Editing Infertility: Diagnosis and Evaluation (section)

=== Trans-rectal Ultrasound (TRUS) ===
*Used to 
**Assess the anatomy of the primary organs/structures involved in ejaculation including the prostate, seminal vesicles, vasal ampulla, and ejaculatory ducts
**Rule out ejaculatory duct obstruction
*'''Should not be performed as part of the initial evaluation'''
*'''<span style="color:#ff0000">Indications</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
*#'''<span style="color:#ff0000">Semen analysis suggestive of ejaculatory dust obstruction (2):</span>'''
*#*'''<span style="color:#ff0000">Low semen volume with azoospermia and palpable vasa</span>'''
*#*'''<span style="color:#ff0000">Low semen volume and significant asthenospermia (total motility <40% or progressive motility <32%)</span>'''
*#**'''<span style="color:#ff0000">Normal semen is derived from testicular (~10%), prostatic (~20%), and seminal vesicle (~70%) fluid.'''
*#***All components are androgen sensitive so that men with testosterone deficiency may have low semen volume and the utility of TRUS in such circumstances may be low.
*#***'''<span style="color:#ff0000">Seminal vesicle fluid is alkaline. Obstruction that limits or prevents the seminal vesicle contribution will lead to acidic semen (pH <7.0)'''.
*#****Men with a normal semen pH are unlikely to have a complete distal genital tract obstruction.
*#'''<span style="color:#ff0000">Symptoms (e.g., painful ejaculation)</span>''' 
*In men with CBAVD, TRUS does not contribute to the diagnosis or treatment, so it should not be done for evaluation of such infertile men.
*'''<span style="color:#ff0000">Findings associated with ejaculatory duct obstruction (4):</span>[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]'''
*#'''<span style="color:#ff0000">AP diameter of seminal vesicle >1.5cm</span>'''
*#'''<span style="color:#ff0000">Ejaculatory duct caliber (>2.3mm)</span>'''
*#'''<span style="color:#ff0000">Dilated vasal ampulla (>6mm)</span>'''
*#'''<span style="color:#ff0000">Prostatic cysts (midline or paramedian (ejaculatory duct)</span>'''