Scrotal Ultrasonography in the Assessment of Subfertile Males

Subfertility is defined as a failure to conceive after one year of unprotected regular sexual intercourse. A prospective study was conducted to identity the role of ultrasonography in assessing the cause of male subfertility in a Sri Lankan population. The objective of the study was to identify the role of ultrasonography in assessing the cause of male subfertility in a Sri Lankan population. The sample consists of 86 patients referred for scrotal ultrasonography for the assessment of male subfertility. Ultrasound scan of the scrotum was done for the assessment of the testicular volume, testicular pathologies and extra testicular pathologies. The patients who were azoospermic or had seminal fluid volume less than 2.5ml were subjected to Trans Rectal Ultrasound Scan (TRUS) to exclude any obstruction to the seminal fluid pathway. As the results mean duration of subfertility was 4.47 (SD=2.63). 91.9% of the study population had primary subfertility while 8.1% had secondary subfertility. Testicular volume was calculated using three measurements and the formula of an ellipsoid. The mean ultrasonic testicular volume of the right testis was 7.66 cm (SD=4.24), and that of the left was 7.43 cm (SD=4.50). 44.2% of patients had some abnormality detected by ultrasound scan while 55.8% had normal ultrasonography. 26.8 % (n = 23) of the sample had varicocele and of which 73.91 % (n = 17) was on left side only, 17.39 % (n = 4) had only right sided varicocele and 8.69 % (n = 2) had bilateral disease. 4.7% of patients had epididymal cysts and 4.7% had testicular microlithiasis. When considering the echo pattern of the testis 77.9 % (n = 67) had normal echo pattern but 16.3% (n = 14) had heterogeneous echo pattern. As a conclusion the commonest abnormality detected in sub fertile men was a left sided varicocele. However there was a significant difference in the mean testicular size of Sri Lankan sub fertile men.