Male Infertility Imaging 1-The Upper Tract 2-The Lower Tract
Workshop Imaging in infertility 4 th annual Congress of the Mediterranean Society for Reproductive Medicine, Cannes, 21-23 avril 2005 -
There is a male factor involved in up to half of all infertile couples. Potential etiologies are many and require a thorough evaluation with a complete medical history and laboratory studies. In selected cases, the modern imaging methods have improved our ability to clearly define diagnoses.
Ultrasonography with color-Doppler imaging has supplanted other imaging modalities in the primary evaluation of scrotal disorders and lower reproductive tract abnormalities.
For the last 20 years we routinely perform a US examination of the kidneys, the scrotum contents and tranrectal US (TRUS) in every case a excretory cause of male hypofertility could be suspected. It can sometimes lead to other studies like MR imaging or other imaging methods.
The workshop will describe the practical and daily approach of the examination and will depict the normal and abnormal anatomy of the testicle, epididymis, vas deferens, seminal vesicle (SV), ejaculatory ducts, and prostate in male infertility with US and MRI.
The upper tract
The scrotal examination can show testicular atrophy which is often associated with secretory hypo- or azoospermia. The causes of atrophy are varied and include cryptorchidism, post-infectious processes, varicocele or post-surgical sequellae. Incidentally microlithiasis and tumors can be found.
In excretory hypo- or azoospermia, the examination of the excretory system will look for dilation of the rete testis, the efferent tubules, or the epididymis which are suggestive of a downstream obstacle. US will also show post-inflammatory changes or congenital abnormalities like the absence of the distal part of the epididymis in absence of the vas deferens. Scrotal US permits also to guide semen aspiration
The lower tract
TRUS permits to confirm the bilateral or unilateral absence of the vas deferens and the associated lesions of the SV. It can show the wolffian abnormalities of the lower reproductive tract, the enlarged SV in polycystic kidney diseases, or the obstructive cysts of the prostatic base. The management of these cysts include fluid aspiration with TRUS guidance. TRUS can also assess the dilation of the ejaculatory ducts, with lithiasis or post-infectious prostatic changes. Endorectal MRI as well as other urinary tract explorations can be usefull in selected cases.
US is presently routine part of the investigation of infertile men when excretory hypo- or azoospermia is suspected or when physical and standard laboratory examinations do not explain the hypofertility.