Abstract
Infertility affects 15–20% of the reproductive age range population; the male factor accounts for up to 40–60% of these. With female factor infertility catching most of the limelight in research, diagnosis and treatment, the other half of the problem has not been duly addressed. Imaging has an important role to play in the evaluation of male infertility, especially to identify correctible (obstructive) causes. We review the scrotal, trans-rectal sonographic and Doppler findings in infertile men to aid in the accurate diagnosis and proper management of such patients.
Sommario
L’infertilità colpisce il 15–20% della popolazione in età riproduttiva e il sesso maschile rappresenta il 40–60% di questa percentuale. L’infertilità femminile continua ad essere il polo di attrazione principale della ricerca, della diagnosi e del trattamento mentre l’altra metà del problema non è stata ancora adeguatamente affrontata. L’imaging svolge un ruolo importante nella valutazione dell'infertilità maschile, specialmente per identificare le cause correggibili (ostruttive). In questo pictorial essay valutiamo i risultati dell’ecografia scrotale, trans-rettale ed eco-Doppler in uomini infertili per indicare una corretta metodologia per una diagnosi accurata e quindi per una efficace gestione di tali pazienti.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig1_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig2_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig3_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig4_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig5_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig6_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig7_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig8_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig9_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig10_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig11_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig12_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig13_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig14_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig15_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40477-018-0294-5/MediaObjects/40477_2018_294_Fig16_HTML.jpg)
Similar content being viewed by others
References
Boivin J, Bunting L, Collins JA, Nygren KG (2007) International estimates of infertility prevalence and treatment seeking: potential need and demand for infertility medical care. Hum Reprod 22(6):1506–1512
Organization, World Health (1987) Towards more objectivity in diagnosis and management of male infertility. Int J Androl 7:1–53
American Urological Association (2011) Best practice statement: The optimal evaluation of the infertile male. 2010
Cooper TG, Noonan E, Von Eckardstein S, Auger J, Baker HW, Behre HM, Haugen TB, Kruger T, Wang C, Mbizvo MT, Vogelsong KM (2010) World Health Organization reference values for human semen characteristics. Hum Reprod Update 16(3):231–245
Foresta C, Garolla A, Bettella A, Ferlin A, Rossato M, Candiani F (1998) Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function. Hum Reprod (Oxford, England) 13(11):3090–3093
World Health Organization (2010) WHO laboratory manual for the examination and processing of human semen, 5th edn. World Health Organization, Geneva
Ammar T, Sidhu PS, Wilkins CJ (2012) Male infertility: the role of imaging in diagnosis and management. Br J Radiol 85(special_issue_1):59–68
Belenky A, Avrech OM, Bachar GN, Zuckerman Z, Rafael ZB, Fisch B, Cohen M (2001) Ultrasound-guided testicular sperm aspiration in azoospermic patients: a new sperm retrieval method for intracytoplasmic sperm injection. J Clin Ultrasound 29(6):339–343
Pierik FH, Dohle GR, van Muiswinkel JM, Vreeburg JT, Weber RF (1999) Is routine scrotal ultrasound advantageous in infertile men? J Urol 162(5):1618–1620
Kim W, Rosen MA, Langer JE, Banner MP, Siegelman ES, Ramchandani P (2007) US–MR imaging correlation in pathologic conditions of the scrotum. Radiographics 27(5):1239–1253
Kuligowska E, Fenlon HM (1998) Transrectal US in male infertility: spectrum of findings and role in patient care. Radiology 207(1):173–181
Roberts M, Jarvi K (2009) Steps in the investigation and management of low semen volume in the infertile man. Can Urol Assoc J 3(6):479
Donkol RH (2010) Imaging in male-factor obstructive infertility. World J Radiol 2(5):172
Raza SA, Jhaveri KS (2012) Imaging in male infertility. Radiol Clin 50(6):1183–1200
Mittal PK, Little B, Harri PA, Miller FH, Alexander LF, Kalb B, Camacho JC, Master V, Hartman M, Moreno CC (2017) Role of imaging in the evaluation of male infertility. RadioGraphics 37(3):837–854
d’Ancona CL, Netto NR, Stedile JAG, Billis A (1989) Vasography: experimental study. Int Urol Nephrol 21(1):73–79
Solivetti FM, Drusco A, Pizzi G, Elia F, de Mutiis C, Teoli M, Bacaro D (2008) Percutaneous vesiculodeferentography in the diagnosis of male infertility: a review of our results and the data reported in the literature. J Ultrasound 11(3):102–106
Practice Committee of the American Society for Reproductive Medicine (2006) Report on management of obstructive azoospermia. Fertil Steril 86(5):S259–S263
Heshmat S, Lo KC (2006) Evaluation and treatment of ejaculatory duct obstruction in infertile men. Can J Urol 13:18–21
Moon MH, Kim SH, Cho JY, Seo JT, Chun YK (2006) Scrotal US for evaluation of infertile men with azoospermia. Radiology 239(1):168–173
Souza CAB, Cunha-Filho JSL, Fagundes P, Freitas FM, Passos EP (2005) Sperm recovery prediction in azoospermic patients using Doppler ultrasonography. Int Urol Nephrol 37(3):535–540
Spitz A, Kim ED, Lipshultz LI (2000) Contemporary approach to the male infertility evaluation. Obstetrics Gynecol Clin 27(3):487–516
Brugh VM III, Lipshultz LI (2004) Male factor infertility: evaluation and management. Med Clin North Am 88(2):367–385
Gazvani R, Lewis-Jones DI (2004) Cystic fibrosis mutation screening before assisted reproduction. Int J Androl 27(1):1–4
Brugh VM III, Matschke HM, Lipshultz LI (2003) Male factor infertility. Endocrinol Metab Clin North Am 32(3):689–707
Kuligowska E, Fenlon HM (1998) Transrectal US in male infertility: spectrum of findings and role in patient care. Radiology 207(1):173–181
Hendry WF (1998) Disorders of ejaculation: congenital, acquired and functional. Br J Urol 82:331–341
Saboo SS, Brodsky GL, Di Salvo D (2012) Sonographic-pathologic correlation of epididymal changes in a suspected case of postvasectomy pain syndrome. J Ultrasound Med 31(6):973–974
Jarow JP, Espeland MA, Lipshultz LI (1989) Evaluation of the azoospermic patient. J Urol 142(1):62–65
Kim ED, Lipshultz LI, Howards SS (2002) Male infertility. In: Gillenwater JY, Grayhack JT, Howards SS, Mitchell ME (eds) Adult and pediatric urology, vol 2, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1683–1758
Ahlberg NE, Bartley O, Chidekel N, Fritjofsson Å (1966) Phlebography in varicocele scroti. Acta Radiol Diagn 4(5):517–528
Weidner W, Pilatz A, Altinkilic B (2010) Varicocele: an update. Andrology 49:163–1655
Kocakoc E, Serhatlioglu S, Kiris A, Bozgeyik Z, Ozdemir H, Bodakci MN (2003) Color Doppler sonographic evaluation of inter-relations between diameter, reflux and flow volume of testicular veins in varicocele. Eur J Radiol 47(3):251–256
Zorba UO, Sanli OM, Tezer M, Erdemir F, Shavakhabov S, Kadioglu A (2009) Effect of infertility duration on postvaricocelectomy sperm counts and pregnancy rates. Urology 73(4):767–771
Romeo C, Santoro G (2009) Varicocele and infertility: why a prevention? J Endocrinol Invest 32(6):559–561
Pilatz A, Altinkilic B, Köhler E, Marconi M, Weidner W (2011) Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele? World J Urol 29(5):645–650
Kurpisz M, Havryluk A, Nakonechnyj A, Chopyak V, Kamieniczna M (2010) Cryptorchidism and long-term consequences. Reprod Biol 10(1):19–35
Adesanya OA, Ademuyiwa AO, Evbuomwan O, Adeyomoye AAO, Bode CO (2014) Preoperative localization of undescended testes in children: comparison of clinical examination and ultrasonography. J Pediatric Urol 10(2):237–240
Bujan L, Mieusset R, Mansat A, Moatti JP, Mondinat C, Pontonnier F (1989) Testicular size in infertile men: relationship to semen characteristics and hormonal blood levels. BJU Int 64(6):632–637
Schuppe HC, Pilatz A, Hossain H, Meinhardt A, Bergmann M, Haidl G, Weidner W (2010) Orchitis und Infertilität Orchitis and male infertility. Der Urol 49(5):629–635
Qublan HS, Al-Okoor K, Al-Ghoweri AS, Abu-Qamar A (2007) Sonographic spectrum of scrotal abnormalities in infertile men. J Clin Ultrasound 35(8):437–441
Engin G, Kadioglu A, Orhan I, Akdöl S, Rozanes I (2000) Transrectal US and endorectal MR imaging in partial and complete obstruction of the seminal duct system: a comparative study. Acta Radiol 41(3):288–295
Dandapat MC, Padhi NC, Patra AP (1990) Effect of hydrocele on testis and spermatogenesis. Br J Surg 77(11):1293–1294
Pinggera GM, Mitterberger M, Bartsch G, Strasser H, Gradl J, Aigner F, Pallwein L, Frauscher F (2008) Assessment of the intratesticular resistive index by colour Doppler ultrasonography measurements as a predictor of spermatogenesis. BJU Int 101(6):722–726
Herwig R, Tosun K, Schuster A, Rehder P, Glodny B, Wildt L, Illmensee K, Pinggera GM (2007) Tissue perfusion-controlled guided biopsies are essential for the outcome of testicular sperm extraction. Fertil Steril 87(5):1071–1076
Biagiotti G, Cavallini G, Modenini F, Vitali G, Gianaroli L (2002) Spermatogenesis and spectral echo‐colour Doppler traces from the main testicular artery. BJU Int 90(9):903–908
Acknowledgements
None.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflict of interest to declare.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Sihag, P., Tandon, A., Pal, R. et al. Sonography in male infertility: a look beyond the obvious. J Ultrasound 21, 265–276 (2018). https://doi.org/10.1007/s40477-018-0294-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40477-018-0294-5