Infertility Flashcards
Infertility is attributable to male factor in __% of cases
50
Blood-testis barrier is made up of ____ cells
sertoli
____ cells produce testosterone stimulated by ___ hormone
Leydig…. LH
Sertoli cells are stimulated by ____ hormone
FSH
Semen composition
Seminal vesicles - ___ cc, fructuose, alkaline
Prostate - ____ cc, acidic
Testes - ____ cc
SV - 1.5cc
Prostate - 0.5cc
Testes - 0.1cc
History taking in infertility exam
Prior fertility • Libido/sexual function • Testis pain or swelling • Cryptorchidism • Prior inguinal or scrotal surgery • Brothers’ fertility history
Medications that affect fertility
Calcium channel blockers Gout medications • Cimetidine • Sulfasalazine • Exogenous testosterone
Physical exam for infertility
Body habitus (Klinefelters)
Hair distribution
Gynecomastia
GU exam - testicular size, palpable vas deferens, cryptorchidism, varicoceles
absence of sperm in ejaculate
Azoospermia
Azoospermia with FSH < 7.6 & testes > 4.5 cm
obstructive azoospermia
Low sperm count
Low volume
Low pH
No fructose
Ejaculatory duct obstruction
Endocrine labs for initial infertility workup
AM Testosterone & FSH
Low T
High FSH
High LH
Primary hypogonadism (i.e. testicular failure)
Low T
Low FSH
Low LH
Secondary hypogonadism (hypothalmic issue)
Exogenous testosterone replacement down regulates ___ which down stream leads to inhibition of spermatogenesis
GnRH
Treatment for Hypogonadotrophic Hypogonadism
hCG to stimulate leydig cells
FSH to stimulate sertoli cells
Azoospermia, low T, elevated fsh, atrophic testes
Klinefelter (47XXY)
Imaging for ___ anomalies should be offered in those with unilateral vasal agenesis or CBAVD
renal
Grade ___ varicocele is palpable only with valsalva
I
Grade ___ varicocele is palpable without valsalva
II
Grade ___ varicocele is visible on exam
III
Criteria to intervene on varicocele
Infertility, testicular size differential
