6 - Infertility Flashcards
Definition of infertility (he said this was a test q)
A couple’s inability to conceive a child after 1 yr of sex w/o contraceptives
1 yr!!!
Types of male infertility?
Hypothalamic-pituitary disease (1-2%)
Testicular disease (primary testicular defect 30-40%)
Post-testicular defects (sperm transport 10-20%)
Idiopathic (40-50%)
What is oligozoospermia?
Presence of <15 million sperm/mL in the ejaculate
Azoospermia definition?
Complete absence of sperm
History factors for infertility?
Prior testicular insults Infections Environmental factors - heat, radiation, chemo, pesticide Meds Drugs/etoh/tobacco/pot Surgical hx
Med effects on sperm can be?
Affect spermatogenesis
- testosterone, finasteride, SSRI
Affects sperm motility
- sulfasalaxzine, nitrofuratonin
Cause retrograde ejaculation
- tamsulosin
Lowers FSH
- phenytoin
Loss of libido, ha, visual probs, galactorrhea can indicate?
Pituitary tumor
Medical/surgical hx that effects fertility?
Varicocele - motility/morphology Obesity Cardiovascular Thyroid Liver disease Radical pelvic or retoperitoneal surg
When doing an infertility work up you should ask?
Sexual function Freq and timing of intercourse Lubricant use Previous fertility Previous infertility workup Parter age (>35)
Features of hypogonadism on PE?
Underdeveloped sex characteristics
Diminished male hair
Body habitus/obesity
Gynecomastia
PE for infertility must check?
Hypogonadism
Penis
Scrotum
Prostate
Labs for infertility - normal results you should?
Repeat (min 2 samples on 2 occasions 60 days apart)
Semen analysis abnormal results, you should?
Low ejaculate (<1.5 mL) - post ejaculate urine sample (for sperm)
Abnormal sperm (<15 million)
- repeat
- LH, FSH, testosterone, prolactin
Semen analysis bottom line?
1st result -> confirm w 2nd
If same - done
If different - get a 3rd test
2 results to confirm
Genetic testing for infertility?
If sperm concentration <10 million/mL or azoospermia
Test for Y chromosome microdeletions and karyotypic abnormalities (i.e. klinefelters syndrome)
Special tests for infertility
Low motility
- test for sperm vitality and autoantibodies
- if round cells >1 million/mL -> leukocyte esterase or peroxidase staining
- testicular biopsy
Infertility imaging?
Scrotal US
TRUS
MRI
Infertility tx
ID and treat underlying cause
Patient education
- time intercourse
- avoid all lubes
Healthy lifestyle habits
Stop offending meds
Avoid gonadotoxin exposure
If tx cant fix infertility?
Refer to fertility specialist for assisted reproductive techniques
Adoption education
Success rate for infertility cases?
Up to 25% of infertility cases will remain unresolved/unexplained after appropriate workups have been completed
You’re american when you go into the bathroom
You’re american when you come out
What are you when you’re in the bathroom?
European
