Use of Ultrasound in Male Infertility: Appropriate Selection of Men for Scrotal Ultrasound
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Purpose of Review
Male factor infertility is a complex and multifaceted problem facing the modern urologist and is identified in 30–40% of infertile couples. This review focuses on the use of ultrasound, as an adjunct screening tool, in the initial evaluation of male infertility.
Access to male reproductive urologist for assessment of male infertility is limited and about a quarter of infertile couples do not complete the male component in their infertility assessment. Ultrasound evaluation of the infertile male is low-cost and non-invasive and helps uncover underlying pathologies that may be missed during the initial assessment. The addition of ultrasound allows the physician to accurately assess testicular anatomy and dimensions, as well as vascular environments, which may help guide treatment decisions.
Scrotal ultrasound evaluation, in conjunction with a semen analysis and as an adjunct to physical exam, can be offered in the initial assessment of men who present for infertility consultation given its low cost, non-invasive nature, and ability to detect and discriminate between various etiologies of male infertility. Further, when directed by physical exam and semen analysis findings, it provides a valuable tool to select men for referral to a reproductive urologist, especially for infertile couples who are only screened by reproductive endocrinologists and female infertility specialists.
KeywordsMale infertility Ultrasound Men’s health Scrotal ultrasound
Compliance with Ethical Standards
Conflict of Interest
Joseph M. Armstrong, Sorena Keihani, and James M. Hotaling each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.• Thoma ME, McLain AC, Louis JF, King RB, Trumble AC, Sundaram R, et al. Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertil Steril. 2013;99(5):1324–31 e1. https://doi.org/10.1016/j.fertnstert.2012.11.037. 15.5% of couples struggle with fertility. CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J. Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. Vital Health Stat. 2005;23(25):1–160.Google Scholar
- 3.Center for Disease Control and Prevention. Reproductive Health. https://www.cdc.gov/reproductivehealth/infertility/index.htm. Accessed 12 Jan 2018 2018.
- 6.Sigman M. Infertility in the male. 4th ed. Cambridge University press; 2009.Google Scholar
- 7.Niederberger CS. Campbell-Walsh urology. 11th ed. Philadelphia: Elsevier.Google Scholar
- 9.•• Eisenberg ML, Lathi RB, Baker VL, Westphal LM, Milki AA, Nangia AK. Frequency of the male infertility evaluation: data from the national survey of family growth. J Urol. 2013;189(3):1030–4. https://doi.org/10.1016/j.juro.2012.08.239. Access to male infertility specialist is disparate and limited in the USA and 18–27% of couples do not complete assessment of the male infertility component. CrossRefPubMedGoogle Scholar
- 14.Pinggera GM, Mitterberger M, Bartsch G, Strasser H, Gradl J, Aigner F, et al. Assessment of the intratesticular resistive index by colour Doppler ultrasonography measurements as a predictor of spermatogenesis. BJU Int. 2008;101(6):722–6. https://doi.org/10.1111/j.1464-410X.2007.07343.x.CrossRefPubMedGoogle Scholar
- 15.Unsal A, Turgut AT, Taskin F, Kosar U, Karaman CZ. Resistance and pulsatility index increase in capsular branches of testicular artery: indicator of impaired testicular microcirculation in varicocele? J Clin Ultrasound. 2007;35(4):191–5. https://doi.org/10.1002/jcu.20331.CrossRefPubMedGoogle Scholar
- 16.• Hillelsohn JH, Chuang KW, Goldenberg E, Gilbert BR. Spectral Doppler sonography: a noninvasive method for predicting dyspermia. J Ultrasound Med. 2013;32(8):1427–32. https://doi.org/10.7863/ultra.32.8.1427. The authors suggest that a testicular vascular resistive index of > 0.6 is associated with impaired spermatogenesis. CrossRefPubMedGoogle Scholar
- 20.Sakamoto H, Yajima T, Nagata M, Okumura T, Suzuki K, Ogawa Y. Relationship between testicular size by ultrasonography and testicular function: measurement of testicular length, width, and depth in patients with infertility. Int J Urol. 2008;15(6):529–33. https://doi.org/10.1111/j.1442-2042.2008.02071.x.CrossRefPubMedGoogle Scholar
- 25.Sakamoto H, Ogawa Y, Yoshida H. Relationship between testicular volume and testicular function: comparison of the Prader orchidometric and ultrasonographic measurements in patients with infertility. Asian J Androl. 2008;10(2):319–24. https://doi.org/10.1111/j.1745-7262.2008.00340.x.CrossRefPubMedGoogle Scholar
- 28.•• Kurtz MP, Zurakowski D, Rosoklija I, Bauer SB, Borer JG, Johnson KL, et al. Semen parameters in adolescents with varicocele: association with testis volume differential and total testis volume. J Urol. 2015;193(5 Suppl):1843–7. https://doi.org/10.1016/j.juro.2014.10.111. Decreased testicular volume in adolescents with varicocele increases risk for lower sperm counts. CrossRefPubMedGoogle Scholar
- 31.Nowroozi MR, Ayati M, Amini E, Radkhah K, Jamshidian H, Delpazir A, et al. Assessment of testicular perfusion prior to sperm extraction predicts success rate and decreases the number of required biopsies in patients with non-obstructive azoospermia. Int Urol Nephrol. 2015;47(1):53–8. https://doi.org/10.1007/s11255-014-0856-1.CrossRefPubMedGoogle Scholar
- 32.Altinkilic B, Pilatz A, Diemer T, Wolf J, Bergmann M, Schonbrunn S, et al. Prospective evaluation of scrotal ultrasound and intratesticular perfusion by color-coded duplex sonography (CCDS) in TESE patients with azoospermia. World J Urol. 2018;36(1):125–33. https://doi.org/10.1007/s00345-017-2039-z.CrossRefPubMedGoogle Scholar
- 38.• Garolla A, Torino M, Miola P, Caretta N, Pizzol D, Menegazzo M, et al. Twenty-four-hour monitoring of scrotal temperature in obese men and men with a varicocele as a mirror of spermatogenic function. Hum Reprod. 2015;30(5):1006–13. https://doi.org/10.1093/humrep/dev057. Elevated scrotal temperature associated with varicocele negatively impacts sperm quality. CrossRefPubMedGoogle Scholar
- 42.•• Locke JA, Noparast M, Afshar K. Treatment of varicocele in children and adolescents: a systematic review and meta-analysis of randomized controlled trials. J Pediatr Urol. 2017;13(5):437–45. https://doi.org/10.1016/j.jpurol.2017.07.008. Compared to conservative treatment, there is improvement in semen parameters with varicocele repair. CrossRefPubMedGoogle Scholar
- 47.• Esteves SC, Roque M, Agarwal A. Outcome of assisted reproductive technology in men with treated and untreated varicocele: systematic review and meta-analysis. Asian J Androl. 2016;18(2):254–8. https://doi.org/10.4103/1008-682X.163269. Varicocele repair may improve outcomes of assisted reproductive techniques. CrossRefPubMedGoogle Scholar
- 51.•• Kim HJ, Seo JT, Kim KJ, Ahn H, Jeong JY, Kim JH, et al. Clinical significance of subclinical varicocelectomy in male infertility: systematic review and meta-analysis. Andrologia. 2016;48(6):654–61. https://doi.org/10.1111/and.12495. The authors revisit the significance of subclinical varicoceles and suggest that treatment of subclinical varicoceles may improve semen parameters and fertility. CrossRefPubMedGoogle Scholar
- 56.Jarow JP, Sigman M, Kolettis L, Lipshultz LI, McClure D, Nangia A. AUA Best practice statements: the optimal evaluation of the infertile male: Americal Urological Association 2011.Google Scholar
- 57.Pezzella A, Barbonetti A, D'Andrea S, Necozione S, Micillo A, Di Gregorio A, et al. Ultrasonographic caput epididymis diameter is reduced in non-obstructive azoospermia compared with normozoospermia but is not predictive for successful sperm retrieval after TESE. Hum Reprod. 2014;29(7):1368–74. https://doi.org/10.1093/humrep/deu092.CrossRefPubMedGoogle Scholar
- 58.Pezzella A, Barbonetti A, Micillo A, D'Andrea S, Necozione S, Gandini L, et al. Ultrasonographic determination of caput epididymis diameter is strongly predictive of obstruction in the genital tract in azoospermic men with normal serum FSH. Andrology. 2013;1(1):133–8. https://doi.org/10.1111/j.2047-2927.2012.00010.x.CrossRefPubMedGoogle Scholar
- 60.•• Hanson BM, Eisenberg ML, Hotaling JM. Male infertility: a biomarker of individual and familial cancer risk. Fertil Steril. 2018;109(1):6–19. https://doi.org/10.1016/j.fertnstert.2017.11.005. Infertility may be a biomarker for cancer and the detailed work-up of infertile males should be given significant consideration. CrossRefPubMedGoogle Scholar
- 61.Paduch DA. Testicular cancer and male infertility. Curr Opin Urol. 2006;16(6):419–27. https://doi.org/10.1097/01.mou.0000250282.37366.d2.CrossRefPubMedGoogle Scholar
- 64.World Health Organization. Infertility is a global public health issue. 2018. http://www.who.int/reproductivehealth/topics/infertility/perspective/en/. 2018.
- 67.Healthcare Bluebook. https://www.healthcarebluebook.com/page_Default.aspx. Accessed March 2018.