ABSTRACT
The purpose of this article is to evaluate the role of ultrasonography of male reproductive system, especially scrotal and transrectal ultrasonography in the management of infertile males before ICSI as a predictive value for sperm recovery in testicular sperm extraction [TESE]. In this study selected group of 140 infertile men with azoospermia were examined with scrotal and transrectal US. According to clinical and transrectal examination, these patients were subdivided into two groups. Group I of 64 patients had evidence of major obstructive abnormalities of male genital tract system and group II of 76 patients had no or minor non obstructive transrectal US abnormalities. All the 140 patients in the last two semen analysis have azoospermia which persists in spite of medical or surgical treatment. In group I, five patients had congenital bilateral absence of the vas deferens, two have congenital unilateral absence of the vas deferens and congenital obstructive pathology of the contralateral duct system. Proximal or distal duct system obstruction was diagnosed in 57 cases. These patients have a normal FSH level and small volume of ejaculate, and significantly higher testicular volume. In 61 patients of them [95.3%] testicular sperm were found in testicular biopsy. The other 76 patients in Group II were subdivided into two categories according to the presence or absence of minor non-obstructive transrectal abnormalities. In the 30 patients who had additional abnormalities thought to be directly related to semen deficiency 17 cases [56.7%] showed sperms in testicular biopsy. These patients have FSH at the upper level of normal with testicular volume at lower level of normal and with low ejaculate volume. In the remaining 46 patients with high level FSH, low testicular volume in US with normal ejaculatory volume and within normal transrectal US, only 19 cases [41.3%] showed sperms in testicular biopsy