Disorders of Male Reproduction Flashcards
What percentage of inability conceive can be contributed to male infertility?
40-50% of couples with infertility, the male is the sole cause or contributes to the cause of infertility
Describe the cells and their respective products that are stimulated by LH and FSH.
FSH stimulates stertoli cells that produce sperm
LH stimulates Leydig cells that produce testosterone
Contrast the presentation of pituitary disease in pre-puberty v. post puberty.
pre-pubertal: dx due to growth retardation, delayed puberty or adrenal and thyroid deficiency, testes are small and soft
post-pubertal: symptoms of specific hormone deficiency/excess, mass effects or symptoms of underlying process, testosterone is low and Gn levels are inappropriately low, testes are small and firm
What are the features of Kallman Syndrome?
congenital hypogonadotropic hypogonadism, with anosmia presenting with delayed puberty; cryptorchidism and gynecomastia
What are the treatments used in Kallman Syndrome?
testosterone replacement used to achieve virilization, if fertility is desired, exogenous gonadotropins are used (more difficult regimen, more expensive)
What sources can cause androgen excess and what is the result?
exogenous anabolic steroid (abuse)- all administered testosterone is a male contraceptive
androgen-producing tumor
both lead to testicular hypo function by lowering FSH and LH via negative feedback
Will someone with congenital adrenal hyperplasia have a high or low ACTH? What is the tx for CAH?
21-hydroxylase deficiency results in decreased cortisol synthesis and an increase in ACTH (steroids are shunted to androgen pathway)
patients can be treated with glucocorticoids and Gn secretion will resume
What are possible causes of excess estrogen?
tumors in the adrenal cortex
Stroll or Leydig cells of the testis
Hepatic dysfunction, excess alcohol use
obesity- peripheral aromatase
How is AIS inherited? What would you expect for LH and testosterone levels?
x-linked recessive
elevated LH and testosterone levels (no feedback)
FSH are normal or high
(broad range of phenotypes from phenotypic females to phenotypic males)
What would you expect of hormone levels in a patient with Klenfelter’s syndrome? What are common features?
syndrome of hypogonadism: low testosterone, elevated FSH and LH, high estrogen/testosterone ratio (not absolute estrogen); small firm testis and azoospermia
variable phenotypes, long limbs, breast development
Are patients with Klinefelter’s Syndrome able father children?
no therapy available to improve spermatogenesis
microsurgical testicular sperm extraction (TESE) has been performed and sperm have been used in IVF with ICSI
What chromosomal deletions can lead to infertility and what are the features of this syndrome?
deletions in the long arm of the Y chormosome AZFa, AXFb and AZFc occur de novo and are not inherited (unless through IVF)
males are phenotypically normal without other known problems; sperm are found in 50% of men with AZFc with testicular biopsy (are candidates for IVF, ICSI), sperm are never seen in patients with AZFb variant
Describe the TESE procedure.
can be done in-office
cord block is usually used for anesthesia
IV sedation can be given to relax patient
What are the sequalae of cryptorchidism?
low sperm counts in 50% with bilateral, 25% in unilateral; the higher the testis, the more severe the testicular dysfunction
germ cells absent in 20-40% of inguinal testes and 90% of intra-abdominal testes, although 80-90 with surgically corrected unilateral cryptorchidism or 30-50% with corrected bilateral cryptorchidism
How common is varicocele?
abnormal toruosity and dilation of the testicular veins is seen in 15-20% of all men and in 40% of men presenting with infertility
*most common correctable cause of male infertility
