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Ultrasound and infertility: Diagnostic and therapeutic uses

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Abstract

Ultrasound has become essential in the diagnosis and management of the infertile male. Scrotal ultrasonography provides a detailed examination of the testes and assesses the presence or absence of varicoceles and can identify other abnormalities of the scrotal contents and the spermatic cord. Transrectal ultrasonography can “visualize” the excurrent ejaculatory ductal system, including the ejaculatory ducts, seminal vesicles, and vas deferens. The expansion of these ultrasonographic techniques has provided the urologist with non-or minimally invasive techniques with which to evaluate the infertile male. These advancements consequently have led to innovative surgical and radiologic treatments.

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References and Recommended Reading

  1. Mosher WD, Pratt WF: Fecundity and infertility in the United States: incidence and trends [editorial]. Fertil Steril 1991, 56:192–193.

    PubMed  CAS  Google Scholar 

  2. Fisch H, Lipshultz LI: Diagnosing male factors of infertility. Arch Pathol Lab Med 1992, 116:398–405.

    PubMed  CAS  Google Scholar 

  3. MacLeod J: Human male infertility. Obstet Gynecol Surv 1971, 26:335–351.

    Article  PubMed  CAS  Google Scholar 

  4. Sigman M, Lipshultz LI, Howards SS: Evaluation of the subfer-tile male. In Infertility in the Male, edn. 2. Edited by Lipshultz LI, Howards SS. St. Louis: Mosby-Year Book; 1991:179.

    Google Scholar 

  5. Pierik FH, Dohle GR, van Muiswinkel JM, et al.: Is routine scrotal ultrasound advantageous in infertile men? J Urol 1999, 162:1618–1620. This study demonstrates that routine scrotal ultrasound not only provides valuable information in the diagnostic evaluation of infertile men, but it also reveals that infertile men have substantially more pathological conditions, which were more effectively detected by ultrasound as compared with clinical palpation. The high prevalence of testicular malignancies highlights the clinical relevance of routine scrotal ultrasonography in infertile men.

    Article  PubMed  CAS  Google Scholar 

  6. Siegel MS: The male fertility investigation and the role of the andrology laboratory. J Reprod Med 1993, 38(5):317–334.

    PubMed  CAS  Google Scholar 

  7. World Health Organization: Laboratory Manual for the Examina-tion of Human Semen and Sperm-Cervical Mucus Interaction. Cambridge, UK: Cambridge University Press; 1993:44.

    Google Scholar 

  8. MacLeod J, Wang Y: Male infertility potential in terms of semen quality: a review of the past, a study of the present. Fertil Steril 1979, 31:103–116.

    PubMed  CAS  Google Scholar 

  9. Sokol RZ, Sparkes R: Demonstrated paternity in spite of severe idiopathic oligospermia. Fertil Steril 1987, 47:356–358.

    PubMed  CAS  Google Scholar 

  10. Amelar RD, Dubin L, Schoenfeld C: Semen analysis. Urology 1973, 2:605–611.

    Article  PubMed  CAS  Google Scholar 

  11. Kruger TF, Acosta AA, Simmons KF, et al.: Predictive value of abnormal sperm morphology in in vitro fertilization. Fertil Steril 1988, 49:112–117.

    PubMed  CAS  Google Scholar 

  12. MacLeod J: The semen examination. Clin Obstet Gynecol 1965, 8:115.

    Article  Google Scholar 

  13. World Health Organization: WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male. Cambridge, UK: Cambridge University Press; 2000.

    Google Scholar 

  14. Raboch J, Skachova J: The pH of human ejaculate. Fertil Steril 1965, 16:252.

    PubMed  CAS  Google Scholar 

  15. Burns P: Ultrasound imaging and Doppler: principles and instrumentation. In Ultrasonography of the Urinary Tract, edn. 3. Edited by Resnick M, Rifkin MD. Baltimore: Williams & Wilkins; 1991:1–33.

    Google Scholar 

  16. Honig SC: New diagnostic techniques in the evaluation of anatomic abnormalities of the infertile male. Urol Clin North Am 1994, 21:417–432.

    PubMed  CAS  Google Scholar 

  17. Honig SC: Use of ultrasonography in the evaluation of the infertile man. World J Urol 1993, 102–110.

  18. Skyrme RJ, Fenn NJ, Jones AR, Bowsher WG: Testicular microlithiasis in a UK population: its incidence, associations and follow-up. BJU Int 2000, 86(4):482–485. This article reviews the incidence and associated risks of testicular microlithiasis. It found a strong significant association between testicular tumors and testicular microlithiasis.

    Article  PubMed  CAS  Google Scholar 

  19. Lenz S, Thomsen JK, Giwercman A, et al.: Ultrasonic texture and volume of testicles in infertile men. Hum Reprod 1994, 9:878–888. Ultrasonography was used to calculate testicular volume and texture. The mean ultrasonic volume of both the right and left testicle was found to be smaller in infertile men as compared with the findings of normal men. A positive correlation between sperm count and ultrasonic volume was seen. Ultrasonic texture also was evaluated. The texture of the testicle for infertile men had higher degrees of irregularity than are found in normal men.

    PubMed  CAS  Google Scholar 

  20. Paltiel JJ, Connolly LP, Atala A, et al.: Acute scrotal symptoms in boys with an indeterminate clinical presentation: comparison of color Doppler sonography and scintigraphy. J Urol 1998, 160(4):1597–1598. This article compared color Doppler ultrasound with scintigraphy in the evaluation of the acute scrotum. There was no statistical difference between the ability of the two modalities to demonstrate testicular torsion in boys with acute scrotal symptoms.

    Article  Google Scholar 

  21. McClure D, Khoo D, Jarvi K, et al.: Subclinical varicocele: the effectiveness of varicocelectomy. J Urol 1991, 145:789–791.

    PubMed  CAS  Google Scholar 

  22. Geatti O, Gasparini D, Shapiro B: A comparison of scintigra-phy, thermography, ultrasound and phlebography in grading of clinical varicocele. J Nucl Med 1991, 32:2092–2097.

    PubMed  CAS  Google Scholar 

  23. World Health Organization: Comparison among different methods for the diagnosis of varicoceles. Fertil Steril 1985, 43:575–582.

    Google Scholar 

  24. Petros JA, Andriole GI, Middleton WD, et al.: Correlation of testicular color Doppler ultrasonography and venography in the detection of left varicoceles in men with infertility. J Urol 1991, 145:785–788.

    PubMed  CAS  Google Scholar 

  25. Clements R, Griffiths GJ, Peeling WB, Conn IG: Transrectal ultrasound of the ejaculatory apparatus. Clin Radiol 1991, 44:240–244.

    Article  PubMed  CAS  Google Scholar 

  26. Wessels EC, Ohori M, Grantmyre JE, et al.: The prevalence of the ejaculatory ducts detected by transrectal ultrasound (TRUS) in a self referred (screening) group of men [abstract 973]. J Urol 1992, 147(pt 2):456A.

    Google Scholar 

  27. Weintraub MP, De Mouy E, Helistrom WJG: Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction. J Urol 1993, 150:1150–1154.

    PubMed  CAS  Google Scholar 

  28. Sharlip ID: Obstructive azoospermia or oligospermia due to mullerian duct cyst. Fertil Steril 1984, 41:298–303.

    PubMed  CAS  Google Scholar 

  29. Carson CC: Transurethral resection for ejaculatory duct stenosis and oligospermia. Fertil Steril 1984, 41:482–484.

    PubMed  CAS  Google Scholar 

  30. Pryor JP, Hendy WF: Ejaculatory duct obstruction in subfertile males: analysis of 87 patients. Fertil Steril 1991, 56:725–730.

    PubMed  CAS  Google Scholar 

  31. Carter SS, Shinohara K, Lipshultz LI: Transrectal untrasonogra-phy in disorders of the seminal vesicles and ejaculatory ducts. Urol Clin North Am 1989, 16:773–790.

    PubMed  CAS  Google Scholar 

  32. Silber SJ: Ejaculatory duct obstruction. J Urol 1980, 124:294–297.

    PubMed  CAS  Google Scholar 

  33. Patterson L, Jarow JP: Transrectal ultrasound in the evaluation of the infertile man. J Urol 1990, 144:1469–1471.

    PubMed  CAS  Google Scholar 

  34. Jarow JP: Seminal vesicle aspiration in the management of patients with ejaculatory duct obstruction. J Urol 1994, 152:899–901.

    PubMed  CAS  Google Scholar 

  35. Katz D, Mieza M, Nagler HM: Ultrasound guided transrectal seminal vesiculography: a new approach to the diagnosis of male reproductive tract abnormalities [abstract 330]. J Urol 1994, 151:310A.

    Google Scholar 

  36. Shabsigh R, Lerner S, Fishman IJ: The role of transrectal ultrasonography in the diagnosis and management of pros-tatic and seminal vesicle cysts. J Urol 1989, 141:1206–1209.

    PubMed  CAS  Google Scholar 

  37. Ohl DA, Menge AC, Jarow JP: Unilateral obstruction of the vas deferens diagnosed by seminal vesicle aspiration. J Urol 1999, 162:2048–2051.

    Article  PubMed  CAS  Google Scholar 

  38. Kuligowska E, Fenlon HM: Transrectal US in male infertility: spectrum of finding and role in patient care. Radiology 1998, 207:173–181. This article assesses the range and utility of using new higher performance equipment for transrectal ultrasonography with innovative surgical and radiologic treatments for male infertility. The study particularly emphasized the role of the vas deferens in the pathogenesis of other distal ductal anomalies. Patients with ejaculatory duct obstruction were identified and treated with transurethal resection of the ejaculatory ducts, and the majority of these patients on follow-up seminal analysis demonstrated normal ejaculate volumes and normal spermatozoal counts. Patients with cysts of the vas deferens or seminal vesicles were offered treatment with transrectal ultrasound-guided cyst aspiration. Patients with noncorrectable defects were referred for microscopic epididymal sperm aspiration and in vitro fertilization.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Beth Israel Medical Center, 10 Union Square East, 10003, New York, NY, USA

    Michael Zahalsky MD & Harris M. Nagler MD

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  1. Michael Zahalsky MD
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  2. Harris M. Nagler MD
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Zahalsky, M., Nagler, H.M. Ultrasound and infertility: Diagnostic and therapeutic uses. Curr Urol Rep 2, 437–442 (2001). https://doi.org/10.1007/s11934-001-0036-6

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  • DOI: https://doi.org/10.1007/s11934-001-0036-6

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