Martin and colleagues reported on the study of 192 sterile couples. Martin pointed out "that 33 (17%) of the men in this group were azoospermic and two more could produce no ejaculate at all. From an examination of the semen from these patients he came to several very important conclusions. He pointed out that in order to determine the potential fertility of a male patient, the semen must be fresh, because if a sample of semen is allowed to age, sperm movement is lost. However, he also noted that sperm motility could be preserved by cooling the semen sample. He also found that repeated samples of semen are necessary as some patients may produce an azoospermic sample and then at a later date can be found to have semen containing low numbers of sperm. Having examined large numbers of samples of human semen, he made detailed drawings of human spermatozoa and noted their polymorphism, particularly in relation to the variations in both size and shape of the sperm heads. He was perhaps the first person to describe twin-headed sperm and to describe sperm with two tails. He also noted the presence of cytoplasmic droplets on spermatozoa but could not explain their nature or their aetiology. He described psammoma bodies in semen and surmised that they came from the prostate. A further fundamental observation made by Edward Martin during surgery on these patients was that intratesticular sperm are immotile.

"In this paper, he [Martin] described the first epididymo-vasostomy. Initially, he carried out epididymo-vasostomies on three dogs after tying the vas proximally and then attempted this procedure on a patient with obstructive azoospermia" (Anne. M. Jequier, "Edward Martin (1859-1938). The founding father of modern clinical andrology," Int. J. Androl., 14 (1991), 1-10).

With J. Valentine Levi and M. E. Pennington.

The patient described in this paper gave a past history of epididymitis and also of gonococcal urethritis which was known at that time as ‘gleet’ and which had resulted in a urethral stricture. The epididymo-vasostomy was carried out unilaterally as a side-to-side procedure on the left side only. The epididymo-vasal fistula was constructed using silver wire. Six weeks later, sperm were noted in a semen sample and 281 days later, the patient’s wife delivered a full term infant!

Of 11 men with an epididymal obstruction, seven underwent a unilateral and four a bilateral epididymo-vasostomy. The operations consisted of the formation of a side-to-side epididymo-vasal fistula using silver wire sutures. From these 11 operations, seven patencies resulting in three pregnancies were obtained.

"In this publication Dr Martin also made some important observations. He made it clear that obstruction of the epididymis and subsequent azoospermia could be induced by a single attack of epididymitis. He demonstrated that epididymovasostomy is successful in the treatment of obstructive azoospermia. He also pointed out that azoospermia can be caused in two main ways, namely, not only by obstruction but also by functional disorders of the testis. He also showed that epididymo-vasostomy can only be of value when the vas is patent and that testing vasal patency per-operatively is an important step prior to the completion of the operation" (Anne M. Jequier, "Edward Martin (1859-1938). The founding father of modern clinical andrology," Int. J. Androl., 14 (1991) 1-10).

Cordotomy for the relief of intractable pain.