Campbell Male Infertility 2021 Flashcards
Semen analysis should be done ___ days after ejaculation.
Increase probability of conception, frequency of intercourse: ___
Female fecundity declines after age: ___
1-2 days after ejaculation.
intercourse every day around the time of ovulation is likely the best strategy
Age 35
TRUE or FALSE
Cancer can negatively affect spermatogenesis, with or without spermatotoxic chemotherapy.
TRUE. Especially if the cancer is of testicular origin.
TICS
Toxins
Infectious/inflammatory disease
Childhood history
Sexual History
Toxins that interfere with spermatogenesis, sperm function, and sperm delivery
Antiandrogens: bicalutamide, flutamide, nilutamide Anti-HTN: spironolactone Anti-retroviral: indinavir Stavudine Corticosteroids or exogenous estrogen
Exogenous testosterone reduces spermatogenesis by: ___
Conversion to estradiol (by aromatase) –> inhibition of LH secretion by the pituitary –> reduces spermatogenesis
Opioid abuse can cause : __ which can negatively affect spermatogenesis.
Hypogonadotropic hypogonadism
Men should be encouraged to ___ before undergoing oncologic therapy.
Childhood RT doses of ___ lessened chances of having future offspring.
Crypopreserve sperm
7.5 Gy and above
Scrotal temperature is ___ below core body temperature, due to countercurrent heat exchange.
2-4 degrees Celsius
Consuming locally grown produce, effects:
Lower serum free testosterone, LH, and sperm concentration and normal sperm morphology
Hydrocele and hernia surgery during childhood can cause: ___
Vasal obstruction
** vasal occlusion as a result of inflammation associated with this material should be considered in an infertile man
Approximately ___ of men with torsion will have sperm counts below 20 mL/min.
36-39%
** Torsion disrupts intratesticular architecture inc. Sertoli cells in the blood-testis barrier –> 11% develop antisperm antibodies
Unilateral cryptorchidism, treated paternity rate: ___
Bilateral, treated, paternity rate: ___
96%
70%
Recommend orchidopexy before ___ age from a reproductive perspective.
10 years of age
Male obesity causes reproductive by: ___
overabundance of adipose cells that contain the enzyme aromatase –> peripheral conversion from testosterone –> elevated estradiol
Measurement of the testis: ___ cm is associated with spermatogenic impairment.
A volume of ___ mL is considered low
=< 4.6 cm
=< 20 mL
What is Meacham’s maxim?
Search for the vas as if perform- ing the first step of a vasectomy, bringing it to the surface of the skin.
If what is presumed to be the vas disappears from the examiner’s fingers three times, the clinician can be confident that the vas is absent.
If unilateral absence of vas deferens –> possibility of ___ and ___.
Consider doing a/an ___.
Wolffian duct development and renal agenesis
Consider doing a renal ultrasound
** In the US: cystic fibrosis gene mutation
Varicocele grading
Grade I, which is palpable only with the patient standing and performing a Valsalva maneuver
Grade II, which is palpable but not visible;
Grade III, a varicocele that is so large as to be visible by the examining physician through the rugae of the scrotum
Palpable seminal vesicles may suggest: ___
Engorgement and possible ejaculatory ductal obstruction
** seminal vesicles cannot typically be palpated
Endocrine evaluation should be done in men with ___
All men with infertility, even those in whom sperm density is greater than 20 million/mL
Lower limit for concentration of bioavailable testosterone
164 ng/dL
** 54.5 % of 300 ng/dL (54-68% bound to albumin)
Conditions with decreased SHBG (Sex Hormone–Binding Globulin)
Obesity Nephrotic syndrome Hypothyroidism Glucocorticoids, progestins, and androgenic steroid therapy Acromegaly Diabetes mellitus
Conditions with INCREASED SHBG (Sex Hormone–Binding Globulin)
Aging Hepatic cirrhosis and hepatitis Hyperthyroidism Anticonvulsant therapy Estrogen therapy Human immunodeficiency virus disease
Pituitary hypoandrogenism causes LH to ___.
Leydig cell hypoandrogenism causes LH to ___.
Pituitary: LH decreases
Leydig cell dysfunction: LH is elevated to varying degrees
