RELATIONSHIP BETWEEN TESTICULAR VOLUME AND SPERM COUNT IN INFERTILE MEN IN SOUTHERN NIGERIA. *Manuel B.A. *Ugboma E.W, * Nwankwo N.C *Department of Radiology, University of Port-Harcourt Teaching Hospital

OUTLINE INTRODUCTION IMAGING MODALITIES STUDY AIM METHODOLOGY RESULTS DISCUSSION CONCLUSION RECOMMENDATION LIMITATION REFERENCES

INTRODUCTION Infertility can be defined as the failure to conceive following 12 months of regular unprotected intercourse. In Nigeria, infertility is a cause of many psychological and social problems for the childless couple. Studies have shown male factor in infertility ranges from 30-50%.

IMAGING MODALITIES Scrotal ultrasound Transrectal ultrasound Magnetic resonance imaging of the brain Magnetic resonance imaging of the prostate gland Magnetic resonance imaging of the distal ductal system. Vasography

Scrotal ultrasound plays an invaluable role in the evaluation of the infertile man. It is non-invasive and can detect abnormalities that can be corrected to improve the chances of conception. The gold standard for assessment of testicular function in men being evaluated for infertility is semen analysis. There however is a relationship between testicular volume and testicular function. Scrotal ultrasound can be used to measure testicular volume and thus based on this relationship be a pointer to testicular function

STUDY AIM To examine the relationship between testicular volume obtained by scrotal ultrasound and testicular function in infertile men in Southern Nigeria.  

METHODOLOGY Cross-sectional descriptive study of 100 men. INCLUSION CRITERIA Patients must be either be managed or investigated as a case of infertility. Patients must be between 25 and 65 years old. EXCLUSION CRITERIA Patients being managed for hypertension. Patients being managed for diabetes mellitus. Patients being managed for kidney disease or kidney failure. Patients being managed for any form of extratesticular malignancy such as leukemia, stomach cancer, lung cancer etc.

Demographic data such as age and level of education were obtained using a questionnaire. Seminal fluid analysis results was also recorded. All scrotal ultrasound scans were carried out with a Mindray DC-8 diagnostic ultrasound system using a 7.5MHz transducer in the presence of a male chaperone

The scrotal sacs were examined to detect the testicular volume Testicular volume was obtained using the formula Length × Width × Height × 0.71 Small testis was defined as any testis with a volume less than10.3cm3

Figure 1: Grayscale ultrasound of a normal testis showing points of measurement: (A) longitudinal image; (B) transverse image A B

Data was analyzed using Statistical package for social sciences (SPSS) for windows version 20.0. Results were presented as mean ± standard deviation, percentages, tables and graphs as appropriate.

RESULTS

TABLE 1:AGE DISTRIBUTION OF SUBJECTS AGE (years) Frequency Total (%) 26 - 30 4 31 -35 27 36 - 40 39 41 - 45 21 46 - 50 9 total 100

TABLE 2: HIGHEST EDUCATIONAL LEVEL ATTAINED BY SUBJECTS Frequency Total (%) Secondary 19 Tertiary 81 Total 100

TABLE 3: FREQUENCY OF YEARS OF INFERTILITY AND TYPE OF INFERTILITY TOTAL PRIMARY INFERTILITY SECONDARY INFERTILTIY 1 13 4 17 2 21 8 29 3 14 5 19 6 7 9 10 11 66 34 100

FIG 2: Small testis. Sonogram showing a testis which on measurement had a volume of 2.39cm3 and heterogenous echogenicity

FIG 3: SCATTER PLOT SHOWING THE CORRELATION BETWEEN TESTICULAR VOLUME AND TOTAL SPERM COUNT

FIG 4: LINE GRAPH OF SPERM CONCENTRATION AND MEAN TESTICULAR VOLUME

DISCUSSION The mean age of patients was 38.16 ± 4.7 years, with the highest frequency of patients falling within the 36-40 age group. This agreed with a study carried out by Tijani et al. The mid-30s is when most men get married and want to start a family and thus this is the age range when fertility issues come to light

The average number of years of infertility in this study was 3. 3±2 The average number of years of infertility in this study was 3.3±2.2 years. This is lower than the mean number of years of infertility found in a study in Calabar which was 6 years and another in south-east Nigeria which was 5 years. This may be due to increasing awareness among the male partners that they may play a role in the issue of childlessness and so are seeking medical help earlier than in previous years

The results of this study agree with previous studies as there was a statistically significant positive correlation between testicular volume and total sperm count ( p<0.0001). The mean testicular volume(MTV) in this study was 13.14±5.37cm3 with a sharp peak in sperm concentration at a MTV of 25.1-27cm3 These figures are in contrast to a study carried out by Tijani et al which recorded a MTV of 15.32±3.1ml with a sharp peak in sperm concentration at 18-20ml in the infertile males in the study

This difference may be because the study by Tijani et al only recruited patients who were azoospermic or oligospermic who had at least a 2 year history of infertility. This criteria was not used to select the patients in the current study as 50% of the study population had normal sperm concentration

The current study also observed that a MTV of 7cm3 and below was associated with severe oligospermia (sperm concentration <5 X 106cells/ml). This is similar to the report by Sakamoto et al who noted that a MTV of 7.5ml was associated with severe oligospermia. These values however differ from that obtained by Tijani et al who reported severe oligospermia at a MTV of 12ml or less. This difference is most likely due to difference in selection criteria for the study population between the studies.

CONCLUSION This study found a significant positive correlation between testicular volume and total sperm count. It was also observed that mean testicular volumes of less than 7cm3 were associated with severe oligospermia and sperm concentration tended to increase from above this value to peak at a mean testicular volume of 25.1-27cm3. When this is compared to other studies it implies that a mean testicular volume of at least above 7cm3 is necessary to produce sperm concentrations out of the severe oligospermic range

RECOMMENDATIONS Men being investigated for infertility should be routinely evaluated with scrotal ultrasound scan.

LIMITATIONS A control group was not used in this study. This was due to the difficulty of recruiting healthy men to undergo a scrotal ultrasound scan strictly for research purposes.

REFERENCES Tijani KH, Oyende BO, Awosanya GO, Ojewola RW, Lawal AO, Yusuf AO. Scrotal abnormalities and infertility in west African men: A comparison of fertile and sub-fertile men using scrotal ultrasonography. Afr J Urol 2014;20(4):180-183. Sakamoto H, Saito K, Shichizyo T, Ishikawa K, Igarashi A, Yoshida H. Color Doppler ultrasonography as a routine clinical examination in male infertility. Int J Urol. 2006;13(8):1073-8. Ekwere PD, Archibong EI, Bassey EE, Ekabua JE, Ekanem EI, Feyi- Waboso P. Infertility among Nigerian couples as seen in Calabar. Port Harcourt Medical Journal. 2007; 2:35-40 Kiridi EK, Nwankwo NC, Akinola RA, Agi CA, Ahmed A. Ultrasound measurement of testicular volume in healthy Nigerian adults. Journal of Asian scientific research 2011;2(2):45-52 Tijani KH, Oyende BO, Awosanya GO, Ojewola RW, Yusuf AO. Assessment of testicular volume: A comparison of fertile and subfertile West African men. Afr J Urol 2014;20(3):136-140 Sakamoto H, Ogawa Y, Yoshida H. Relationship between testicular volume and testicular function: comparison of the Prader orchidometric and ultrasonographic measurements in patients with infertility. Asian J Androl 2008;10(2):319–24

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