A couple complains of primary infertility in spite of staying together for 4 year and having unprotected intercourse, all tests in wife are normal. Semen analysis shows a volume of 0.8 mL/sperm count is 0, fructose is absent what is done next?
Ans. is b, i.e. Ultrasound for obstructionRef: Reproductive medicine secrets by Peter Chan 1st/ed, p33Absent fructose in semen means block is below the level of seminal vesicles which is not allowing sperms from testis and seminal fluid with fructose from seminal vesicle to be present in the semen. This means there is an obstructive pathology. The best way to detect obstruction is to perform a Transrectal Ultrasound.Also Know* Role of Transrectal ultrasound in male infertility: Transrectal ultrasound (TRUS): is done to visualize the seminal vesicles, prostate and ejaculatory ducts obstruction. Indications of TRUS are: (i) Azoospermia or severe oligospermia with a normal testicular volume, (ii) Abnormal digital rectal examination, (iii) Ejaculatory duct abnormality (cysts, dilatation or calcification), (iv) Genital abnormality (hypospadias).
Testicular FNAC
Ultrasound for obstruction
Local palpation of vas
Karyotyping
Endometriosis and Infertility