Steps in the investigation and management of low semen volume in the infertile man

Abstract

An adequate semen volume of ejaculate fluid is required to transport sperm into the female reproductive tract and allow for fertilization of the oocyte. Thus, seminal fluid volume is an important part of the semen analysis done to investigate male infertility. In this article, we review the anatomy and physiology of ejaculation, the various etiologies of low-volume ejaculation (artifactual, structural, functional). We then present a comprehensive algorithm for the evaluation, diagnosis and treatment of the infertile man presenting with low semen volume.

Figures

Fig. 1.

Algorithm for the evaluation and treatment of a man presenting with low-volume ejaculation. S/A = semen analysis; OAT = oligoasthenoteratozoospermia; Abdo US = abdominal ultrasound; CF = cystic fibrosis; PEU = post-ejaculate urinalysis; TRUS = transrectal ultrasound; PESA = percutaneous epididymal sperm aspiration; IVF = in vitro fertilization; ICSI = intracytoplasmic sperm injection; MRI = magnetic resonance imaging; RE = retrograde ejaculation; TURED = transurethral resection of the ejaculatory ducts; SV = seminal vesicle; IUI = intrauterine insemination; EDO = ejaculatory duct obstruction.