Editing Infertility: Management (section)

====Diagnosis and Evaluation====
*'''<span style="color:#ff0000">Findings associated with ejaculatory duct obstruction:'''
*#'''<span style="color:#ff0000">Azoospermic or severely oligospermic and/or asthenospermic men with at least one palpable vas deferens'''
*#'''<span style="color:#ff0000">Low semen volume'''
*#'''<span style="color:#ff0000">Acidic semen pH'''
*#'''<span style="color:#ff0000">Negative, equivocal, or low semen fructose levels'''
*#'''<span style="color:#ff0000">Normal serum levels of FSH'''
*#'''<span style="color:#ff0000">Testis biopsy reveals normal spermatogenesis'''
*'''Transrectal US'''
**'''A (müllerian duct)''' '''midline cystic lesion or dilated ejaculatory ducts and seminal vesicles can be visualized  '''
***'''<span style="color:#ff0000">Suggestive if AP diameter of seminal vesicle >1.5cm'''
**'''Microscopic examination of TRUS-guided aspiration of the cystic or dilated ejaculatory ducts or seminal vesicles can be performed.'''
***'''If motile sperm are found''', they are cryopreserved and 2 to 3 mL of indigo carmine diluted with water-soluble radiographic contrast is instilled. '''If a radiograph confirms a potentially resectable lesion, TURED is performed without the need for prior vasography'''
****'''Transrectal sonography with aspiration should be performed immediately before anticipated [TURED] surgery and uses the same bowel preparation and antibiotic prophylaxis as for transrectal prostate biopsy.'''
***'''If no sperm are found in the aspirate, vasography is necessary'''.
****'''If no sperm are found in either vas when the vasotomy is made and vasography reveals ejaculatory duct obstruction, it is best to abandon attempts at reconstruction and simply perform microsurgical epididymal sperm aspiration and cryopreservation for future IVF and ICSI.'''
****Performance of simultaneous vasoepididymostomy and TURED is unlikely to be successful.