Campbell Male Infertility 2021 Flashcards

1
Q

Semen analysis should be done ___ days after ejaculation.
Increase probability of conception, frequency of intercourse: ___
Female fecundity declines after age: ___

A

1-2 days after ejaculation.

intercourse every day around the time of ovulation is likely the best strategy

Age 35

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2
Q

TRUE or FALSE

Cancer can negatively affect spermatogenesis, with or without spermatotoxic chemotherapy.

A

TRUE. Especially if the cancer is of testicular origin.

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3
Q

TICS

A

Toxins
Infectious/inflammatory disease
Childhood history
Sexual History

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4
Q

Toxins that interfere with spermatogenesis, sperm function, and sperm delivery

A
Antiandrogens: bicalutamide, flutamide, nilutamide
Anti-HTN: spironolactone
Anti-retroviral: indinavir
Stavudine
Corticosteroids or exogenous estrogen
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5
Q

Exogenous testosterone reduces spermatogenesis by: ___

A

Conversion to estradiol (by aromatase) –> inhibition of LH secretion by the pituitary –> reduces spermatogenesis

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6
Q

Opioid abuse can cause : __ which can negatively affect spermatogenesis.

A

Hypogonadotropic hypogonadism

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7
Q

Men should be encouraged to ___ before undergoing oncologic therapy.

Childhood RT doses of ___ lessened chances of having future offspring.

A

Crypopreserve sperm

7.5 Gy and above

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8
Q

Scrotal temperature is ___ below core body temperature, due to countercurrent heat exchange.

A

2-4 degrees Celsius

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9
Q

Consuming locally grown produce, effects:

A

Lower serum free testosterone, LH, and sperm concentration and normal sperm morphology

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10
Q

Hydrocele and hernia surgery during childhood can cause: ___

A

Vasal obstruction

** vasal occlusion as a result of inflammation associated with this material should be considered in an infertile man

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11
Q

Approximately ___ of men with torsion will have sperm counts below 20 mL/min.

A

36-39%

** Torsion disrupts intratesticular architecture inc. Sertoli cells in the blood-testis barrier –> 11% develop antisperm antibodies

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12
Q

Unilateral cryptorchidism, treated paternity rate: ___

Bilateral, treated, paternity rate: ___

A

96%

70%

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13
Q

Recommend orchidopexy before ___ age from a reproductive perspective.

A

10 years of age

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14
Q

Male obesity causes reproductive by: ___

A

overabundance of adipose cells that contain the enzyme aromatase –> peripheral conversion from testosterone –> elevated estradiol

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15
Q

Measurement of the testis: ___ cm is associated with spermatogenic impairment.

A volume of ___ mL is considered low

A

=< 4.6 cm

=< 20 mL

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16
Q

What is Meacham’s maxim?

A

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.

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17
Q

If unilateral absence of vas deferens –> possibility of ___ and ___.

Consider doing a/an ___.

A

Wolffian duct development and renal agenesis

Consider doing a renal ultrasound

** In the US: cystic fibrosis gene mutation

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18
Q

Varicocele grading

A

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

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19
Q

Palpable seminal vesicles may suggest: ___

A

Engorgement and possible ejaculatory ductal obstruction

** seminal vesicles cannot typically be palpated

20
Q

Endocrine evaluation should be done in men with ___

A

All men with infertility, even those in whom sperm density is greater than 20 million/mL

21
Q

Lower limit for concentration of bioavailable testosterone

A

164 ng/dL

** 54.5 % of 300 ng/dL (54-68% bound to albumin)

22
Q

Conditions with decreased SHBG (Sex Hormone–Binding Globulin)

A
Obesity
Nephrotic syndrome
Hypothyroidism
Glucocorticoids, progestins, and androgenic steroid therapy Acromegaly
Diabetes mellitus
23
Q

Conditions with INCREASED SHBG (Sex Hormone–Binding Globulin)

A
Aging
Hepatic cirrhosis and hepatitis Hyperthyroidism
Anticonvulsant therapy
Estrogen therapy
Human immunodeficiency virus disease
24
Q

Pituitary hypoandrogenism causes LH to ___.

Leydig cell hypoandrogenism causes LH to ___.

A

Pituitary: LH decreases

Leydig cell dysfunction: LH is elevated to varying degrees

25
Q

FSH + testis size by caliper orchidometer

Obstructive azoospermia: ___

Non-obstructive: ___

A

Obstructive: FSH =< 7.6 IU/L, testis long axis > 4.6 cm

Non-obstructive (spermatogenic dysfunction): FSH > 7.6 IU/L, testis long axis <=4.6 cm

26
Q

Total testosterone to estradiol ratio of ___ is suggested to indicate reproductive dysfunction.

A

< 10:1

27
Q

Initial endocrine screening for male reproductive dysfunction

A
In the morning:
Total testosterone
SHBG
Albumin
LH and FSH (pituitary)
Estradiol (evaluate aromatization)
28
Q

Lower parameter for sperm concentration: ___

Upper parameter: ___

A

Lower: 13.5 million/mL (lower, likely infertile)

Upper: 48 million/mL (greater than this, likely fertile)

29
Q

__ day/s of abstinence optimal for assessing bulk semen parameters.

A

1 day only

30
Q

Threshold value for seminal hypovolemia: ___

If aspermia or seminal hypovolemia –> perform ___ and ___ to detect retrograde ejaculation

A

1.0 mL

Post-ejaculatory UA
TRUS (assess obstruction)

31
Q

Necrozoospermia

A

The condition describing a large number of nonliving sperm

32
Q

Conditions associated with antisperm antibody formation

A
vasectomy
testis trauma
orchitis
cryptorchidism
testis cancer
varicocele
33
Q

Pyospermia threshold (WHO)

A

1 million/mL

34
Q

Genetic disorders affecting the 9 + 2 architecture of cilia (9 peripheral pairs + 2 central pairs of microtubules)

A

Immotile cilia syndrome
Primary cilia dyskinesia (PCD)
Kartagener syndrome: nearly totally immotile but metabolically active

35
Q

Karyotyping should be perfomed in all males with: ___

A
Azoospermia from spermatogenetic dysfunction
Severe oligospermia (< 5 million sperm/mL)
36
Q

Recommend Y chromosomal microdeletion assessment to: ___

A

Azoospermic men before surgical sperm extraction (to counsel on likelihood of retrieval)

**AZFa and AZFb deletions can cause significant pathology = low likelihood of sperm retrieval

37
Q

Globozoospermia

A

A preponderance of sperm with round heads, a condition referred to as globozoospermia, indicates deficient acrosome formation.

TX: IVF with ICSI

38
Q

Varicocele imaging

A

Don’t rely on ultrasound as a necessary diagnostic tool

Varicoceles become palpable at 2.7-3.6 mm
Tx of varicoceles < 3.0 mm = does not improve seminal outcomes

39
Q

Fluid, contrast or otherwise, should NEVER be injected into the vasal lumen in the direction of the epididymis because: ___

A

It will rupture the delicate epididymal tubules

**vasography has been replaced by TRUS and MRI

40
Q

Most commonly identified genetic cause of male infertility

A

Klinefelter syndrome (47, XXY)

** results in azoospermia, small testes, and elevated gonadotropin levels

41
Q

Leydig cell dysfunction: if azoospermia + low testosterone + elevated LH: treatment is ___ if patient desires paternity

A

Surgical sperm extraction

42
Q

Kallman syndrome

A

Decreased pituitary function + anosmia

TX: LH replacement with HCG

FSH replacement with recombinant FSH (rFSH) or hMG

43
Q

Treatment of incomplete form of hypogonadotropic hypogonadism

A

Anti-estrogenic agents to stimulate the pituitary:

Clomiphene citrate
Tamoxifen
Anastrozole
Letrozole

44
Q

In general, mild elevations of prolactin in the range of 20 to 50 μg/L do not warrant further evaluation; if prolactin is significantly elevated, ___ is indicated

A

Cranial MRI

45
Q

Varicoceles negatively affect male reproductive function by: ___

A

Increase in intratesticular temperature secondary to interruption in the countercurrent heat exchange provided in the pampiniform plexus with opposing flow vectors in a central arterial system and surrounding veins

46
Q

Obstruction of the ejaculatory ducts:

A

< 5% of men with azoospermia
Suspect if < 1.0mL volume semen
Imaging: TRUS, MRI, chromotubation, hydarulic measurements
TRUS-guided SV aspiration: =>3 sperm per high-powered field - suggestive of obstruction
TX: TURED if amenable

47
Q

Treatment for retrograde ejaculation

A

Synephrine, pseudoephedrine, ephedrine, or phenylpropanolamine, with approximately one in four patients achieving antegrade ejaculation