Guidelines For Clinical Practice
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World J Radiol. May 28, 2010; 2(5): 172-179
Published online May 28, 2010. doi: 10.4329/wjr.v2.i5.172
Imaging in male-factor obstructive infertility
Ragab H Donkol
Ragab H Donkol, Department of Radiology, Aseer Central Hospital, PO Box 34, 31911, Abha, Saudi Arabia; Department of Radiology, Faculty of Medicine, Cairo University, Kasr Al-Ainy, 1 Al-Saray Street, Al-Manial, 11559, Cairo, Egypt
Author contributions: Donkol RH contributed to design of manuscript, as well as review of articles, collection of data and manuscript writing.
Correspondence to: Ragab H Donkol, Professor, Department of Radiology, Aseer Central Hospital, PO Box 34, 31911, Abha, Saudi Arabia.
Telephone: +966-7-2201169 Fax: +966-7-2248092
Received: March 19, 2010
Revised: April 24, 2010
Accepted: May 1, 2010
Published online: May 28, 2010

The main purpose of imaging evaluation in male infertility is to identify and treat correctable causes of infertility, such as obstruction of the seminal tract. Various imaging modalities are available to evaluate men with obstructive infertility including scrotal ultrasonography, transrectal ultrasound (TRUS), vasography, magnetic resonance imaging, seminal vesicle aspiration, seminal tract washout, and seminal vesiculography. To date the most reliable and accurate diagnostic technique for obstructive infertility is unclear. In this review article, we report the role of these modalities in diagnosis of obstructive infertility. Scrotal sonography is the initial modality, and if patient results indicate non obstructive azoospermia as varicocele or testicular pathology they will be treated according to standard protocols for management of these pathologies. If the patient findings indicate proximal obstructive azoospermia, they can be managed by vasoepididymostomy. If the scrotal ultrasound is normal, TRUS is the second imaging modality. Accordingly, they are classified into patients with criteria of obstructive infertility without urogenital cysts where TRUS-guided aspiration and seminal vesiculography can be performed and transurethral resection of the ejaculatory ducts (TURED) will be the management of choice. In patients with urogenital cyst, TRUS-guided cyst aspiration and opacification are performed. If the cyst is communicating with the seminal tract, management will be transurethral incision of the cyst. If the cyst is not in communication, the obstruction may be relieved after cyst aspiration. If the obstruction is not relieved, TURED will be the management of choice. Sperm harvested during aspiration may be stored and used in assisted reproduction techniques. If the results of TRUS are inconclusive or doubtful, endorectal magnetic resonance imaging should be performed to serve as a “detailed map” for guiding corrective operative interventions.

Keywords: Male fertility, Obstructive infertility, Transrectal ultrasonography, Seminal vesiculography, Endorectal magnetic resonance imaging