Microscopic Evaluation of The Testis in Azoospermic Patients with Reference to Androgen Receptors in Sertoli Cells

摘要

Background: The reproductive ability of sexually mature males is dependent on the capacity of the testes tubules to produce large numbers of highly viable sperms and the interstitial cells to produce adequate levels of androgens to ensure maturation of the reproductive system.Azoospermia, defined as the complete absence of spermatozoa in the ejaculate, invariably results in infertility but does not necessarily imply sterility. It is identified in approximately 1% of all men and in 10 to 15% of infertile males. Patients and methods: The use of biopsies had been approved by the ethics committee of the Faculty of Medicine, Al Azhar University. All testicular biopsies were taken after written informed consent at the Department of Clinical Andrology, International Islamic Center for Population and Research Studies.Eleven patients with idiopathic infertility, were enrolled in this study and were assessed and diagnosed by a complete examination and specific investigations. Results: This study included 11 patients. They were divided into two groups obstructive azoospermia (OA) and Non-obstructive azoospermia. Non-obstructive azoospermia is subdivided into 4 groups: Early maturation arrest, late maturation arrest, Sertoli cell only (Sco) and Klienfilter syndrome. Conclusion: Spermatogenesis and maintenance of reproductive functions are controlled by androgens which are steroid hormones. Androgens exert most of their effects through genomic actions, which involve their binding to the androgen receptor (AR).AR plays important roles during later stages of sperm formation and maturation by influencing the four major cell types: Sertoli, Leydig, peritubularmyoid, and germ cells. Except for maturation arrest non-obstructive azoospermia, AR positive staining was not detected in germ cells. The highest number of Sertoli cell androgen receptors was in sections of testis from obstructive azoospermia and non- obstructive late maturation arrest patients, Testicular sections from patients with Klinefelter syndrome presented the lowest number of androgen receptor positive cells.It was concluded that the present study revealed that demonstration of androgen receptors in testicular sections is a good indicator of spermatogenic activity. Such information is valuable for the decision of obtaining spermatozoa from the testis for ICSI.