221b male infertility Flashcards by Daniel Reinhardt

testorone

2% is free and unbound –> biologically active

98% bound to SHBG and albumin

T –> DHT and estradiol

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testorone

2% is free and unbound –> biologically active

98% bound to SHBG and albumin

T –> DHT and estradiol

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testicle

FSH –> sertoli cells –> spermatogenesis, ABP, inhibin, activin, other important products for sperm development

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sertoli cells - spermatogenesis role

linked by tight junctions –> blood testis barrier for immunologically privileged site

nurse developing sperm

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spermatogenesis

90 days
wave in production in a spiral orientation in tubule

each spermatocyte –> 4 spermatids

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where does sperm maturation occur?

epididymis which takes 15 days there

many changes in surface proteins, charge, membrane, motility

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fertilization

ampullary portion of fallopian tube

sperm enter uterus vi acerical mucus changes

sperm undergoes capacitation and hyperactivation (makes it extra fast when exposed to female repro mucus –> fast and more straight path)

acrosome - lytic enzymes release for fertilization

zona reaction in zona pellucida prevents polyspermy

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male infertility

pre-testicular

testicular

post-testicular

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causes of male infertility

varicocele>idiopathic>obstruction

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male infertility exam

history

physical - general, secondary sexual characteristics, gynecomastia, abdomen scars, scrotum - varicocele, presence of vas deferens, etc

lab tests - FSH, testorone

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variocele

more common in infertile men

Grade III –> bag of worms

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lab testing

FSH, testorone
low T–> LH and prolactin
low FSH –> LH and prolactin
obese –> estradiol

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semen

normal pH is 7.2 (prostate is acidic, seminal vesicle are alkaline)

low volume, normal pH - incomplete collection or retrograde ejaculation (DM patients)

low volume, acidic pH – ejaculatory duct pathology, absence of vas deferences/seminal vesicles

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rx - sexual behavior and meds

every other day
2 days before ovulation is key
don’t use most lubes
drugs - beta blockers (ED), alpha blockers (retrograde), SSRI’s (can’t climax)

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rx - sexual behavior and meds

every other day
2 days before ovulation is key
don’t use most lubes
drugs - beta blockers (ED), alpha blockers (retrograde), SSRI’s (can’t climax)

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testicle

FSH –> sertoli cells –> spermatogenesis, ABP, inhibin, activin, other important products for sperm development

sertoli cells - spermatogenesis role

linked by tight junctions –> blood testis barrier for immunologically privileged site

nurse developing sperm

medical treatment of hormonal disorders

hormonal disorders (kallman’s –> low LH, FSH –> treatable), rx - hCG, FSH replacement, (low T –> clomiphene citrate or hCG drive up T)

androgen excess (anabolics, CAH, tumors) –> drop LH/FSH levels and stop normal T production and sperm production

Estrogen excess - obese men, liver failure; –I gonadotropin secretion (consider aromatase inhibitors (testolactone, anastrozole)

Prolactin Excess –I GnRH secretion (Rx - use bromocriptine or carbergoline)

Don’t give T

ejaculatory dysfunction - neuropathetic (use sympathomimetic agents like pseudoephdrine - sympathetic process)

genital duct infection/inflammation
ED (rx - PDE5 inhibitors)

where does sperm maturation occur?

epididymis which takes 15 days there

many changes in surface proteins, charge, membrane, motility

klinefelter syndrome

47, XXY
1/500 male births
causes azoospermia
traid: small, firm testes, gynecomastia, azoospermia

male infertility

pre-testicular

testicular

post-testicular

causes of male infertility

varicocele>idiopathic>obstruction

male infertility exam

history

physical - general, secondary sexual characteristics, gynecomastia, abdomen scars, scrotum - varicocele, presence of vas deferens, etc

lab tests - FSH, testorone

variocele

more common in infertile men

Grade III –> bag of worms

lab testing

FSH, testorone low T--> LH and prolactin low FSH --> LH and prolactin obese --> estradiol

semen

normal pH is 7.2 (prostate is acidic, seminal vesicle are alkaline) low volume, normal pH - incomplete collection or retrograde ejaculation (DM patients) low volume, acidic pH -- ejaculatory duct pathology, absence of vas deferences/seminal vesicles

does shape of sperm matter?

yes - need normal shape for functional sperm

rx - sexual behavior and meds

every other day 2 days before ovulation is key don't use most lubes drugs - beta blockers (ED), alpha blockers (retrograde), SSRI's (can't climax)

pesticides and herbicides - sperm

men in rural areas had lower sperm numbers due to higher levels in ground water

fever and sperm

impacts sperm if fever w/in 3 months --> consider repeat sperm testing 4-8 weeks later before making final decision

drugs

tabacco impacts alcohol doesn't drugs screw up sperm production (marijuana, cocaine, anabolic steroids)

medical treatment

hormonal disorders (kallman's --> low LH, FSH --> treatable), rx - hCG, FSH replacement, (low T --> clomiphene citrate or hCG drive up T) ejaculatory dysfunction genital duct infection/inflammation ED

surgical treatments

varicocele --> testicular hyperthermia (heat transfer from artery --> vein --> outside of body via counter current exchange (if pooling then lose counter current)) ejactulaory duct --> obstruction due to prostat cyst, stenosis, calculi (dx via transrectal US --> see dilation next to obstruction) epeidiymis or vasocostomy can be rehooked up obsturctive azoospermia - congenital bilateral absence of vas deferens (CF patients) --> can retrieve sperm and use via IVF/ICSI nonobstructive azoospermia - can still look for sperm in testicle, 50% still have sperm --> use IVF-ICSI

klinefelter syndrome

47, XXY 1/500 male births causes azoospermia traid: small, firm testes, gynecomastia, azoospermia

Y chromosome microdeletions

10-15% of azoospermic men --> deletion in nonoverlapping regions of Y" chromosome some microdeletions will not have any sperm