Role of USG, Doopler, Colour Doppler, X ray in aiding diagnosis of causes of 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