Disorders of Male Reproduction Flashcards
1,2,3 causes of male infertility
#1 is idiopathic #2 is varicocele #3 is obstruction
Which cells do FSH and LH act on?
- fSh → Sertoli cells. SS.
* Lh → Leydig cells. LL.
Kallmann syndrome
Presentation
Genetics
Treatment
- Presents w/ cryptorchidism, delayed puberty, micropenis (50% of the time) and gynecomastia. Pxs may be tall due to delayed closure of the epiphyseal plates.
- May be X linked (KAL gene), autosomal dominant, or autosomal recessive
- Achieve virilization w/ testosterone replacement. However, this inhibits spermatogenesis, so if px wants a baby, must use gonadotropins instead.
- hCG is LH analog. Usually sufficient.
- FSH is 2nd line and expensive >$100 / week
#1 cause of endogenous androgen excess in males Treatment
CAH
Treat w/ glucocorticoids to lower ACTH
Causes of estrogen excess in males (4)
Sxs (3)
- Etiology: adrenal cortex tumor, sertoli cell / leydig cell tumor, hepatic dysfunction, obesity (aromatase converts androgens to estrogen).
- Sxs – ED, gynecomastia, testicular atrophy
Working up prolactin excess
Test TRH to rule out hypothyroidism (TRH stimulates prolactin secretion). Get MRI of pituitary.
Genetics of androgen insensitivity
X linked
Klinefelter's Levels of FSH, testosterone, estradiol Sxs Diagnosis Fertility therapy
- High FSH and estradiol, but low testosterone.
- Sxs - Delayed puberty, eunuchism, gynecomastia, sexual dysfunction (testes are small / firm; cannot make sperm)
- Diagnosed w/ barr body screening (inactivated X chromosome) and confirmation w/ chromosome analysis.
- No therapy to improve spermatogenesis. TESE (testicular sperm extraction) w/ IVF and ICSI (intracytoplasmic sperm injection) works 50% of the time. Offspring are typically karyotypically normal
3 Y chromosome deletions Which is most common? Which is worst? Inheritance Presentation Treatment
- AZF a / b / c. Azoospermia factor.
- AZFc is most common. Sperm are found in 50% of these men w/ biopsy.
- AZFb is 2nd most common and worst to have. NO viable sperm.
- These most often occur de novo and are usually NOT inherited, however, once present, these deletions WILL be transmitted to male offspring. Genetic counseling.
- Phenotypically normal, except for abnormal spermatogenesis.
- No treatment to improve spermatogenesis, but may use IVF w/ ICSI.
Varicocele How common? Etiology of right sided varicoceles (3) Diagnosis Fertility problems Treatment
- Most common correctible cause of male infertility
- Right sided are rare. May indicate thrombosis or occlusion of vena cava via renal tumor. Associated w/ situs inversus.
- US diagnostic criteria: >3mm in diameter and reversal of flow.
- Associated w/ smaller ipsilateral testes, but repair allows for normalization
- 90% of pxs have decreased sperm motility and 65% have low sperm counts.
- Treat w/ mild inguinal incision and staple shut the veins
Pathophysiology of orchitis
Which diseases cause it? (5)
Fertility treatment
- Interstitial edema and mononuclear infiltration results in atrophy of the seminiferous tubules.
- Severe bilateral orchitis may cause hyperonadotropic hypogonadism and gynecomastia.
- Caused by mumps, syphilis, gonorrhea, leprosy, and mono
- May use TESE w/ IVF / ICSI for fertility.
Which testicular cells are more / less resistant to radiation?
Spermatids are more resistant than spermatogonia or spermatocytes. Leydig cells also quite resistant, so testosterone levels are typically normal.
Side effects of heavy marijuana use (4)
Decreased testosterone, gynecomastia, low sperm, and pyospermia (inflammatory cells in semen are oxidants → damaged sperm)
What does cocaine due to fertility?
Low sperm counts
Meds that act as gonadotoxins (7)
Diuretics, spironolactone, CCBs, AB’s, sulfasalazine, cimetidine, opiates
