Azoospermia

AZOOSPERMIA (from the Greek a- negative particle, zoon-animal, and sperma-seed), is a condition in which the semen contains absolutely no spermatozoa. A distinction is made between true azoospermia, when spermatozoa are not produced by the testicles, and false azoospermia, in which there is merely an obstruction to the spermatozoa. Idiopathic azoospermia in otherwise completely healthy individuals or temporary, passing azoospermia after preceding heavy losses of semen is a very rare phenomenon. Azoospermia can be the result of the absence of testicles, congenital or acquired atrophy of the testicles, bilateral cryptorchidism, various kinds of tumors and inflammatory processes (in syphilis and tuberculosis, less often in gonorrhea and mumps). True azoospermia can also occur as a result of mechanical damage to both testicles (trauma, pressure from a hydrocele, varicocele, or scrotal hernia), in certain metabolic diseases (diabetes, obesity), in chronic intoxication, severe forms of tuberculosis, chronic sepsis, alcoholism, and occupational poisonings by phosphorus, lead, and arsenic. False azoospermia is encountered significantly more often than true azoospermia, usually following bilateral gonorrheal epididymitis (observed in 75% of all cases thereof), upon blockage of some section of the vas deferens of the epididymis by a post-inflammatory scar, upon destruction of the ciliated epithelium in the duct, or upon sluggishness or complete absence of auxiliary peristaltic movements in it (post-inflammatory proliferation of connective tissue within the thickness of its walls). Obstruction to spermatozoa can also occur after unilateral epididymitis. This is explained by the fact that the inflammatory process in one of the epididymides is frequently combined with a disease of the vas deferens on the other side, chiefly in the region of the latter's ampulla. Azoospermia can, finally, occur upon obliteration of the ejaculatory ducts after posterior urethritis, prostatitis, or spermatocystitis. Treatment represents an ungrateful task. In true azoospermia, it must be directed against the underlying affliction: temporary abstinence in azoospermia resulting from sexual excesses, specific treatment for syphilitic testicular disease, treatment of diabetes, obesity, and tuberculosis in functional disorders of the testicles associated with these diseases; elimination of chronic intoxication of the body in alcoholism and occupational poisonings. Attempts to treat cicatricial changes remaining after gonorrheal involvement of the epididymides using injections of fibrolysin, mud therapy, diathermy, and ionization usually do not yield an effect in terms of restoring patency to spermatozoa. Likewise, there is little hope of a favorable outcome in vaso-orchidostomy due to frequently occurring scar tissue formation at the site of implantation of the vas deferens into the testicular tissue.

I. Shrudolinsky.