A couple presents with infeility. On investigating, the husband is found to have azoosermia on semen analysis. Vas was not palpable on perrectal examination. Semen had low volume, high viscosity and fructose was present. What will you do next ?
**Core Concept**
The couple's infertility is likely due to a male factor, specifically azoospermia, which indicates the absence of sperm in the ejaculate. The low volume, high viscosity of the semen, and presence of fructose suggest a blockage in the seminal vesicles, which are responsible for producing fructose, a key energy source for sperm.
**Why the Correct Answer is Right**
Given the presence of fructose in the semen, it is likely that the seminal vesicles are functioning, but the sperm is being blocked from entering the ejaculate. The absence of a palpable vas deferens on the perirectal examination suggests a possible congenital absence or agenesis of the vas deferens, which is often associated with cystic fibrosis. This condition requires further investigation, including genetic testing and possibly a semen analysis with a post-ejaculatory urination (PEU) sample to assess for ejaculatory duct obstruction.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because it does not address the underlying cause of azoospermia and does not take into account the presence of fructose in the semen.
* **Option B:** This option is incorrect because it implies a blockage at the level of the epididymis, which is less likely given the presence of fructose in the semen.
* **Option D:** This option is incorrect because it does not address the specific issue of azoospermia and does not take into account the findings on the perirectal examination.
**Clinical Pearl / High-Yield Fact**
In cases of azoospermia, it is essential to investigate the underlying cause, which may involve genetic testing, imaging studies, and semen analysis with a post-ejaculatory urination (PEU) sample. A thorough evaluation can help identify the underlying cause and guide treatment options.
**Correct Answer:** C.