In a couple for treatment of infeility from the last four years, female paner is normal. Male paner has 0.8 ml semen volume per ejaculate on two repeated samples and absent fructose, with no sperms on examination under microscope. What is the next line of management?
(A) Per-rectal examination to check ejaculatory duct obstruction (B) Give antioxidants (C) Testicular biopsy (D) Transrectal ultrasound to detect duct obstruction
(D) Answer- D. Transrectal ultrasound to detect duct obstructionAbsent fructose with no sperms in ejaculate is suggestive of obstruction of vas deferens with seminal vesicle agenesis or obstruction. Next line of management in this patient would be transrectal ultrasound to detect duct obstruction.Transrectal Ultrasound-High-frequency (5-7) mHz transrectal ultrasound (TRUS) offers superb imaging of the prostate, seminal vesicles, and ejaculatory ducts.Due to both accuracy and convenience, TRUS has replaced surgical vasography in the diagnosis of obstructive lesions that cause infeility.