Smallpox as an Etiologic Factor in Male Infertility

Abstract

An attempt was made to assess the role of smallpox infection as an etiologic factor in infertility in men. The study is based on the analysis of 800 patients who had registered with the Family Welfare Bureau in Bombay, India during the past 19 years for investigation and treatment of infertility. A thorough history was taken and a physical examination was performed on each patient. In every case a routine semen analysis was repeatedly performed 2 or 3 times, at an interval of 15-30 days, to assess the magnitude of spontaneous variations occurring in the semen. In all cases of azoospermia and in cases of severe oligospermia, where the sperm count was less than 10 million/cu cm, a testicular biopsy was performed. In 895 cases there was history and evidence of prior smallpox infection. These cases (designated the smallpox series) were analyzed according to the sperm counts and according to the lesions observed in the testicular biopsies. For the control series, another group of 895 serially registered infertile patients who had not had smallpox was analyzed in an identical way. Testicular biopsies were performed in 358 azoospermic cases belonging to each series. In analyzing the cases according to the sperm levels, the mean sperm count prior to therapy was considered to be the representative count in each patient. The incidence of smallpox in the present series of infertile men was 11.18%. The incidence of severe oligospermia and moderate oligospermia was practically the same in both series. The incidence of azoospermia was 42.57% in the smallpox series and only 17.87% in the control series. The incidence of normospermia was only 30.17% in the smallpox series and as much as 52.52% in the control series. The incidence of obstructive azoospermia was as high as 79.36% in the smallpox series. It was 46.23% in the control series. In patients with nonobstructive azoospermia, testicular lesions such as partial or complete arrest of spermatogensis at various levels, germinal cell aplasia, severe tubular atrophy, and hyalinization of the tubules were encountered with comparable frequency in both series. The study supports the frequent clinical impression that the incidence of obstructive azoospermia is very high in patients who have had smallpox. 4 of 5 such cases have obstructive lesions. The site of obstruction is usually at the lower end of the epididymis, and the testes seem to escape the brunt of the disease.