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 befruitfully utilized for the diagnosis and management of azoospermic subjects. Methods: In the semen, mature andimmature germ cells are contributed by the testes, 70% of glycerylphosphoryl choline (GPC) by the epididymis, fruc-tose mostly or solely by the seminal vesicles and acid phosphate (ACP) by the prostate. In 16 normal volunteers, 12vasectomized subjects and 186 azoospennic subjects, these parameters have been studied and the data have been ana-lyzed. Results: Both mature and immature germ cells are absent in the semen of vasectomized subjects as well as inobstructive azoospennia; GPC level is also significantly decreased in both these groups. In cases with non-obstructiveazoospermia immature germ cells are present and seminal GPC, ACP and fructose levels are normal. The diagnosis ofobstructive and non-obstructive azoospermia based on these parameters correlated well with "correct" testicular biopsyfindings. In some cases of azoospermia due to hypospermatogenesis or spermatogenic developmental arrest, the SGCMstudies were very helpful in objectively monitoring the response of the germinal tissue to specific treaunents. Conclu-sion: SGCM and semen biochemical parameters are very valuable non-invasive markers for differentiating obstructivefrom non-obstructive azoospermia. The SGCM findings serve as a dependable non-invasive testicular marker with highpredictive value. (Asian J Androl 2001 Mar; 3: 55-62)