<prompt> A couple complains of primary infertility in spite of staying together for 4 year and having unprotected intercourse, all tests in wife are normal. Semen analysis shows a volume of 0.8 mLsperm count is 0, fructose is absent what is done next?Testicular FNACUltrasound for obstructionLocal palpation of vasKaryotyping  <response>: Ans. is b, i.e. Ultrasound for obstructionRef: Reproductive medicine secrets by Peter Chan 1sted, p33Absent fructose in semen means block is below the level of seminal vesicles which is not allowing sperms from testis and seminal fluid with fructose from seminal vesicle to be present in the semen. This means there is an obstructive pathology. The best way to detect obstruction is to perform a Transrectal Ultrasound.Also Know Role of Transrectal ultrasound in male infertility: Transrectal ultrasound TRUS: is done to visualize the seminal vesicles, prostate and ejaculatory ducts obstruction. Indications of TRUS are: i Azoospermia or severe oligospermia with a normal testicular volume, ii Abnormal digital rectal examination, iii Ejaculatory duct abnormality cysts, dilatation or calcification, iv Genital abnormality hypospadias. 