[Azoospermia with normal plasma FSH and unlowered seminal carnitine. Utilization for diagnosis and treatment]

In secretory azoospermia, plasma FSH is usually high and seminal carnitine in relation with epididymal secretion, normal. In excretory azoospermia, FSH is not increased and seminal carnitine is lowered. Here we report the case of 23 patients in whom FSH was not increased and seminal carnitine not decreased. Among these patients 17 had had surgery with vas deferens and epididymis exploration. Testis biopsy for histological analysis was performed. It turned out that most of the patients (13 of the 17) had a genital tract occlusion located at the junction of corpus--caput of the epididymis (9/13) or at the junction testis-epididymis (4/13). The 4 remaining patients showed arrest of spermatogenesis which was before spermiogenesis in 3 of the 4 cases. This study allows (1) to define the diagnosis value of the seminal carnitine assay, which remains the only test to affirm excretory azoospermia when there is a bilateral occlusion located on the genital tract between the epididymis corpus and the ejaculatory ducts, (2) to consider another treatment than epididymo-vasostomy in cases of occlusion caput--corpus (epididymo-epididymostomy), (3) to detect a population presenting a very early arrest of spermatogenesis without any pituitary effect, probably having a special regulation of FSH secretion.