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RDS Test 1 > B8.010 Prework 1: Evaluation of Male Infertility > Flashcards

B8.010 Prework 1: Evaluation of Male Infertility Flashcards

1
Q

definition and incidence of infertility

A

inability to achieve pregnancy with times intercourse for at least 1 year
10-15% of married couples are affected

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2
Q

sperm head

A

nucleus: takes DNA to egg
acrosome: contains enzymes that allow the sperm to enter the egg

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3
Q

sperm tail

A

propels sperm

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4
Q

steps of spermatogenesis

A
  1. spermatogonial cell multiplication and proliferation at the base of the seminiferous tubules produce primary spermatocytes
  2. primary spermatocytes undergo meiotic division to form secondary spermatocytes
  3. a second meiotic division produces haploid round spermatids
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5
Q

spermiogenesis

A

4th step of spermatogenesis where remodeling of nuclear and cytoplasmic components render spermatozoa

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6
Q

steps required for male normal fertility

A

healthy sperm production
normal ejaculation
adequate sperm number and sperm morphology
normal sperm function: motility

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7
Q

general alterations involved in male infertility

A
  1. defective sperm production
  2. reproductive tract obstruction
  3. sexual disorders, erectile, and ejaculatory dysfunctions (delayed, premature, and retrograde ejaculations)
    * *great amount is idiopathic**
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8
Q

relevant components of medical history to infertility diagnosis

A

sexual history, coital frequency and timing
duration of infertility and prior fertility
childhood illnesses and developmental history
systemic medical illnesses
prior surgeries
toxin/lifestyle exposures/habits
medications

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9
Q

diagnostic testing for male infertility

A

sperm analysis, blood tests, imaging

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10
Q

low volume of semen

A

test for obstructions or retrograde ejaculation

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11
Q

no sperm

A

testicular biopsy

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12
Q

sperm number, morphology, and function defects

A

hormonal tests

check for varicocele, hormones

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13
Q

steps of semen analysis

A
  1. confirm length of abstinence (2-5 days)
  2. produce semen sample (on site preferred)
  3. perform basic semen analysis, minimum of 2 samples should be analyzed
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14
Q

normal volume of ejaculate

A

> 1.5 mL

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15
Q

color of ejaculate

A

whitish, opalescent

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16
Q

ejaculate liquefaction

A

complete within 30 min

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17
Q

ejaculate pH

A

7.2-8.0
infection = basic pH
obstructive azoospermia = acidic pH

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18
Q

normal total sperm #

A

> 39 million

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19
Q

normal sperm concentration

A

> 15 mil per mL

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20
Q

normal sperm vitality

A

> 75%

distinguish live/dead with cell dyes

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21
Q

normal sperm morphology

A

> 4% normal

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22
Q

normal total motile sperm

A

> 40 million

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23
Q

normal total sperm motility

A

> 40%

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24
Q

normal total progressive sperm motility

A

> 32%

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25
Q

normal WBCs in sperm

A

<1 mil

more = chronic inflammation

26
Q

aspermia

A

no ejaculate

27
Q

hypospermia

A

low ejaculate volume

28
Q

azoospermia

A

no spermatozoa in ejaculate

29
Q

oligospermia

A

< 15 mil sperm/ ejaculate

30
Q

asthenozoospermia

A

low sperm motility

31
Q

teratospermia

A

low sperm motility

32
Q

CASA

A

computer sperm analysis for sperm motility

can measure total and different patterns of sperm motility in multiple spermatozoa simultaneously

33
Q

when to do an endocrine evaluation

A

if an abnormal semen analysis
if impaired sexual function
if other clinical findings of endocrinopathy
if patient is taking testosterone or anabolics

34
Q

tests for male endocrine evaluation

A

FSH, LH, T, prolactin

35
Q

genetic testing for male infertility

A

karyotype
Y chromosome microdeletion (AZF)
cystic fibrosis testing
klinefelter (XXY, hypogonadism)

36
Q

transrectal US

A

images prostate, seminal vesicles and vas deferens

rule out obstructive infertility

37
Q

scrotal US

A

for varicocele, epididymal abnormalities, undescended testis

38
Q

anti-sperm antibodies

A

presence indicates autoimmune infertility

39
Q

absent seminal fructose

A

indicates seminal vesicle issues, or duct obstruction

40
Q

sperm-zona binding test

A

hemizona assay

measures binding to isolated ZP and this is compared to normal donor sperm

41
Q

sperm penetration test

A

measured with hamster oocytes freed of ZP

42
Q

medications which can cause male infertility

A 
T replacement therapy
anabolic steroid use
chemotherapy
certain antifungal meds
some ulcer drugs
recreational drugs
43
Q

idiopathic male infertility

A

65+% of infertile males

44
Q

environmental causes of male infertility

A

industrial chemicals
heavy metal exposures
radiation or xrays
overheating the testicles

45
Q

ejaculation issues

A

retrograde ejaculation caused by diabetes, spinal cord injuries, medications, and surgery of the bladder, prostate, or urethra

46
Q

genetic causes of male infertility

A 
chromosomal defect/genetics
klinefelters syndrome
CF
kallmanns 
kartageners
47
Q

other pathological causes of male infertility

A 
infection: orchitis, epididymitis, STIs
hormone imbalances
DM
hypothyroidism
undescended testicles
varicocele
testis tumors
antisperm antibodies
48
Q

what is a varicocele

A

dilation and tortuosity of the internal spermatic veins (pampiniform plexus) that drain the testis and are within the spermatic cord

49
Q

testicular venous drainage

A

veins of pampiniform plexus ascend and pass along the inguinal canal
merge to form the testicular vein, which opens on the R into the IVC (at an acute angle) and on the L side into the L renal vein (at a right angle)

50
Q

development of varicocele

A

commonly develops during puberty
affects 15% of males
most are L sides, 1% right sides and 1% bilateral
40% of men with primary infertility

51
Q

presentation of varicocele

A

most asymptomatic, sometimes scrotal pain
most common symptom is infertility
“bag of worms”

52
Q

labs associated with varicocele

A

volume is at normal levels
sperm count is reduced <15 mil sperm/ejaculate
normal morphology is below 4%
sperm motility is reduced
no infection of the male reproductive tract

53
Q

pathophys of infertility in varicocele

A

associated infertility appears to be due to alteration of spermatogenesis and the function of Leydig cells, secondary to the increase in testis temperature, venous pressure, and hypoxia

54
Q

varicocele treatment

A

surgical hydrocelectomy offers the most definitive treatment

55
Q

indications for varicocele surgery

A

female partner has normal fertility or a reversible cause of infertility
varicocele is palpated or corroborated by ultrasound
male partner has one or more abnormal semen parameters

56
Q

varicocele surgery goals and outcomes

A

ligation of the internal spermatic veins with preservation of the lymphatics
70% of cases have improvement of the semen quality and 30-35% natural pregnancy rates

57
Q

complications of varicocele surgery

A

testicular hydrocele
occlusion of internal spermatic lymphatic channel during vein ligation during varicocele surgery
lack of drainage and fluid accumulation in scrotum

58
Q

treatment for obstructive, undescended testis, or varicocele causes of infertility

A

surgery

59
Q

treatment for absence of ductal system

A

sperm retrieval from testis or epididymis

  • IVF
  • ICSI
60
Q

low sperm quality but good numbers

A

intrauterine insemination

RDS Test 1 (22 decks)

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