Infertility Flashcards
Infertility def
Couples inability to conceive after 1yr of intercourse w/out contraceptives
Infertility def
Couples inability to conceive after 1yr of intercourse w/out contraceptives
Male infertility causes
MC-idiopathic
Hypothalamic-pituitary DZ
Testicular Dz (primary teste issues)
Post-testicular defects D/O of sperm transport
Oligozoospermia def
<15mil/mL sperm
Azoospermia def
Complete abscence of sperm
Spermatogenesis takes
74d
Infertility Spermatogenesis consideration during W/U
Review past 3 months for gonadotoxic exposure/insults
Infertility testicular insult hx
Torsions
Cryptochidism
Trauma
Infertility infectious insult hx?
Mumps orchitis
Epididymitis
STIs
Infertility Environmental insult hx?
Excess heat
Chemo/rad
Pesticides
Infertility insults spermatogenesis due Rx
Testosterone Finasteride Cimetidine SSRI’s Spironolactone
Infertility insults motility due Rx
Sulfasalazine
Nitrofurantoin
Infertility retrograde ejaculation due Rx
Tamsulosin
Infertility lowered FSH due Rx
Phenytoin
Other common Rx affecting fertility
ETOH
tobacco
Bud
Infertility due to varicocele affects?
Motility/morphology
Infertility due to obesity, CV, thyroid, liver disease affects?
Decreased spermatogenesis
Infertility due to DM affects?
Decreased spermatogenesis
Retrograde ejaculation
Anejaculation
Infertility due to pituitary tumor affects?
Loss of libido
+
HA, visual disrupted, galactorrhea
Infertility Hx basic thoughts
Sexual fx Freq/timing intercourse Lubricant use Previous fertility success Previous infertility w/u Age >35 partner age
Infertility PE
hypogonadism features
Penis/scrotum inspection
Prostate examination
hypogonadism features
Underdeveloped sexual characteristics
DEC male hair patterns
Body habitus/obesity
Gynecomastia
Scrotal inspection includes
Testicular size
Check varicocele
Palpate vas deferens/epididymis
How to check varicocele
Standing and w/ valsalva
Infertility labs
Semen analysis \+- (endocrine) Testosterone FSH/LH PRL Estradiol Genetic testing (10mil) -CH-y microdeletions
Analyze semen timeframe
2-3d after ejaculatory abstinence
W/in 1hr of collection
Semen analysis criteria
Volume
Conc
Motility
Morphology
Nl semen volume
1.5-5.0mL
Low semen volume causes?
Retrograde ejaculation
Duct obstruction
Congenital bilateral vasa deferentia abscence
Androgen insufficiency
Nl sperm motility?
> 45% motile
Nl sperm motility?
> 45% motile
Male infertility causes
MC-idiopathic
Hypothalamic-pituitary DZ
Testicular Dz (primary teste issues)
Post-testicular defects D/O of sperm transport
Oligozoospermia def
<15mil/mL sperm
Azoospermia def
Complete abscence of sperm
Low sperm concentration reflex
<15mil
Repeat semen analysis
>ABNL -LH, FSH, PRL testosterone
Infertility Spermatogenesis consideration during W/U
Review past 3 months for gonadotoxic exposure/insults
Infertility testicular insult hx
Torsions
Cryptochidism
Trauma
Infertility infectious insult hx?
Mumps orchitis
Epididymitis
STIs
Infertility Environmental insult hx?
Excess heat
Chemo/rad
Pesticides
Infertility insults spermatogenesis due Rx
Testosterone Finasteride Cimetidine SSRI’s Spironolactone
Infertility insults motility due Rx
Sulfasalazine
Nitrofurantoin
Infertility retrograde ejaculation due Rx
Tamsulosin
Infertility lowered FSH due Rx
Phenytoin
Other common Rx affecting fertility
ETOH
tobacco
Bud
Infertility due to varicocele affects?
Motility/morphology
Infertility due to obesity, CV, thyroid, liver disease affects?
Decreased spermatogenesis
Infertility due to DM affects?
Decreased spermatogenesis
Retrograde ejaculation
Anejaculation
Infertility due to pituitary tumor affects?
Loss of libido
+
HA, visual disrupted, galactorrhea
Infertility Hx basic thoughts
Sexual fx Freq/timing intercourse Lubricant use Previous fertility success Previous infertility w/u Age >35 partner age
Infertility PE
hypogonadism features
Penis/scrotum inspection
Prostate examination
hypogonadism features
Underdeveloped sexual characteristics
DEC male hair patterns
Body habitus/obesity
Gynecomastia
Scrotal inspection includes
Testicular size
Check varicocele
Palpate vas deferens/epididymis
How to check varicocele
Standing and w/ valsalva
Infertility labs
Semen analysis \+- (endocrine) Testosterone FSH/LH PRL Estradiol Genetic testing (10mil) -CH-y microdeletions
Analyze semen timeframe
2-3d after ejaculatory abstinence
W/in 1hr of collection
Semen analysis criteria
Volume
Conc
Motility
Morphology
Nl semen volume
1.5-5.0mL
Low semen volume causes?
Retrograde ejaculation
Duct obstruction
Congenital bilateral vasa deferentia abscence
Androgen insufficiency
Nl sperm conc?
> 15mil
Nl sperm motility?
> 45% motile
Reasons for ABNL motility
Varicocele Antisperm antibodies Infection Flagella ABNLs Partial duct obstruct
Reasons for ABNL Sperm morphology
varicocele
Infection
Gonadotoxins
Tob smoke
For dx ensure semen analysis is conducted how many times?
2 samples on
2 seperate visits
At least 60d apart
Low ejaculate volume reflex
<1.5mL
Obtain post-ejaculation urine samples
-centrifuge, R/O retrograde ejaculation
Low sperm concentration reflex
<15mil
Repeat semen analysis
>ABNL -LH, FSH, PRL testosterone
Semen analysis W/U bottom line
1st test > confirm w/ 2nd
=same result > done
2nd test different > 3rd
Req 2 like results for confirmation
Special infertility test labs
-Low motility > test sperm viability and autoantibodies
-Round cells >1mil > stain for leukocyte esterase/peroxidase staining
Testicular Bx
Infertility imaging
Scrotal U/S
TRUS (transrectal U/S)
MRI
Purpose of Scrotal U/S for infertility
Chacterize testes
Detects subclinical varicocele
Purpose of Transrectal U/S for infertility
Eval prostate/seminal vesicles
Low volume w/out retrograde evidence
Purpose of MRI for infertility
Eval pelvis/scrotum for cryptorchidism
Infertility TXT
ID and TXT UC -refer endocrinology/urology PRN Pt education - timing/habits Stop offending Rx Avoid gonado toxin exposure Ref for fertility specialist (ARTs) Adoption education
Clinical infertility Pearl
25% of cases unresolved/unexplained after W/U
