Background: Infertility affects an estimated 15% of couples globally, amounting to 48.5 million 
couples. Males are found to be solely responsible for 20-30% of infertility cases and contribute to 
50% of cases overall, the aim is to evaluate the role of trans rectal ultrasonography for evaluation of 
male infertility with low semen volume. Methods: This study was carried out on one hundred and 
twenty patients attended the outpatient clinic of the diagnostic radiology department at Al-Azhar 
University Hospital (Assiut) All patients were subjected to the following: Full history taking and 
thorough clinical examination, Physical examination including genital and digital rectal examination 
(DRE). Routine laboratory Semen analysis serum follicle stimulating hormone (FSH), testosterone, 
leutinizing hormone (LH) and prolactin hormone (PRL). Radiological investigations including: 
Transrectal ultrasound (TRUS). Scrotal ultrasound. Results: According to TRUS finding, about 7.5% 
of patients were normal and 92.5% of patients had abnormal findings. With reference to abnormal 
TRUS findings, 9.9% of patients had hypoplastic seminal vesicle, 24.3% had dilated seminal vesicle 
and ejaculatory duct. 5.4% of patients had prostatic midline cyst and the same percentage of patients 
had prostatic calcification. Varicocele was left sided in 36% of patients and bilateral in 18.9% of 
patients. Conclusion: In transrectal and scrotal ultrasonography are important non invasive 
diagnostic tools that minimizes the need for more invasive studies in the evaluation of azoospermia or 
severe oligospermia with low volume ejaculate and can give more information for patients with 
abnormal testicular biopsy findings.