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I Shall first discuss your erection problem. The medication, Udezire is good for providing you with erection and having sexual intercourse. From your history it seems that you are suffering from vascular causes of erectile dysfunction and you should consider treatment with low intensity shockwave therapy. It shall improve your erections and may be even cure erectile dysfunction. It is very new treatment and is available at only limited places. You prolactin levels are marginally high and shall not cause the problems. No test shall inform conclusively about clogged blood vessels. You should certainly get lipid profile. USG scrotum is of no use and shall not contribute to your management.
Regarding your infertility, semen analysis reports change every day and hence a single report is never conclusive. However, I am pretty happy with your latest report also. Since you have been actively trying since long to conceive there is a possibility that your wife has antisperm antibodies and the treatment for that is intrauterine insemination (IUI). You should see your gynecologist and seriously consider IUI.
All the best.
Patient replied :
Thanks for providing your valuable insight sir, so tow I am assuming that Prolactin factor is not that important for my case. I want to ensure if my ED problem is due to any vascular disease as you suggested. Can you recommend me some tests which will tell if blood flow to my penis and testicles is normal or arteries are not clogged, or any other clinical tests which will indicate towards vascular problems. I know its difficult to diagnose this with conviction, but I want to give a try. Apart from that I will also go for lipip profile test as recommended.
Kindly undertake Penile Doppler study. This will determine blood flow to the penis and testicles.
Dr. Rajiv Goel.