Role of Imaging in Male Infertility
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Transrectal ultrasound and scrotal ultrasound are useful in diagnosing male infertility. Transrectal ultrasound can detect midline cysts or stones obstructing the ejaculatory duct. It can also evaluate the seminal vesicles. Scrotal ultrasound can identify varicoceles, epididymitis, testicular tumors, and other abnormalities. X-rays are used for testicular venography to diagnose varicoceles. Imaging plays an important role in evaluating male infertility by detecting treatable causes and ensuring patient safety.
Role of Imaging in Male Infertility
- 1. ROLE OF X-RAY AND USG IN MALE INFERTILITY DIAGNOSIS
- 5. ROLE OF USG
- 6. TRANSRECTAL ULTRASONOGRAHY • Used for evaluation of ejaculatory duct obstruction • Midline prostatic cysts such as Mullerian or Wolffian duct cysts or stones obstructing the ejaculatory duct may be detected • Used for Seminal vesicle aspiration: 3 or more sperms per HPF in the seminal vesicle aspirate- s/o EDO • seminovesiculography
- 7. SCROTAL ULTRASONOGRAPHY • Varicolceles • Epididymitis • Epididymal cyst • Spermatocele • Testicular tumors
- 9. On grey scale imaging a varicocele is seen as serpiginous tubules posterior to the testis (a). Colour flow Doppler confirms flow within varicocele.
- 10. Sagittal sonograms of the superior aspect of the left hemiscrotum show multiple dilated peritesticular veins on color Doppler imaging (A) and an individual vein on gray-scale imaging (B) that measures 4.2 mm when Valsalva maneuver is used. These findings are compatible with a varicocele.
- 11. Bilateral Cryptorchidism: Sagittal sonograms show both testes to be located in the inguinal canals and diminutive. Testicular volume measured 2–3 mL each (normal range, 18–20 mL).
- 12. Long standing obstruction: Heterogeneous testis with associated ectasia of the rete testis (short arrows) and dilated body of the epididymis (long arrow)
- 13. 26-year-old man with no palpable vas deferens on physical examination. Midline transverse sonogram of both testes shows dilatation of the rete testis in the medial aspect of each testis. These findings are typical of congenital bilateral absence of the vas deferens.
- 14. Ultrasound of both testes (sagittal images) demonstrates ectasia of the testes with formation of intratesticular cysts. These finding are suggestive of a seminal tract obstructive etiology which should be managed by epididymo-vasotomy.
- 15. Scrotal ultrasound demonstrating thickening and enlargement of the epididymal body (arrow) in a case of infective epididymitis. The testis is spared from the infective process.
- 16. Epididymal head abnormalities in obstructive azoospermia. (a) Longitudinal (left) and transverse (right) US images in a 31-year-old man with proved CBAVD show tubular ectasia (arrowheads) in the epididymal head.
- 17. Longitudinal testicular ultrasound demonstrating an a dilated, heterogeneous epididymis characteristic of the post vasectomy appearance.
- 18. TRUS demonstrating calcification within the ejaculatory duct with dilatation of the vas deferens proximally.
- 19. A 27-year-old with primary infertility. A: TRUS shows a 3 cm × 2 cm thin walled midline intraprostatic urogenital cyst; B: TRUS-guided contrast opacification of the cyst revealed that the cyst was blind with no communication with the seminal tract. Semen analysis showed improvement of the sperm count 3 d after complete cyst aspiration.
- 20. Transverse sonogram of the right testicle shows multiple hypoechoic masses in the parenchyma, consistent with multifocal tumor. Pathology at surgical resection revealed seminoma.
- 21. 20-year-old man after scrotal trauma 1 week previously who presents with swelling of the scrotum. Transverse sonogram of the scrotum reveals a large amount of fluid surrounding the testicle, consistent with a hydrocele.
- 22. ABDOMINAL ULTRASONOGRAPHY • To rule out associated renal anomalies in patients with vasal agenesis • Upto 20% of males with CFTR mutation negative vasal agenesis willl have ipsilateral renal anomalies
- 23. ROLE OF X-RAY • X-ray are used to do testicular venography and embolisation. Venography is regarded as the gold standard for diagnosis of a varicocoele by demonstrating reflux of contrast into the testicular vein.
- 25. •Given the prevalence of male infertility, the Gynecologist’s familiarity with its appropriate imaging workup and recognition of the commonly involved pathologic processes is critical. •Imaging plays a key role in the evaluation of the hypospermic or azoospermic man. It can detect correctable abnormalities, which can lead to a successful conception. It can also reveal potentially life-threatening disorders in the course of an infertility evaluation. CONCLUSION