الفهرس 
Anatomy and Histology of Male Genital TractOnly 14 pages are availabe for public view
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Abstract
Oligozoospermia is a common presentation of male infertility. It is defined by having less than 15 million sperms/ml of the semen and is most commonly considered by most clinicians to be functional as a result of deficient spermatogenesis. Nevertheless, the existence of obstructive etiology “whether partial or unilateral” must be always put in mind.
Testicular biopsy is most commonly examined by the clinicians in a descriptive, non-quantitative way. This has severely limited its usefulness and led to many errors in its interpretation. For that same reason, testicular biopsy has not found much use in men with oligozoospermia.
Obstructive oligozoospermia is defined as the lack of a correlation between the number of mature spermatids (Sc + Sd) in the testicular biopsy and sperm concentration per milliliter in the ejaculate.
Thus, to establish a definite diagnosis of partial obstruction, the patient may be subjected to the complications of the testicular biopsy. At the same time, failure to identify instances of partial obstruction may subject the patient to unnecessary treatments. Therefore, it seems important not to miss this possibility of partial obstruction in any case of unexplained oligozoospermia and at the same time to find an easy and non-invasive way for confirming this diagnostic possibility.
In previous studies, seminal IGF-1 concentrations have been shown to correlate significantly with the percentage of morphologically normal sperm and sperm density. On the same basis, total seminal α2 macroglobulin level has also been shown to correlate significantly with the sperm density and percentage of progressively motile sperm.
In this study, 40 oligozoospermic patients were included aiming at assessing the value of measuring levels of IGF-1 and α2-macroglobulin in predicting testicular sperm output as judged from quantitative analysis of testicular biopsy in oligozoospermic cases.
Full history taking, general & complete local examination, prostatic discharge examination, hormonal profile, scrotal duplex, semen analyses, bilateral open testicular biopsy under local anesthesia and measurement of IGF-1 and α2-macroglobulin in seminal plasma were performed for each patient.
Johnsen’s score was used to evaluate the degree of spermatogenesis in every tubule to give a score within a given histological section. Then, an exponential curve (Fig.11) was used to predict the expected sperm count in million/ml from the mean number of mature spermatids (Sc+ Sd) per tubule.
In this study, there was no correlation between testicular biopsy findings and actual sperm count in both groups. In contrast to previous reports, there was no correlation between either IGF-1 or α2-macroglobulin in seminal plasma and expected sperm count in either group. At the same time, there was also no statistically significant difference between the actual sperm count and testicular volumes in both groups.
In conclusion, due to lack of correlation between IGF-1 & α2-macroglobulin and the expected sperm count, these markers are not reliable as an alternative method for quantitative testicular biopsy in the diagnosis of patients with partially obstructive oligozoospermia. The need is still there to study other markers or to search for another technique for identification of such cases.