initial testicle, the procedure would be finished, and in such case the participant was excluded. If SR could not be reached during the initial assessment, participants would perform standard/ extensive m-TESE as described by Schlegel (1999) and Amer et al. (2000) with complete and thorough examination of the entire parenchyma on the same testicle. If spermatozoa could not be recovered even after extensive micro-dissection or if the number and/or quality of the retrieved spermatozoa are not fit for ICSI and/or freezing, then the contralateral testicle was exposed by either the standard micro-dissection technique (Schlegel, 1999; Amer et al., 2000) which was applied to 55 patients or the 3D model of m-TESE (Ichioka et al., 2020) which was applied to 63 patients.
The results were as follows:
• The total number of the cases was 118; those cases were divided into 2 groups (Standard 55 cases {46.6 %} & 3D 63 cases {53.4%}).
• Then further divided into 4 subgroups (Standard first timers 25 cases {21.2%}, Standard Redo 30 cases {25.4%}, 3D first timers 27 cases {22.9%} & 3D Redo 36 cases {30.5%}).
• Regarding TESE outcome: Successful sperm retrieval (SSR) was achieved in 17/55 (30.9%) of men who underwent bilateral standard m-TESE, and in 18/63 (28.6%) of cases who underwent unilateral standard m-TESE and contralateral 3D technique.
• The most common histopathological pattern was: SCO which was encountered in 45.5% of men with bilateral standard m.TESE and in 39.7% of men who underwent of men who underwent unilateral standard m-TESE and contralateral 3D technique.
* Only 1 case that underwent unilateral standard m-TESE and contralateral 3D technique had hypospermatogenesis.
* Other histopahthological patterns are illusterated in table 3. The difference between the study groups was statically insignificant (p> 0.05) regarding histopathology.