Testicular doppler in male infertility

Abstract

Varicocele is a common cause of infertility in men that affects 15% of the population and 21-40% of men with fertility disorders. It involves the left testicle in 75-90%, the right testicle in 15-20% and bilaterally in up to 10%. In a study of 1372 infertile men, the findings were varicocele in 29.7%, testicular tumor in 0.5%, testicular cyst in 0.7%, testicular microlithiasis in 0.9%, epididymal cyst in 7.6% and hydrocele in 3.2%. 60% of the varicoceles, as well as 67% of the findings detected in the ultrasound were not suspected in the physical examination. Ultrasound with the use of Color Doppler, is the method of choice for the assessment of patients with infertility, since it has a sensitivity of 97% and specificity of 94% compared with phlebography. Sonography allows adequate evaluation of testicular size and volume, characteristics of the parenchyma, as well as detection the presence of dilated veins, their diameter and location. It is precisely with these findings and presence of venous reflux that we can estimate the degree of severity of the varicocele. There are several classifications that take into consideration whether the reflux is with the Valsalva maneuver or is spontaneous (more severe). One of the simplest classifications that are used with Color Doppler is: Grade 0, mild reflux during Valsalva (physiological), Grade 1, reflux that ends before finishing Valsalva, Grade 2, persistent reflux throughout Valsalva and Grade 3, reflux basal, persistent and no change with Valsalva. The diameter of the veins is increased > 2 mm. The classifications relating the diameter and the reflux time with the Valsalva maneuver have also been validated, as well as the location of the dilatations: at the level of the spermatic cord, superior pole of the testicle, middle third or to the lower testicular pole, as per example the Classification of Sarteschi. In many cases of severe varicocele, a decrease in testicular size and volume is associated. The normal volume is 15 +/- 7 cc. The use of linear transducers with frequency >/= 10 MHz is recommended, setting the system for low flow detection by decreasing PRF and increasing gain.