Male infertility: role of imaging in the diagnosis and management

The role of imaging is to identify a potentially correctable cause of infertility. Imaging facilitates selection of the best method for impregnating the female partner, such as sperm aspiration from the epididymis or seminiferous tubules followed by in vitro fertilization or intracytoplasmic sperm injection. Transrectal and scrotal ultrasound are the imaging modalities of choice in the radiological assessment of male infertility. MRI of the prostate and stimulated colour Doppler of the penis can have a role in particular cases. Infertility is a common problem, with male infertility detectable in approximately 50% of involuntarily childless couples. Transrectal and scrotal ultrasound are the imaging techniques of choice, allowing detailed examination of the male reproductive system. No cause for subfertility is detected (idiopathic infertility) in the majority of patients. When a cause is detected, azoospermia is often seen and may be non-obstructive or obstructive. Varicoceles are associated with infertility but the significance of this relationship is uncertain; surgical or radiological repair of varicoceles is not recognized as appropriate treatment for infertility. Ultrasound is more sensitive than clinical examination in the detection of varicoceles. Functional or vasogenic erectile dysfunction can impair conception in couples. Ultrasound with intracavernosal prostaglandin administration allows assessment of the causation of erectile dysfunction and may distinguish between arterial and venous problems. Detection of the cause of infertility is important to allow planning of the most appropriate techniques for achieving conception.