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Azoospermia (zero sperm count) Pls help.

Dear Doctor,

I got married 2 years back but still we don't have any baby.
Then we consulted a gynecologist, and she advised some tests.
My wife was almost ok.
but there are some problems found in my reports.
below are the details of the reports:

Semen Analysis (Done thrice with a gap of 2 weeks):
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* Semen Volume - between 3 ml and 4 ml in all tests
* Colour - Whitish, ( in all three semen analysis)
* Reaction - Alkaline ( in all three semen analysis)
* Liquification time - < 30 minutes ( in all three semen analysis)

Total Sperm count - Zero ( in all three semen analysis)
Semen Fructose Level - 1 mg / dl (Normal value - >200mg/dl)

Blood report
--------------
Testosterone - 4.59 ng / ml (normal)
Prolactin Serum - 10.1 ng / ml (normal)
FSH (Follicle Stimulating harmone) - 20.23 mIU / ml (normal 1.40 - 18.10)
LH - 14.17 mIU / ml (normal 1.50 - 9.30)

Ultrasound Doppler scrotal study
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Both the testes are smaller in shape and size and however normal in echopattern.
right testes measure 26 x 10mm.
left testes measure 27 x 13 mm.
Right epididymis measure 6.7 mm with normal echopattern.
Right epididymis measure 9.8 mm with normal echopattern.
No evidence of inguinal on either side is seen.
No evidence of any fluid in both cavities of tunica vaginalis seen.
Median raphae are normal.
No evidence of inguinal lymphadenopathy on either side.
color flow study reveals normal augmentation of flow in the pampiniform plexi upon valsalva maneouvre.
No reversal / reflux flow seen on either side.
Normal augmentation of flow is seen in the right sided pampiniform plexus.
Left kidney is seen free of any SOL.
Duplex doppler shows right intratesticular artery PSV - 14.03 cm/s and left intratesticular artery PSV - 11.82 cm/s.

Please suggest next plan of action or any treatment.
 
  bminteg on 2010-03-02
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