Sonography in Male Infertility: A Reliable Diagnostic Tool

Introduction

Infertility is the inability to achieve pregnancy after regular unprotected sexual intercourse for over a year. The incidence of infertility is rising drastically. Several studies indicate a rise in individuals seeking assisted reproduction to overcome their infertility issues. Infertility can be associated with both men and women. Various factors, such as advanced age, lifestyle choices, stress, poor nutrition, and anatomic or structural abnormalities, contribute to infertility. Infertility can be classified as primary or secondary. Primary infertility is when the individual cannot conceive, whereas secondary infertility is the inability to conceive after a previous conception. However, with advanced diagnostic aids and sophisticated treatments, infertility can be successfully treated.

Why Is Tackling Infertility Important?

Infertility is a stressful and depressing situation for most individuals. It is one of the major causes responsible for emotional and physical distress. It can also cause increased social negativity among women. Studies have reported increased anxiety, depression, and anger in infertile couples. Infertility is also one of the prime reasons for divorce among couples. Hence tackling infertility is essential to negate the psychological and physical stress, thereby offering better health and improved quality of life.

What Are the Causes of Infertility?

To achieve pregnancy, the ovary must release an egg, the sperm must fertilize the egg, and the fertilized egg must travel through the fallopian tubes to the uterus, where it should be implanted to the uterine wall. Pregnancy is a multistep process that involves several anatomical and environmental factors. Infertility may occur due to problems associated with the male or female reproductive system or a combination of both. In addition, certain risk factors are involved with infertility. They are described below:

• Age: With advancing age, in both females and males, conception could be an issue due to inferior quality and the number of eggs and sperm.

• Smoking: Smoking is one of the primary causes of infertility and also is a hindrance to fertility treatments. In men, it can cause erectile dysfunction resulting in reduced chances of conception.

• Alcohol: Alcohol contributes to infertility by reducing egg count and decreasing sperm motility.

• Weight Issues: Being overweight or underweight indicates a lifestyle issue contributing to an increased risk of infertility.

• Stress: Work-related stress has also been found to contribute partly to infertility as it affects the quality of sperm and egg.

What Is Male Infertility?

Male infertility refers to a condition where conception is not possible due to problems associated with the male reproductive system. Male infertility accounts for 30 % of total infertility. Male fertility depends on two significant factors: healthy sperm (quantity, quality, and motility) and normal reproductive anatomy.

What Are the Causes of Male Infertility?

Fertility is a multifaceted process, and various male factors are involved in conception. They are:

• At least one of the testicles should be healthy and functioning properly.

• The male hormone testosterone must be sufficient to produce and maintain high-quality sperm.

• Sperm production should be sufficient (less than 15 million per millimeter of the semen sample is considered low sperm count).

• The sperm should be of good quality.

• Sperm motility should be normal so that it reaches and penetrates the egg.

• Sperms, once produced in testicles, are transported through tiny tubes where they are mixed with semen and ejaculated through the penis. Hence there should be no abnormality associated with the male reproductive organs.

Various factors can disrupt the normal biology of male fertility. They are categorized as medical causes, environmental causes, and lifestyle causes.

1. Medical Causes:

Various health issues can result in male infertility. They are described below:

• Varicocele: The enlargement of veins in the testicles is known as varicocele. It is due to abnormal blood flow in the veins. Varicocele can decrease sperm quantity and quality. However, varicocele can be treated efficiently, thereby managing infertility caused due to it.

• Infection: Infections and inflammation of the reproductive organs can result in permanent damage, though sperms can be retrieved through therapeutic interventions.

• Ejaculation Issues: Certain medical conditions like diabetes, spinal trauma, or surgery to the genitourinary tract could result in a condition called retrograde ejaculation, which results in the semen entering the bladder instead of being ejaculated through the penis.

• Immune-Mediated Conditions: Autoimmune diseases can produce antibodies that may recognize sperm as a foreign body and destroy them.

• Tumors: Certain cancerous or non-cancerous tumors can affect the male reproductive organs, thereby disturbing the hormone or perm production. Therapeutic procedures such as chemotherapy or surgery can also affect male infertility.

• Developmental Defects: Developmental defects such as undescended testicles, congenital absence of one or both testicles, scrotal or penile abnormalities, and blockage of the tubules carrying sperm could result in infertility.

• Chromosomal Defects: Specific syndromes could result in abnormal development of male reproductive organs.

• Problems With Intercourse: Erectile dysfunction, premature ejaculation, painful intercourse, or relationship issues could interfere with normal sexual intercourse.

2. Environmental Causes:

Exposure to chemicals, radiation, and heavy metals are known to cause infertility. Overheating of testicles due to prolonged sitting, wearing tight clothes, or working on the laptop for a long time causes an increase in the temperature of the scrotum and thereby reduces sperm production.

3. Lifestyle Causes:

Obesity, smoking, drinking alcohol, and substance abuse are very well known to decrease sperm quantity and quality.

How Is Male Infertility Diagnosed?

Diagnosing male infertility requires a series of work. It could be complex and intricate, yet it is crucial for the success of infertility treatments.

• Physical Examination and Medical History: A detailed physical examination and an elaborate medical history could help the doctor assess the health of the reproductive system and sexual habits.

• Semen Analysis: Semen analysis is a necessary test in determining male fertility as it provides detailed information on the quantity, quality, and movement of the sperm. Any abnormality in the number, shape, or size can also be easily assessed by sperm analysis.

• Blood Tests: Blood tests can be done to check for any hormonal or genetic conditions that could result in infertility.

• Imaging Tests: Imaging techniques like ultrasound and MRI (magnetic resonance imaging) may prove beneficial in assessing the structural abnormalities causing infertility. In addition, these techniques can aid in biopsy or even retrieve sperm for infertility treatments such as in vitro fertilization (IVF). Certain invasive techniques, such as venography or vasography, can be used to determine the vessel or tubal blockage hindering the release of sperm.

What Is the Role of Sonography in Diagnosing Male Infertility?

Ultrasound is the initial diagnostic investigation done to assess infertility. Sonography is an imaging technique that uses high-frequency sound waves to image the internal structures of the body. It is a simple, non-invasive, and economical diagnostic procedure that can be used to assess soft tissues. In male infertility, ultrasound can be used to determine testicular, scrotal, or prostate abnormalities and the patency of the sperm duct (thin tube-like structure through which the sperm passes into the urethra for ejaculation).

Sonography does not use any radiation and hence is extremely safe. Instead, a high-frequency sound wave is emitted into the body with the help of a small device known as a transducer. These sound waves travel into the body and bounce back upon hitting the internal structures. These returning sound waves are captured by the transducer and processed by a computer into images. Various types of ultrasound used in assessing male infertility are described below:

• Scrotal Ultrasound: Scrotal ultrasound is done to evaluate the scrotum and abnormalities associated with the testis, such as varicocele.

• Transrectal Ultrasound: In transrectal ultrasound, the transducer probe is inserted into the rectum to evaluate the blockages associated with the sperm duct or prostatic abnormalities.

• Ultrasound-Guided Biopsy: Ultrasound has the benefit of real-time imaging. Hence, sonography is extremely beneficial when conducting a scrotal or testicular biopsy where the abnormal tissue sample can be precisely located and biopsied. In addition, sonographic imaging can also be used for image-guided retrieval of sperm for assisted reproduction treatment, such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

• Doppler Ultrasound: Doppler ultrasound is a specialized technique that helps evaluate the blood flow through the vessels. This is extremely useful for detecting testicular varicocele that can result in male infertility.

Conclusion

Infertility in men is a challenging yet easily manageable condition. With the advent of novel fertility treatments, diagnostic techniques also saw some upgrades. Though semen analysis is a necessary test for sperm analysis, imaging techniques can substantiate the diagnosis by ascertaining the underlying pathologies. Ultrasound remains the mainstay diagnostic tool in evaluating infertility. However, sonography is the simplest, non-invasive, and most economical way to diagnose male infertility and assist in infertility treatments.