Patients with fertility problems may be referred for scrotal ultrasonography (US) to evaluate testicular size, to assess testicular parenchyma, to examine epididymal integrity, and to ascertain the presence of varicocele. The scrotal ultrasound scan is carried out with the patient in the supine position, exposing the scrotum with the thighs and the abdomen covered. The testis, epididymal head, epididymal body, and epididymal tail are examined sequentially. Pulsed Doppler is also utilized to detect a subclinical varicocele by demonstrating the presence as well as the duration of reverse venous flow in the testicular veins. The use of ultrasound-guided testicular sperm aspiration in azoospermic patients has been described. A 21-gauge butterfly needle is directed into the testicular regions to be sampled under real-time gray-scale and power Doppler sonographic guidance, avoiding the echogenic mediastinum testis and the vascular plexus of the tunica albuginea, as well as the prominent testicular parenchymal vessels.

This chapter summarizes various imaging modalities in the workup of male infertility with emphasis on indications and outcome interpretation. The conditions outlined in this chapter are commonly identified causes for oligospermia and azoospermia, and are the usual targets for imaging investigations. Color Doppler ultrasound (CDUS) has become the most frequently used imaging modality for varicocele detection. Ultrasound studies of spermatic veins have suggested that the presence of multiple large veins. In CBAVD the diagnosis is established clinically by the absence of the two vasa deferentia on palpation. Intratesticular cysts include cysts of the tunica albuginea, tubular ectasia of the rete testis, and testicular cysts. Testicular microlithiasis (TM) is characterized by the presence of numerous punctate calcifications within the testis. Transrectal ultrasound (TRUS)-guided echo-enhanced seminal vesiculography in combination with transurethral resection of the ejaculatory duct (TURED) is considered the best imaging method when treating ejaculatory duct obstruction (EDO).