Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ELS/ALS Exam Review > Andrology > Flashcards

Andrology Flashcards

1
Q

What are seven sperm tests which have had decreased clinical usage after the development of ICSI?

A
  1. Hypo-Osmotic Swelling Test
  2. Cervical Mucus/Sperm Interaction Assays
  3. DNA Damage/Fragmentation
  4. Acrosome Reaction Assays
  5. Sperm Zona Binding Assays
  6. Sperm Penetration Assay (SPA or Zona Free Hamster Oocyte Penetration Assay)
  7. Sperm FISH (Fluorescence In Situ Hybridization) for Chromosome Aneuploidy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is the Hypo-Osmotic Swelling sperm test quality-controlled?

A

New batches of HOS solution should be checked against the old batch, and scores should not be significantly (p>0.05) different (by paired t-test) before reagents should be accepted for use. If the difference is significant, then discard the new batch and prepare another solution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is the DNA Damage/Fragmentation sperm test quality-controlled?

A

The tests require the use of both normal control semen from a fertile male and sperm with damage (for example after exposure to hydrogen peroxide). The normal range for each test and each laboratory should be determined individually with analysis of a cohort of fertile men, definition of the mean and 2 standard deviations below the mean.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is the Acrosome Reaction Assay sperm test quality-controlled?

A

Sperm are assessed before and after exposure to an agent that induces the acrosome reaction (progesterone, AG23187) and staining. The staining patterns observed include a cap, equatorial band and black appearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is the Sperm Zona Binding Assay sperm test quality-controlled?

A

The use of known normal fertile sperm and zone are required for this test and its proper interpretation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is the Sperm Penetration Assay sperm test quality-controlled?

A

The development of a quality control system for this bioassay was critical to its clinical success. Cryopreserved aliquots of semen from men in the normal and abnormal ranges of sperm penetration tested sequentially in each successive assay allows routine methods of quality assessment to ensure the assay is in control and reproducible over time. A statistically determined normal range determined by analysis of a cohort of proven fertile men is necessary. The use of a fresh semen sample in each assay from a known fertile donor is a requirement as well.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is the Sperm FISH sperm test quality-controlled?

A

A large body of literature shows low levels of chromosome aneuploidy in sperm of normal men. Each laboratory must determine their own normal ranges by analysis of a large cohort of proven fertile men and large numbers of sperm counted. Each assay must include both positive and negative assay as well as sample controls.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is the Sperm FISH sperm test quality-controlled?

A

A large body of literature shows low levels of chromosome aneuploidy in sperm of normal men. Each laboratory must determine their own normal ranges by analysis of a large cohort of proven fertile men and large numbers of sperm counted. Each assay must include both positive and negative assay as well as sample controls.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Of the seven rarely performed sperm tests, which is the most simple and what question does it answer?

A

The Hypo-Osmotic Swelling Test; determines whether immotile sperm are alive with an intact membrane and immotile or whether they are dead (a viability test for immotile sperm).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is the Hypo-Osmotic Swelling Test different than a sperm viability test (with a live/dead stain)?

A

The former specifically represents a test of viability when immobility is present and differs from a live/dead stain in that the latter only measures whether the sperm membrane is physically disrupted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the premise behind the Hypo-Osmotic Swelling Test?

A

Based upon the premise that when placed in a hypo-osmotic condition (150mOsm/L or less), a normal, live sperm maintains an osmotic gradient and absorbs fluid resulting in a swelling of the plasma membrane resulting in the curling of the tail in a lollipop like manner. One study described a test based upon this principle that showed a normal ejaculated semen sample has >60% viability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain the units “mOsm/L.”

A

Osmolarity is the number of milliosmoles/liter (mOsm/L) of solution. It is the concentration of an osmotic solution. This is the common bedside calculation used in clinical settings for osmotic activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define “hypo-osmotic.”

A
  1. Of, relating to, or characterized by having a lower osmotic pressure than a surrounding fluid under comparison.
  2. A condition in which the total amount of solutes (both permeable and impermeable) in a solution is lower than that of another solution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is sperm motility acquired?

A

During its passage through the epididymis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How may a completely immotile (not even twitching) TESE sample be successfully used for ICSI?

A

By individually picking up the sperm and placing it in a hypotonic solution, and noting that any swelling indicates sperm viability. These sperm can then be immediately placed in an injection medium and used for ICSI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is a sperm sample considered normal or abnormal according to a Hypo-Osmotic Swelling Test?

A

The HOS test is normal if >60% of the sperm in the semen exhibit tail swelling when placed in the hypotonic solution. A score of <50% is considered abnormal. The percentile of spermatozoa with curled tails in the untreated sample should be subtracted from the percentage obtained after treatment to obtain the actual percentage of spermatozoa that reacted in the HOS test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the three things needed to perform the Hypo-Osmotic Swelling test and it is considered (relatively) easy to incorporate into the clinical setting?

A
  1. Microscope
  2. Scale
  3. Consumables
    Yes; it’s considered easy to incorporate clinically.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does the WHO suggest in reference to the Hypo-Osmotic Swelling test?

A

That this test might be considered a useful adjunct to viability testing rather than a sperm function test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When should the Post-Coital Test be performed?

A

In the early stages of infertility investigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the Post-Coital Test also called?

A

Sims-Huhner Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the two purposes of the Post-Coital Test?

A
  1. To determine the number of active sperm in the cervical mucus as a result of coitus
  2. To evaluate sperm survival and behavior many hours after coitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When should the Post-Coital Test be performed?

A

As closely as possible to the time of ovulation, 9-24 hours post-coitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What three pieces of instruction are patients given prior to the Post-Coitus Test?

A
  1. Abstain for ~2 days
  2. Have intercourse the night before the scheduled day of the PCT
  3. Not use vaginal lubricants or douches or baths after intercourse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is cervical mucus retrieved for the Post-Coital Test?

A

The physician inserts a speculum into the vagina and aspirates a sample of the fluid pool in the posterior vaginal fornix using a syringe (without a needle) or a pipe or a polyurethane tube. Then, with a different syringe/catheter, he/she aspirates a sample of mucus from the endocervical canal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is done with the sample retrieved from a Post-Coital Test?

A

It’s placed on a glass slide with a cover slip and examined under phase-contrast microscopy at 200X to 400X.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What two things may fewer than 5 sperm/hpf with less than 2+ (b) sperm motility on a Post-Coital test indicate?

A
  1. Oligozoospermia and/or

2. Abnormal cervical mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

For what three reasons do some investigators consider a Semen Analysis the “neglected test?”

A
  1. Lack of standardization
  2. Wife variation in results among and between laboratories
  3. Apparent need for increased quality control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

The most recent editions of the WHO manual recommend that semen samples should be collected after a minimum of what but not longer than what days of abstinence?

A

48 hours; 7 days, respectively.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why should two or three samples be collected for patients seeking a semen analysis?

A

Due to sometimes large within subject variation observed in semen parameters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

For what two reasons should coitus interruptus be avoided as a method of semen collection prior to analysis?

A
  1. Withdrawal methods of collection often result in lost sample.
  2. Specimens collected by this method will sometimes contain epithelial cells, which are of vaginal origin.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Why are “split ejaculate” collection techniques rarely used now?

A

Improved sperm wash, gradient, and centrifuge procedures can be used to isolate sperm-rich portion of ejaculate instead.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What should lubricants be tested for prior to use for semen collection?

A

Sperm toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

For what four reasons is collection in the laboratory considered superior to home collection?

A
  1. Allows a controlled environment for collection,
  2. Ensures that patient uses proper collection containers provided by the laboratory,
  3. Aids in identification of individual producing the specimen
  4. Avoids transportation problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why should patients be asked if any problems occurred while collecting semen specimens?

A

In case any ejaculate was lost during collection, which could result in artificially reduced semen volume or sperm count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How often should collection cups be tested for sperm toxicity?

A

Every time a change in container or lot occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What five steps are needed to test a container for sperm toxicity?

A
  1. Obtain a sample from a normal donor in an approved, previously tested container.
  2. Place half of the ejaculate into the new container to be tested.
  3. Incubate both containers either in an environmentally controlled incubator (preferred) or at room T.
  4. Remove an aliquot from each container at various times (i.e., 30 minutes, 1, 2, 4, 6 and 8 hours) and comparing motility.
  5. Percent motility should be roughly equivalent, and if not, the new container fails toxicity testing and should not be used. Each laboratory should establish written procedures for toxicity testing and for acceptable ranges of comparison.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a spermicidal agent?

A

A material that is toxic to sperm

38
Q

According to the WHO manual, semen volume should be measured according to the what of the specimen, as opposed to the what?

A

Weight, as opposed to the measured volume (stupid, I know)

39
Q

When should a semen analysis be performed?

A

30min-1hr of collection

40
Q

Semen is normally ejaculated in what form and why?

A

As a coagulum controlled by secretions from the seminal vesicles

41
Q

How long does it take for ejaculated semen to liquify and why?

A

0.5-1hr controlled by secretions from the prostate

42
Q

Hyperviscosity of semen can impair accurate measurements of what three things?

A
  1. Motility
  2. Kinetics
  3. Count
43
Q

Hyperviscosity can be treated chemically using what two things?

A
  1. Alpha-amylase

2. Chymotrypsin

44
Q

How can hyperviscosity be mechanically reduced and what drawback is there to this method?

A

By passing the sample through an 18g needle several times; but this can artificially reduce sperm motility and should be noted on the semen analysis report form.

45
Q

Define “Hypospermia.”

A

Reduced semen volume (lower than 1.5mL, according to the WHO 5th ed., and lower than 2.0mL according to the WHO 4th ed)

46
Q

What are three possible reasons for hypospermia?

A
  1. Collection error
  2. Reduced abstinence
  3. Ejaculatory dysfunction
47
Q

Define “Aspermia.”

A

No semen

48
Q

What can cause Aspermia and what should be done after finding it?

A

Retrograde ejaculation and should be followed by a postejaculation urine analysis to check of the presence of sperm in urine

49
Q

Define “hematospermia.”

A

A pinkish color to the semen, most probably indicating the presence of blood and can be seen during the microscopic analysis

50
Q

Abnormal semen pH can be indicative of what and why?

A

Secondary sex gland dysfunction (since secretions from the prostate and seminal vesicles contribute to seminal pH)

51
Q

What five things should be noted if found in addition to sperm on the wet mount analysis?

A
  1. Epithelial cells
  2. Bacteria
  3. Trchomonas
  4. Gross microscopic debris, like spermine crystals
  5. Round cells (immature germ cells or WBC)
52
Q

List the degrees and sites of attachment the WHO 5th ed. uses to grade sperm agglutination.

A

GRADE 1: Less than ten sperm per agglutinate; many free sperm
GRADE 2: 10-50 sperm per agglutinate; free sperm
GRADE 3: agglutinates of more than 50 sperm; some sperm still free
GRADE 4: all sperm agglutinated and agglutinates interconnected
GRADE A: head-to-head
GRADE B: tail-to-tail
GRADE C: tail-tip-to-tail-tip
GRADE D: mixed (some clear head-to-head and tail-to-tail)
GRADE E: tange (heads and tails enmeshed; heads are not clear of agglutinates as they are in tail-to-tail)

53
Q

Explain the Subjective Scale for measuring Semen Viscosity.

A

NORMAL = Semen drawn into pipet easy; released in distinct drops
1 + = Semen released with slight stringing
2 + = Semen released with moderate stringing
3 + = Semen difficult to draw into pipet. Release requires pressure. No distinct drops.
4 + = Semen cannot be drawn into pipet. Semen pours as solid mass.

54
Q

How often should semen be checked for liquefaction?

A

Every 30 minutes

55
Q

Nonliquifaction of semen can be caused by what?

A

Prostatic dysfunction

56
Q

The thread of an abnormally viscous sample of semen will be how long from the plastic pipet to the specimen cup it is being pipetted into?

A

Greater than 2cm long

57
Q

What five things (besides motility/count/kinetics) should a wet mount of semen be used to look for?

A
  1. Epithelial cells
  2. Bacteria
  3. Trichomonas
  4. Any gross microscopic debris (spermine crystals, etc.)
  5. Round cells
58
Q

Differentiation of what two types of round cells should never be made on an unstained specimen?

A
  1. Immature germ cells

2. White blood cells

59
Q

Explain the Subjective Scale for Reporting Sperm Agglutination.

A 
ABSENT = No agglutination observed.
1+ = Occasional sperm agglutinated
2+ = 25% or less of sperm agglutinated
3+ = 25-50% of sperm agglutinated
4+ = Gross agglutination; few free swimming sperm
60
Q

Explain the WHO 5th Ed. Methodology for grading sperm agglutination.

A

GRADE 1 = Isolated (Less than ten sperm per agglutinate, many free sperm)
GRADE 2 = Moderate (10-50 sperm per agglutinate, free sperm)
GRADE 3 = Large (agglutinates of greater than 50 sperm, some sperm still free)
GRADE 4 = Gross (all sperm agglutinated and agglutinates interconnected)
GRADE A = Head-to-head
GRADE B = Tail-to-tail
GRADE C = Tail-tip-to-tail-tip
GRADE D = Mixed (come clear head-to-head and tail-to-tail)
GRADE E = Tangle (heads and tails enmeshed; heads are not clear of agglutinates as they are in tail-to-tail)

61
Q

What are three objective ways of measuring sperm motility?

A
  1. Makler
  2. Disposable counting chambers
  3. CASA
62
Q

What three terms does the WHO 5th Ed. recommend using to describe sperm motility?

A
  1. PR (Progressive) = sperm moving actively, either linearly or in a large circle
  2. NP (Non-Progressive) = all other patterns of motility with absence of progression
  3. IM (Immotility) = no movement
63
Q

For what and when should eosin staining be used in a semen analysis, according to WHO 5th Ed.?

A

To determine sperm viability when motility is less than 30% or 40% progressively motile

64
Q

Eosin staining is one way to differentiate between what two causes of immotile sperm?

A

Necrozospermia vs. immotile cilia syndrome (Kartagener syndrome)

65
Q

The WHO 5th Ed. suggests lowering the reference limit for normal motility of sperm from what to what?

A

From 50% in previous editions, to 40% (PR and NP) and 32% (PR only).

66
Q

Define “asthenozoospermia.”

A

Decreased sperm motility (less than 50% motility).

67
Q

What are three possible causes of a post-semen analysis diagnosis of asthenozoospermia?

A
  1. Collection error
  2. Presence of a varicocele
  3. Idiopathic reasons
68
Q

What does sperm “kinetics” refer to?

A

The ability of the sperm to move in a forward, progressive manner; velocity

69
Q

Explain the Subjective Scale for Reporting Sperm Kinetics.

A

0 or “None” = No forward progression
1 or “Poor” = Weak, sluggish, forward or random progression
2 or “Fair” = Moderate, forward, unidirectional progression
3 or “Good” = Good forward unidirectional progression
4 or “Excellent” = Rapid forward unidirectional progression

70
Q

What are three advantages of using CASA?

A
  1. Increased objectivity and consistency of measurements
  2. Increased accuracy and precision of analysis
  3. Provides a description of vigor (velocity and tail beat frequency) and pattern of motion linearity, and amplitude of lateral head displacement)
71
Q

What are three disadvantages of using CASA?

A
  1. Can overestimate or underestimate sperm counts
  2. Sperm counts should be between 20-50 million/mL for accurate analysis. Counts outside this range may require dilution to bring the counts “in range” of the system.
  3. Requires extensive QC to demonstrate accuracy and precision
72
Q

For what six aspects of sperm kinematics does the CASA provide objective measurements?

A
  1. Curvilinear velocity (VCL)
  2. Average path velocity (VAP)
  3. Straight-line velocity (VSL)
  4. Linearity (straightness) = VSL/VCL
  5. Amplitude of lateral head displacement (ALH)
  6. Beat/cross frequency (BCF)
73
Q

What does “Curvilinear velocity” of sperm refer to?

A

Point-to-point cell speed calculated on sequential frames is the closest to the actual path velocity

74
Q

What does “Average path velocity” of sperm refer to?

A

Velocity along the “average” path of sperm travel; smoothed curial mean velocity

75
Q

What does “Straight-line velocity” of sperm refer to?

A

The straight line distance traveled between start and end of the observed computerized (CASA) track

76
Q

What does “linearity,” or “straightness,” of sperm refer to?

A

VSL divided by VCL; low score indicates circular motion, high score indicates forward progression of sperm on CASA

77
Q

What does “Amplitude of lateral head displacement” of sperm refer to?

A

Average side-to-side displacement distance of the head; Capacitated sperm will have a high ALH.

78
Q

What does “Beat/cross frequency” of sperm refer to?

A

Indirect measure of flagellar beat frequency

79
Q

What is the oldest and most widely used method of counting sperm?

A

Hemocytometer

80
Q

The WHO 5th ed. recommends using what for counting sperm?

A

100micrometer deep hemocytometer

81
Q

What are the six steps for properly using a hemocytometer?

A
  1. Prepare a 1:20 dilution of semen sample using water. Although formalin is recommended by some as a diluent, water is more convenient.
  2. Mix thoroughly.
  3. Fill both sides of the chamber with the diluted sample.
  4. Allow preparation to settle (5 min.).
  5. Count all sperm within the 5 red blood cell (RBC) squares; count both sides of the chamber and take the average.
  6. If using a 1:20 dilution, the average number will represent sperm in millions/mL.
82
Q

When was the Makler chamber developed?

A

1980’s

83
Q

What are the four steps to properly using a Makler chamber?

A
  1. Place one drop (5-10micrometers) onto the center of the lower disk.
  2. Place the cover glass on the chamber. This cover glass contains the counting grid.
  3. Count the number of sperm in 10 squares.
  4. The number counted is sperm in millions/mL.
84
Q

What does the suffix “-spermia” refer to in Semen Analysis nomenclature?

A

Refers to semen

85
Q

What does the suffix “-zoospermia” refer to in Semen Analysis nomenclature?

A

Refers to sperm

86
Q

Define “Aspermia.”

A

No ejaculate volume

87
Q

Define “Hyperspermia.”

A

Increased ejaculate volume

88
Q

Define “Hypospermia.”

A

Decreased ejaculate volume

89
Q

Define “Pyospermia.”

A

Presence of WBCs in semen

90
Q

Define “Hematospermia.”

A

Presence of RBCs in semen

ELS/ALS Exam Review (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions