Imaging and angiography in male factor infertility

Capsule:
Ultrasound imaging and angiography techniques play a crucial role in the diagnosis and treatment of men with subfertility.

Authors:
Michael Jurewicz, M.D., Bruce R. Gilbert, M.D., Ph.D.

Volume 105, Issue 6, Pages 1432-1442

Abstract:

Ultrasound imaging and angiography play a crucial role in the diagnosis and treatment of men with subfertility. The most commonly used imaging modality is ultrasound (US), which can be used for diagnostic purposes or to aid in treatment. Scrotal US can be used to document varicoceles in subfertile men in the context of difficult examination or for confirmation before treatment. Spectral Doppler, sonoelastography, and power Doppler have aided in the evaluation and treatment of azoospermia and oligospermia. They have proven useful in the detection of spermatogenesis and sperm retrieval. In the population with congenital Wolffian duct abnormalities, renal US can evaluate renal anomalies. In subfertile men with low ejaculate volume and oligospermia or azoospermia transrectal US can be used to evaluate and assist in treatment of ejaculatory duct obstruction. Non-US–based modalities are also commonly used in evaluating and treating men with subfertility. Magnetic resonance imaging (MRI) can be used for evaluation of pituitary adenomas in hypogonadism. More invasive imaging modalities used during treatment of subfertile men include vasography for vasal obstruction, venography and angioembolization for varicocele, and US-guided needle placement for testis-sparing surgery. Male subfertility is a complex problem and the use of imaging techniques is often essential in providing accurate diagnosis and appropriate treatment.

  • msamplaski

    While US scrotum is the most common imaging modality that I use, an increasing number of men come in asking about the utility of MRI pelvis. This is particularly true for orchalgia patients who have had a normal US scrotum, but are still concerned that there may be some type of pathology that US has missed. In addition, patients do seem to have the perception that US is an inferior type of imaging, as compared with CT or MRI.

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