Color-Doppler Ultrasound and New Imaging Techniques in Andrological Examination

The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics

BACKGROUND

Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters.

OBJECTIVES

To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters.

METHODS

A cohort of 248 HFM (35.3 ± 5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures.

RESULTS

The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was ~ 17 ml. The lowest reference limit for right and left testis was 12 and 11 ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5 mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage.

CONCLUSIONS

The present findings will help in better understanding male infertility pathophysiology, improving its management.

New Approaches to Assess Fertility in Domestic Animals: Relationship between Arterial Blood Flow to the Testicles and Seminal Quality

The early identification of infertile males improves reproduction efficiency at a production level and is essential to secure high production rates. Before entering a breeding program, males must pass an initial breeding soundness examination (BSE) which consist of several diagnostic exams whose end point is to estimate their future fertility. There is ongoing research to find new markers that allow better identification of fertile males. Doppler mode allows the quantitative and qualitative evaluation of the irrigation of organs. When evaluating the reproductive system, Doppler mode has been successfully used for the evaluation of the uterine and ovarian irrigation. In males, it is gaining relevance for the evaluation of testicular irrigation. Researchers have found a relationship between pulsed-wave Doppler velocimetric parameters and seminal quality in various domestic animal species. This suggests Doppler ultrasound parameters should be considered as objective parameters to evaluate testicular function. In this review, we analyze the results in the main domestic animal species and discuss the differences and similarities among the results. We also discuss the effect of the location of the measurements, breed, season and laterality in the measurement of Doppler velocimetric parameters as well as the impact and limitations of this method of assessing breeding soundness.