221b male infertility

Question 1

testorone

Answer 1

2% is free and unbound –> biologically active

98% bound to SHBG and albumin

T –> DHT and estradiol

Question 2

testorone

Answer 2

2% is free and unbound –> biologically active

98% bound to SHBG and albumin

T –> DHT and estradiol

Question 3

testicle

Answer 3

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

Question 4

sertoli cells - spermatogenesis role

Answer 4

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

nurse developing sperm

Question 5

spermatogenesis

Answer 5

90 days
wave in production in a spiral orientation in tubule

each spermatocyte –> 4 spermatids

Question 6

where does sperm maturation occur?

Answer 6

epididymis which takes 15 days there

many changes in surface proteins, charge, membrane, motility

Question 7

fertilization

Answer 7

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

Question 8

male infertility

Answer 8

pre-testicular

testicular

post-testicular

Question 9

causes of male infertility

Answer 9

varicocele>idiopathic>obstruction

Question 10

male infertility exam

Answer 10

history

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

lab tests - FSH, testorone

Question 11

variocele

Answer 11

more common in infertile men

Grade III –> bag of worms

Question 12

lab testing

Answer 12

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

Question 13

semen

Answer 13

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

Question 14

rx - sexual behavior and meds

Answer 14

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)

Question 15

rx - sexual behavior and meds

Answer 15

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)

Question 16

testicle

Answer 16

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

Question 17

sertoli cells - spermatogenesis role

Answer 17

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

nurse developing sperm

Question 18

medical treatment of hormonal disorders

Answer 18

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)

Question 19

where does sperm maturation occur?

Answer 19

epididymis which takes 15 days there

many changes in surface proteins, charge, membrane, motility

Question 20

klinefelter syndrome

Answer 20

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

Question 21

male infertility

Answer 21

pre-testicular

testicular

post-testicular

Question 22

causes of male infertility

Answer 22

varicocele>idiopathic>obstruction

Question 23

male infertility exam

Answer 23

history

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

lab tests - FSH, testorone

Question 24

variocele

Answer 24

more common in infertile men

Grade III –> bag of worms

Question 25

lab testing

Answer 25

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

Question 26

semen

Answer 26

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

Question 27

does shape of sperm matter?

Answer 27

yes - need normal shape for functional sperm

Question 28

rx - sexual behavior and meds

Answer 28

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)

Question 29

pesticides and herbicides - sperm

Answer 29

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

Question 30

fever and sperm

Answer 30

impacts sperm

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

Question 31

drugs

Answer 31

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

Question 32

medical treatment

Answer 32

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

Question 33

surgical treatments

Answer 33

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

Question 34

klinefelter syndrome

Answer 34

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

Question 35

Y chromosome microdeletions

Answer 35

10-15% of azoospermic men –> deletion in nonoverlapping regions of Y” chromosome

some microdeletions will not have any sperm