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Spermatogenesis and spectral echo-colour Doppler traces from the main testicular artery
G Biagiotti1, G Cavallini, F Modenini
1Reproductive Medicine Unit, Società Italiana Studi di MEdicina della Riproduzione (SISMER), Bologna, Italy.
Insights
Doppler ultrasound measures, specifically peak systolic velocity (PSV) and resistive index (RI) of testicular arteries, effectively distinguish causes of male infertility (dyspermia). These Doppler indices are more reliable than follicle-stimulating hormone (FSH) or testicular volume.
Area of Science:
- Reproductive Medicine
- Medical Imaging
- Urology
Background:
- Male infertility, or dyspermia, encompasses various conditions affecting sperm production and function.
- Distinguishing the specific causes of dyspermia is crucial for effective treatment and management.
- Current diagnostic methods may not always reliably differentiate between various etiological factors of infertility.
Purpose of the Study:
- To evaluate the utility of testicular artery Doppler ultrasound parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI), in differentiating causes of dyspermia.
- To compare the diagnostic value of these Doppler indices against established markers such as follicle-stimulating hormone (FSH) and testicular volume.
Main Methods:
- A cohort of men with various forms of dyspermia (azoospermia, oligoasthenospermia, varicocele, male accessory glans inflammation) and fertile controls were included.
- Measurements of testicular volume, serum FSH levels, and Doppler parameters (PSV, EDV, RI) of testicular arteries were obtained.
- Statistical analysis, including analysis of variance, was employed to compare these parameters across different patient groups.
Main Results:
- Peak systolic velocity (PSV) and resistive index (RI) demonstrated significant utility in differentiating patient groups.
- End-diastolic velocity (EDV), follicle-stimulating hormone (FSH), and testicular volume were not effective in distinguishing the causes of dyspermia.
- Patients with varicoceles exhibited the highest PSV and RI, while those with obstructive azoospermia and fertile controls showed similar values. Unexplained oligoasthenospermia and obstructive azoospermia groups had progressively lower PSV and RI values.
Conclusions:
- Testicular artery resistive index (RI) and peak systolic velocity (PSV) are reliable indicators for clinical use in identifying infertile men.
- PSV and RI effectively differentiate between obstructive and non-obstructive azoospermia.
- End-diastolic velocity (EDV), follicle-stimulating hormone (FSH), and testicular volume lack diagnostic value in distinguishing the causes of male infertility.
Objective:
To assess whether the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) of testicular arteries may be useful in distinguishing the various causes of dyspermia when compared with follicle-stimulating hormone (FSH) and testicular volume.
Patients, Subjects And Methods:
The study included nine men with obstructive and 20 with unobstruc-tive azoospermia, 17 with oligoasthenospermia and clinical varicoceles, with male accessory glans inflammation (MAGI), 38 with undetermined oligoasthenospermia, 19 with MAGI, 11 with clinical varicoceles, 32 subjects with normal sperm analysis and recent paternity (fertile controls), and 15 with normal sperm analysis and a varicocele with recent paternity (fertile + varicoceles). Testicular volume, FSH, PSV, EDV and RI were compared among the dyspermic and/or control groups using analysis of variance.
Results:
The PSV and RI were useful for identifying the different groups of patients, while EDV, FSH and testicular volume were not. Men with varicoceles, varicoceles + MAGI or fertile with varicoceles had the highest PSV and RI; fertile controls, those with obstructive azoospermia and MAGI had similar PSVs and RIs, those with unexplained oligoasthenospermia had a significantly lower PSV and RI, and men with unobstructive azoospermia had the lowest PSV and RI.
Conclusions:
The RI and PSV are reliable indicators for routine clinical use to identify infertile/dyspermic men, while EDV, FSH and testicular volume are not. The RI and especially PSV clearly differentiated obstructive from unobstructive azoospermia.