021215 male infertility Flashcards
male infertility can be broken down into what causes
pre-testicular
testicular
post-testicular
male infertility is treatable/reversible?
many causes are
most common cause of male infertility
testicular cause
includes varicocele, gonadotoxins (marijuana), primary testicular problems
post testicular causes of male infertility
obstruction ejaculation disorders (sp cord injury)
gynecomastia points towards
hormone issue
normal testicular volume
18-20 cc
how to evaluate infertile male
full history and exam SEMEN ANALYSIS (at least 2 times) --is variable day to day
hormone studies to examine HPG axis (total testosterone, FSH, reserve LH, estradiol, prolactin if testosterone is low)
scrotal US if testicular abnormality is identified (scrotal US can pick up testicular cancer)
semen analysis looks at what
volume concentration motility total motile sperm total sperm absence of WBCs, RBCs, or bacteria
testosterone is converted to estradiol in
body fat
so body may make testosterone fine, but if fat converts it, then you may have low testosterone
if FSH is increased, why is it not good?
means pt is not making enough inhibin
causes of male infertility-most common?
varicocele most common
then idiopathic
decreased semen volume and lowered pH point to
seminal vesicle abnormality
vasal agenesis is usually occurring with
seminal vesicle hypoplasia or absence
CBAVD
congenital bilateral absence of vas deferens
80-90% associated with mutation of at least one CFTR gene. most have two mutations. mutations cause involution of genital ducts during embryogenesis. spermatogenesis is not impaired.
could also be due to renal agenesis/anomalies/injury to Wolffian duct
Kallmann syndrome
can have anosmia
lack of GnRH due to failure of hypothalamus
