ROLE OF SONOGRAPHY IMAGING IN MALE INFERTILITY

Abstract

Introduction: Infertility is known as major problem as life crisis for many couples. Investigation of male infertility is assuming greater importance with male factors implicated as it caused half of the infertile couples. Infertility is defined as infertility is a disease of reproductive system defined by failure to achieve the clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. It is also define as failure of couple to conceive after 12 months of regular intercourse without the use of contraception in women <35 years; and regular intercourse after 6 months without the use of contraception in women ≥ years. A recent report on the status of infertility in India, states that nearly 50% of infertility is related to the reproductive anomalies or disorders in the male. Male infertility include as pretesticular, testicular and post testicular causes. Common causes may be due to deficiencies in the semen and semen quality is used as a surrogate measure of male fecundity. Testicular causes are mainly cryptorchidism, varicocele exposure to gonadotoxins and post testicular causes which included disorders and obstruction of ejaculation and erectile dysfunction. There are many studies which found that sperm count of less than 10 million per milliliter is also suboptimal for fertility; however there is no cut off value of sperm count that is diagnostic of infertility. The common investigations done in evaluating fertility is Ultrasound examinations of scrotum and semen analysis. Ultrasound is a very useful modality for assessing the testicular size which is also related to condition like epididymo-orchitis, varicocele and undescended testis.
 Aim: The main aim of this study is to deteremine the used of ultra sonography in the evaluation of male infertility and to compared with clinical and surgical findings.
 Material and Methods: All the patients were referred to the Department of Radiology for transrectal and scrotal ultrasonography with high frequency transducer having a frequency of 7.5 MHz and Color Doppler wherever indicated. In this study all male patients with infertility and abnormal semen analysis and with the case of infertility with coincident scrotal findings on clinical examination were included. Transrectal ultrasound was done by positioned in left lateral decubitus position. On each side testis and epididymis was identified as completely as possible and compared for symmetry, size, texture and vascularity.
 Result: In this study patients with abnormality were found in highest number on clinical palpation and ultrasound was varicocele. In 18 cases Varicocele was detected on clinical examination and 24 cases in ultrasound. In 9 cases Hydrocele was detected in clinical examination and Ultrasound. In 5 cases epididymal cysts were detected in clinical findings and 6 cases were found in Ultrasound Findings whereas 2 cases of epididymitis was found in ultrasound and only 1 case in clinical examination. Therefore the total number of abnormalities was found by ultrasound which was significantly greater as compared to physical examination. The p-value was 0.001 which shows statistically significant.
 Conclusion: Transrectal ultrasound enables high resolution imaging of prostate, seminal vesicles and distal vas deferens and is implicated in diagnosing the cause of obstructive azoospermia. Therefore Imaging plays an important complementary role to clinical examination and laboratory analyses for the detection of precise anatomy and level of abnormality. Hence transrectal and scrotal ultrasound provides valuable information in the diagnostic evaluation of infertile men and pathological conditions can be detected on ultrasound compared to clinical palpation.
 Keywords: Infertility, Sonography, Transrectal, Testicular