A couple complains of inability to concieve in spite of staying together for 4 years and having unprotected intercourse, all tests in wife are normal. Semen analysis shows a volume of 0.8ml, sperm count is 0, fructose is absent, what is the next best step ?
Absent fructose in Semen indicates either there is congenital absence of seminal vesicle or there is obstruction in the ejaculatory duct system. The Best way to detect obstruction is to perform a Transrectal ultrasound. Transrectal ultrasound (TRUS) in a Male,Shows: Seminal vesices,prostate and ejaculatory ducts obstruction. This should be done when there is (1) Azoospermia or severe oligospermia with a normal testicular volume, (2) Ejaculatory duct abnormality (cysts, dilatation or calcification), (3) Genital abnormality (Hypospadias).
Testicular FNAC
Ultrasound for obstruction
Local palpation of Vas
Karyotyping
Infeility (Eggs'plantation!)