Imaging the Infertile Male-2: Obstructive Syndromes and Other Disorders

  • Min Hoan Moon
  • Seung Hyup Kim
Part of the Medical Radiology book series (MEDRAD)


The evaluation of infertile men begins with a detailed clinical history and physical examination and then proceeds to laboratory test including semen analysis, hormonal assays, sperm function test, and genetic test. Imaging studies can be used selectively as part of the comprehensive evaluation of male infertility. In this chapter, we review the spectrum of diseases responsible for male infertility, discuss appropriate imaging modalities to be proven for specific clinical settings, and illustrate characteristic imaging findings that permit specific diagnosis. We also discuss how imaging studies may be used to distinguish defects of sperm production from obstruction of sperm passage. The discussion is divided into three main categories: obstruction in sperm passage, impairment in sperm function, and defect in sperm genesis.


Congenital Adrenal Hyperplasia Male Infertility Transrectal Ultrasound Primary Ciliary Dyskinesia Ejaculatory Duct 
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  1. Afzelius BA (1976) A human syndrome caused by immotile cilia. Science 193:317–319PubMedCrossRefGoogle Scholar
  2. Afzelius BA (1979) The immotile-cilia syndrome and other ciliary diseases. Int Rev Exp Pathol 19:1–43PubMedGoogle Scholar
  3. Bartynski WS, Lin L (1997) Dynamic and conventional spin-echo MR of pituitary microlesions. AJNR Am J Neuroradiol 18:965–972PubMedGoogle Scholar
  4. Bhansali A, Banerjee PK, Dash S et al (1992) Pituitary and testicular involvement in primary haemochromatosis. A case report. J Assoc Physicians India 40:757–759PubMedGoogle Scholar
  5. Bick D, Franco B, Sherins RJ et al (1992) Brief report: intragenic deletion of the KALIG-1 gene in Kallmann’s syndrome. N Engl J Med 326:1752–1755PubMedCrossRefGoogle Scholar
  6. Breeland E, Cohen MS, Warner RS et al (1981) Epididymal obstruction in azoospermic males. Infertility 4:49–66PubMedGoogle Scholar
  7. Brugh VM 3rd, Lipshultz LI (2004) Male factor infertility: evaluation and management. Med Clin North Am 88:367–385PubMedCrossRefGoogle Scholar
  8. Brugh VM 3rd, Matschke HM, Lipshultz LI (2003) Male factor infertility. Endocrinol Metab Clin North Am 32:689–707PubMedCrossRefGoogle Scholar
  9. CA BryanPJ, Morrison SC et al (1988) US findings in adrenogenital syndrome. J US Med 7:675–679Google Scholar
  10. Colpi GM, Negri L, Nappi RE et al (1997) Is transrectal ultrasonography a reliable diagnostic approach in ejaculatory duct sub-obstruction? Hum Reprod 12:2186–2191PubMedCrossRefGoogle Scholar
  11. Coulam CB, Graham ML 2nd, Spelsberg TC (1984) Androgen insensitivity syndrome: gonadal androgen receptor activity. Am J Obstet Gynecol 150:531–533PubMedGoogle Scholar
  12. Daudin M, Bieth E, Bujan L et al (2000) Congenital bilateral absence of the vas deferens: clinical characteristics, biological parameters, cystic fibrosis transmembrane conductance regulator gene mutations, and implications for genetic counseling. Fertil Steril 74:1164–1174PubMedCrossRefGoogle Scholar
  13. Gale ME (1983) Hermaphroditism demonstrated by computed tomography. AJR Am J Roentgenol 141:99–100PubMedGoogle Scholar
  14. Gambino J, Caldwell B, Dietrich R et al (1992) Congenital disorders of sexual differentiation: MR findings. AJR Am J Roentgenol 158:363–367PubMedGoogle Scholar
  15. Johnson PT, Horton KM, Fishman EK (2009) Adrenal imaging with MDCT: nonneoplastic disease. AJR Am J Roentgenol 193:1128–1135PubMedCrossRefGoogle Scholar
  16. Kartagener M, Stucki P (1962) Bronchiectasis with situs inversus. Arch Pediatr 79:193–207PubMedGoogle Scholar
  17. Kennedy MP, Noone PG, Leigh MW et al (2007) High-resolution CT of patients with primary ciliary dyskinesia. AJR Am J Roentgenol 188:1232–1238PubMedCrossRefGoogle Scholar
  18. Kim SH, Pollack HM, Cho KS et al (1993) Tuberculous epididymitis and epididymo-orchitis: sonographic findings. J Urol 150:81–84PubMedGoogle Scholar
  19. Lambert B (1951) The frequency of mumps and of mumps orchitis and the consequences for sexuality and fertility. Acta Genet Stat Med 2:1–166PubMedGoogle Scholar
  20. Macleod J (1951) Semen quality in 1000 men of known fertility and in 800 cases of infertile marriage. Fertil Steril 2:115–139PubMedGoogle Scholar
  21. Moon MH, Kim SH, Cho JY et al (2006) Scrotal US for evaluation of infertile men with azoospermia. Radiology 239:168–173PubMedCrossRefGoogle Scholar
  22. Nghiem HT, Kellman GM, Sandberg SA et al (1990) Cystic lesions of the prostate. Radiographics 10:635–650PubMedGoogle Scholar
  23. Noone PG, Leigh MW, Sannuti A et al (2004) Primary ciliary dyskinesia: diagnostic and phenotypic features. Am J Respir Crit Care Med 169:459–467PubMedCrossRefGoogle Scholar
  24. Purohit RS, Wu DS, Shinohara K et al (2004) A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. J Urol 171:232–235 discussion 235–236PubMedCrossRefGoogle Scholar
  25. Quinzii C, Castellani C (2000) The cystic fibrosis transmembrane regulator gene and male infertility. J Endocrinol Invest 23:684–689PubMedGoogle Scholar
  26. Rutgers JL, Scully RE (1991) The androgen insensitivity syndrome (testicular feminization): a clinicopathologic study of 43 cases. Int J Gynecol Pathol 10:126–144PubMedCrossRefGoogle Scholar
  27. Siminoski K, D’Costa M, Walfish PG (1990) Hypogonadotropic hypogonadism in idiopathic hemochromatosis: evidence for combined hypothalamic and pituitary involvement. J Endocrinol Invest 13:849–853PubMedGoogle Scholar
  28. Sivit CJ, Hung W, Taylor GA et al (1991) Sonography in neonatal congenital adrenal hyperplasia. AJR Am J Roentgenol 156:141–143PubMedGoogle Scholar
  29. Sparacia G, Banco A, Midiri M et al (1998) MR imaging technique for the diagnosis of pituitary iron overload in patients with transfusion-dependent beta-thalassemia major. AJNR Am J Neuroradiol 19:1905–1907PubMedGoogle Scholar
  30. Takihara H, Sakatoku J, Cockett AT (1991) The pathophysiology of varicocele in male infertility. Fertil Steril 55:861–868PubMedGoogle Scholar
  31. Tizzano EF, Silver MM, Chitayat D et al (1994) Differential cellular expression of cystic fibrosis transmembrane regulator in human reproductive tissues. Clues for the infertility in patients with cystic fibrosis. Am J Pathol 144:906–914PubMedGoogle Scholar
  32. Yousem DM, Geckle RJ, Bilker W et al (1996) MR evaluation of patients with congenital hyposmia or anosmia. AJR Am J Roentgenol 166:439–443PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of Radiology, Seoul Metropolitan Boramae Medical CenterSeoul National University, College of MedicineSeoulKorea
  2. 2.Department of RadiologySeoul National University HospitalSeoulKorea

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