This chapter summarizes various imaging modalities in the workup of male infertility with emphasis on indications and outcome interpretation. The conditions outlined in this chapter are commonly identified causes for oligospermia and azoospermia, and are the usual targets for imaging investigations. Color Doppler ultrasound (CDUS) has become the most frequently used imaging modality for varicocele detection. Ultrasound studies of spermatic veins have suggested that the presence of multiple large veins. In CBAVD the diagnosis is established clinically by the absence of the two vasa deferentia on palpation. Intratesticular cysts include cysts of the tunica albuginea, tubular ectasia of the rete testis, and testicular cysts. Testicular microlithiasis (TM) is characterized by the presence of numerous punctate calcifications within the testis. Transrectal ultrasound (TRUS)-guided echo-enhanced seminal vesiculography in combination with transurethral resection of the ejaculatory duct (TURED) is considered the best imaging method when treating ejaculatory duct obstruction (EDO).

Intrauterine insemination (IUI) is indicated for couples with unexplained infertility, mild to moderate male-factor infertility, or certain female factors, such as antisperm antibodies or a hostile cervical environment. Pre-screening for couples attempting an IUI procedure includes testing for infectious diseases, genetic abnormalities, and general medical problems, such as anemia. Oligospermic men have an increased likelihood of harboring genetic anomalies, such as Y-chromosome microdeletions. The use of fertility drugs has been associated with neoplasia, particularly borderline ovarian tumors. Pregnancy complications include multiple gestations, birth defects, low birthweight, and ectopic pregnancies. Chain of custody is a concept that dictates exactly which person or facility has physical control of a laboratory specimen from the time it leaves the patient's body until it arrives at its ultimate destination. In IUI, the initial specimen is the man's ejaculate and the final destination is his designated partner's uterus.