infertility Flashcards
what are 2 embyrological duct systems and what do they end up as
- wolfian - epidyd, vas, seminal vesicles, ejac. duct
2. mullerian - uterur, fallopian tubes, upper vag
what is sig. of this
wolfian system missing in 80% of CF
what is most important hormone to measure
FSH
what is FSH loop
FSH>sertoli cells>inhibin-ve>hypo>GNrh
what is LH loop
LH>leydig cells>T-ve to>hypo> GNRH
how long does sperm take to mature and sig. of this
70 days to be made
14 days to mature and travel
3 months before can assess Tx
where does sperm mature
epididymis
- gain motility
- stabilize condense chromatin
how long is epidid
6 meters
where is semen from (3)
10% testes
60-70% seminal vesicles
20% prostate
3 factors important about duration of infert. on Hx
- primary vs. secondary
- previous Tx
- female factor
5 other things to ask on Hx
- childhood and dev.
- cryptorchidism
- pubertal dev. - med. Hx
- surg. Hx
- infections
- STI, prostatitis, mumps - env. toxins
- smoking, drugs, steroids, pestiticdes
3 important types of meds, and the phase they affect
- hormonal (pre-testicular)
- andogens, anti androgens - gonadotoxic (testicular)
- Chemo
- ABs - spermatoctoxic (post- testicular)
- Ca channel blockers
4 parts of Phx
- general appearance
- CNS
- breasts - gynecomastia
- abdo scars or masses
5 things to look at on genital exam
- penile anat
- teste size and consistency
- presence of vas
- epidyddimal congestion
- varicocoel
what is normal testes size
2x4 cm
15-22 CC
3 grades of varicocele
- with valsalva
- out all the time
what will FSH, LH, and T look like in pre-test. azoospermia
FSH- low
LH - low
T - low-normal
what will FSH, LH, and T look like in test. azoospermia
FSH- high
LH - high/norm
T - norm
what will FSH, LH, and T look like in post-test. azoospermia
FSH- norm
LH - norm
T - norm
4 genetic issues to screen for
- XXY - klinfelters
- roberson translocation
- XX male - no hope
- Y chromo deletion
what is seen in klinefleters
- gynecomastia
- eunuchoid
- delay puberty
- sterile
what is Tx for klinefleter’s
- testicular sperm extraction
- find a few sperm in lobes of 50%
- IVF them fuckers in
what is TESE success rate
micro - 49%
regular 33%
