Central role of ultrasound in the evaluation of testicular function and genital tract obstruction in infertile males

Andrea Garolla; Giuseppe Grande; Pierfrancesco Palego; Andrea Canossa; Nicola Caretta; Andrea Di Nisio; Giovanni Corona; Carlo Foresta

doi:10.1111/andr.13060

Male Fertility · Male Factor Causes

Central role of ultrasound in the evaluation of testicular function and genital tract obstruction in infertile males

Garolla A, Grande G, Palego P, Canossa A, Caretta N, Di Nisio A, Corona G, Foresta C

Published September 2021 Andrology

DOI 10.1111/andr.13060 PMID 34085393 PMC PMC8596694

RRM Academy Synopsis

Infertile men with low sperm counts show more ultrasound abnormalities

Ultrasound problems were more common in 238 men with low or absent sperm counts than in 63 fertile men, in a retrospective study. Scans through the rectum found problems in about 7 out of 10 men with normal follicle-stimulating hormone and about 4 out of 10 with high levels.

Key Findings

Transrectal abnormalities: 69.9% with normal follicle-stimulating hormone versus 38.4% with high levels. Scrotal abnormalities: 60.0% with high levels versus 28.3% with normal levels (both p < 0.01).
Varicocele appeared in 18.6% of men with normal hormone levels and 28.0% of men with high levels, against 7.9% of controls (both p < 0.05).
Smaller bitesticular volume tracked with more abnormal semen parameters (r = –0.248, p < 0.001). A volume below the study's cutoff was associated with higher azoospermia risk (odds ratio = 1.799 [1.255–2.579]).
The area under the curve for counting testicular blood-vessel spots was 0.619 (CI: 0.553–0.684) for sperm count and 0.808 (CI: 0.757–0.859) for follicle-stimulating hormone.

Interpretation

The study analyzed records from one university hospital, with one experienced sonographer performing every scan. The findings are correlations. The outcomes analyzed were semen, hormone, and ultrasound measures. Men with infections, hormonal disorders, or genetic causes were excluded, and controls were fertile men. The authors call the blood-vessel spot count a new measure that is still not standardized. The authors calculated the cutoffs from their own patient group. The authors argue that guidelines should add routine scrotal ultrasound for men with low sperm counts.

RRM Context

Restorative reproductive medicine evaluates both partners. A blocked duct or a structural problem in the man is a diagnosable cause. Infertility with a treatable male cause stays undiagnosed until someone looks. The authors note that major professional societies and the European Academy of Andrology disagree on when scrotal ultrasound belongs in the workup.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Scrotal color Doppler ultrasonography and transrectal ultrasonography provide crucial information about the clinical status of testes and male accessory glands.

Objective

To analyze the impact of ultrasound in the evaluation of infertile males.

Materials and Methods

A total of 1120 records from infertile men were retrospectively evaluated (from January 2016 up to June 2020). Data on physical examination, semen analysis, sperm culture, scrotal color Doppler ultrasonography and transrectal ultrasonography, as well as sex hormones were analyzed. Among them, 238 reports from oligozoospermic/azoospermic infertile patients (P) fulfilling the inclusion criteria were considered for data analysis. Patients were subdivided into two groups according to follicle-stimulating hormone (FSH) values (Pa with FSH < 8 U/L and Pb with FSH ≥ 8 U/L). Sixty-three fertile volunteers (mean ± SD years) were enrolled as controls (C).

Results

A higher prevalence of ultrasound abnormalities was recorded in P compared to C. Pb group had significantly lower bitesticular volume compared to Pa and C. Pa had a higher prevalence of transrectal ultrasonography abnormalities than Pb (69.9% vs. 38.4%), whereas Pb had a higher prevalence of abnormalities at scrotal color Doppler ultrasonography (60.0% vs. 28.3%, both p < 0.01). Bitesticular volume was inversely proportional to the number of altered seminal parameters and able to predict gonadotropin levels. A bitesticular volume <17 cc was associated with a higher risk of azoospermia (odds ratio = 1.799). Intratesticular vascularization was inversely correlated with gonadotropin levels and directly correlated with sperm count. A higher prevalence of prostate and seminal vesicle alterations was detected in patients and in Pa group, when compared with Pb group.

Discussion and Conclusions

Ultrasound abnormalities are correlated with seminal parameters and may guide the clinician in the diagnostic workflow of male infertility, suggesting spermatogenesis impairment or genital tract obstructions.

Topics

Male Fertility › Male Factor Causes › Azoospermia · Diagnostics › Ultrasound › Transvaginal Ultrasound

Andrea Garolla, Giuseppe Grande, Pierfrancesco Palego, Andrea Canossa, Nicola Caretta, Andrea Di Nisio, Giovanni Corona, Carlo Foresta

A Garolla, G Grande, P Palego, A Canossa, N Caretta, A Nisio, G Corona, C Foresta

PMID 34085393 34085393 DOI 10.1111/andr.13060 10.1111/andr.13060 Garolla et al. 2021, Garolla 2021

Central role of ultrasound in the evaluation of testicular function and genital tract obstruction in infertile males

Infertile men with low sperm counts show more ultrasound abnormalities

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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