Application of seminal germ cell morphology and semen biochemistry in the diagnosis and management of azoospermic subjects.

AIM

To evaluate whether the study of seminal germ cell morphology (SGCM) and semen biochemistry could be fruitfully utilized for the diagnosis and management of azoospermic subjects.

METHODS

In the semen, mature and immature germ cells are contributed by the testes, 70% of glycerylphosphoryl choline (GPC) by the epididymis, fructose mostly or solely by the seminal vesicles and acid phosphatase [corrected] (ACP) by the prostate. In 16 normal volunteers, 12 vasectomized subjects and 186 azoospermic subjects, these parameters have been studied and the data have been analyzed.

RESULTS

Both mature and immature germ cells are absent in the semen of vasectomized subjects as well as in obstructive azoospermia; GPC level is also significantly decreased in both these groups. In cases with non-obstructive azoospermia immature germ cells are present and seminal GPC, ACP and fructose levels are normal. The diagnosis of obstructive and non-obstructive azoospermia based on these parameters correlated well with "correct" testicular biopsy findings. In some cases of azoospermia due to hypospermatogenesis or spermatogenic developmental arrest, the SGCM studies were very helpful in objectively monitoring the response of the germinal tissue to specific treatments.

CONCLUSION

SGCM and semen biochemical parameters are very valuable non-invasive markers for differentiating obstructive from non-obstructive azoospermia. The SGCM findings serve as a dependable non-invasive testicular marker with high predictive value.