Infertility

Question 1

Where does spermatogenesis occur?

Answer 1

Seminiferous tubules

Question 2

Where is testosterone produced?

Answer 2

Leydig cells

Question 3

How is androgen insensitivity syndrome inherited?

Answer 3

X linked recessive

Question 4

Describe Androgen insensitivity syndrome

Answer 4

Testes develop but do not descend, commonly presents at puberty with primary amenorrhoea and lack of pubic hair

Question 5

What happens they are insensitive to testosterone?

Answer 5

Induction of mesonephric duct does not occur

Question 6

What happens in mullerian insensitivity function?

Answer 6

Absent uterus and ovaries

Question 7

What happens if they are insensitive to dihydroxytestosterone?

Answer 7

Female external genitalia with short vagina

Question 8

Where do the testes originate?

Answer 8

Abdominal cavity

Question 9

Describe the origin of the arterial/venous/lymphatic supply to the testes

Answer 9

Testicular artery is a branch of the aorta, lymphatic drainage is to the abdomen and left vein drains to the renal vein and the right vein drains to the IVC

Question 10

Why are the testes outside the body?

Answer 10

Lower temperature

Question 11

What two muscles are involved in the contraction as a result of temperature change?

Answer 11

Dartos - smooth muscle

Cremaster - skeletal muscle

Question 12

What is the name given to undescended testes?

Answer 12

Cryptorchidism

Question 13

When should the testes have descended by?

Answer 13

6-9 months

Question 14

What treatment is available for cryptorchidism?

Answer 14

Orchidoplexy - performed by 12 months because of association with infertility (azoospermia)

Question 15

Why must orchidoplexy be completed by 12 years of age?

Answer 15

Risk of testicular cancer is 6 times higher

Question 16

State the functions of sertoli cells

Answer 16

• forms blood-testes barrier
• provides nutrients
• phagocytosis
• secrete seminiferous tubule fluid
• secrete androgen binding globulin
• secrete inhibin and activin

Question 17

Describe the hormonal pathway from hypothalamus

Answer 17

GnRH

• FSH to sertoli cell which enhances spermatogenesis
• LH to leydig cell which regulates testosterone secretion

Question 18

What male factors aid fertilisation?

Answer 18

Liquified by enzymes in the prostate
Capacitation - biochemical cellular events before fertilisation 
Chemo-attraction to oocyte 
Penetration of cumulus complex 
Acrosome reaction/zona binding 
Fusion with membrane

Question 19

Name four accessory tissues in males what do each of them do

Answer 19

• epididymis and vas deferens (concentrates/stores sperm)
• seminal vesicles (produces semen)
• prostate glands (clot semen and neutralise vagina)
• bulbourethral glands (lubricant)

Question 20

Describe the process of ejaculation

Answer 20

Erection - blood fills with corpus cavernosa
Emission - contraction accessory glands/VD to expell semen
Ejaculation - smooth muscle contraction of urethra and erectile muscles

Question 21

Define infertility

Answer 21

Inability to conceive after 12 months regular intercourse without contraception

Question 22

What percentage of fertility problems are related to the male?

Answer 22

30%

Question 23

What causes male infertility?

Answer 23

Idiopathic 
Obstructive (vasectomy, CF, infection)
Non-obstructive (congenital, mumps, chemo/radiotherapy, tumour, genetic, semen, abnormality, systemic disorder)
Endocrine - hypothalamic tumour, kallman's, pituitary, thyroid disorders, diabetes, androgen insensitivity, steroid abuse, CAH

Question 24

Define the terms;
azoospermia 
asthenozoospermia 
oligozoospermia 
teratozoospermia

Answer 24

no sperm
low motility
low density
abnormal morphology

Question 25

What examination should be done in male infertility?

Answer 25

General

Genital - testicular volume, presence of vas deferens/epididymis, penis, presence of varicocele/other scrotal swelling

Question 26

What is the average testicular volume?

Answer 26

Pre-pubertal 1-3mls

Adults 12-25mls

Question 27

What things does semen analysis assess?

Answer 27

Volume, density, motility, progressive motility, morphology

Question 28

Describe the treatment options for male infertility

Answer 28

Lifestyle
Intra-cytoplasmic sperm injection
Donor insemination

Question 29

When can you establish ovulation?

Answer 29

Day 21 progesterone should be >30

Question 30

What investigation should be done in female infertility?

Answer 30

TSH, rubella immunity, chlamydia screen, smear test, hormone levels, transvaginal ultrasound, hysterosalpingogram (X-ray like test), diagnostic laparoscopy/hydrotubation, hysteroscopy

Question 31

What lifestyle advice should be given at an infertility clinic?

Answer 31

Smoking cessation, BMI 18.5-30, reduce/stop alcohol, moderate caffeine, stop drugs/methadone, folic acid

Question 32

Name four ovulation treatments

Answer 32

• clomifene citrate
• tamoxifen
• gonadotrophin injections
• laparoscopic ovarian diathermy

Question 33

Can tubal blockage be treated?

Answer 33

IVF

Cannulation with guide wire for proximal occlusion

Question 34

Name three assisted reproductive technology

Answer 34

• IVI +/- superovulation
• IVF
• ICSI

Question 35

What is the criteria for eligibility for assisted reproduction technology?

Answer 35

Stable relationship (2 years), female age <40, female BMI 18.5-30, non-smokers, no biological child, no illegal/abusive substances, neither partner sterilised, 2 years unexplained fertility

Question 36

How many cycles of IVF can a couple undergo?

Answer 36

3 cycles