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Urology > Infertility > Flashcards

Infertility Flashcards

1
Q

Infertility def

A

Couples inability to conceive after 1yr of intercourse w/out contraceptives

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2
Q

Infertility def

A

Couples inability to conceive after 1yr of intercourse w/out contraceptives

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3
Q

Male infertility causes

A

MC-idiopathic
Hypothalamic-pituitary DZ
Testicular Dz (primary teste issues)
Post-testicular defects D/O of sperm transport

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4
Q

Oligozoospermia def

A

<15mil/mL sperm

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5
Q

Azoospermia def

A

Complete abscence of sperm

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6
Q

Spermatogenesis takes

A

74d

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7
Q

Infertility Spermatogenesis consideration during W/U

A

Review past 3 months for gonadotoxic exposure/insults

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8
Q

Infertility testicular insult hx

A

Torsions
Cryptochidism
Trauma

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9
Q

Infertility infectious insult hx?

A

Mumps orchitis
Epididymitis
STIs

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10
Q

Infertility Environmental insult hx?

A

Excess heat
Chemo/rad
Pesticides

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11
Q

Infertility insults spermatogenesis due Rx

A 
Testosterone
Finasteride
Cimetidine
SSRI’s
Spironolactone
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12
Q

Infertility insults motility due Rx

A

Sulfasalazine

Nitrofurantoin

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13
Q

Infertility retrograde ejaculation due Rx

A

Tamsulosin

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14
Q

Infertility lowered FSH due Rx

A

Phenytoin

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15
Q

Other common Rx affecting fertility

A

ETOH
tobacco
Bud

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16
Q

Infertility due to varicocele affects?

A

Motility/morphology

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17
Q

Infertility due to obesity, CV, thyroid, liver disease affects?

A

Decreased spermatogenesis

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18
Q

Infertility due to DM affects?

A

Decreased spermatogenesis
Retrograde ejaculation
Anejaculation

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19
Q

Infertility due to pituitary tumor affects?

A

Loss of libido
+
HA, visual disrupted, galactorrhea

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20
Q

Infertility Hx basic thoughts

A 
Sexual fx
Freq/timing intercourse
Lubricant use
Previous fertility success
Previous infertility w/u
Age >35 partner age
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21
Q

Infertility PE

A

hypogonadism features
Penis/scrotum inspection
Prostate examination

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22
Q

hypogonadism features

A

Underdeveloped sexual characteristics
DEC male hair patterns
Body habitus/obesity
Gynecomastia

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23
Q

Scrotal inspection includes

A

Testicular size
Check varicocele
Palpate vas deferens/epididymis

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24
Q

How to check varicocele

A

Standing and w/ valsalva

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25
Q

Infertility labs

A 
Semen analysis
\+- (endocrine)
Testosterone
FSH/LH
PRL
Estradiol
Genetic testing (10mil)
-CH-y microdeletions
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26
Q

Analyze semen timeframe

A

2-3d after ejaculatory abstinence

W/in 1hr of collection

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27
Q

Semen analysis criteria

A

Volume
Conc
Motility
Morphology

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28
Q

Nl semen volume

A

1.5-5.0mL

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29
Q

Low semen volume causes?

A

Retrograde ejaculation
Duct obstruction
Congenital bilateral vasa deferentia abscence
Androgen insufficiency

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30
Q

Nl sperm motility?

A

> 45% motile

31
Q

Nl sperm motility?

A

> 45% motile

32
Q

Male infertility causes

A

MC-idiopathic
Hypothalamic-pituitary DZ
Testicular Dz (primary teste issues)
Post-testicular defects D/O of sperm transport

33
Q

Oligozoospermia def

A

<15mil/mL sperm

34
Q

Azoospermia def

A

Complete abscence of sperm

35
Q

Low sperm concentration reflex

A

<15mil
Repeat semen analysis
>ABNL -LH, FSH, PRL testosterone

36
Q

Infertility Spermatogenesis consideration during W/U

A

Review past 3 months for gonadotoxic exposure/insults

37
Q

Infertility testicular insult hx

A

Torsions
Cryptochidism
Trauma

38
Q

Infertility infectious insult hx?

A

Mumps orchitis
Epididymitis
STIs

39
Q

Infertility Environmental insult hx?

A

Excess heat
Chemo/rad
Pesticides

40
Q

Infertility insults spermatogenesis due Rx

A 
Testosterone
Finasteride
Cimetidine
SSRI’s
Spironolactone
41
Q

Infertility insults motility due Rx

A

Sulfasalazine

Nitrofurantoin

42
Q

Infertility retrograde ejaculation due Rx

A

Tamsulosin

43
Q

Infertility lowered FSH due Rx

A

Phenytoin

44
Q

Other common Rx affecting fertility

A

ETOH
tobacco
Bud

45
Q

Infertility due to varicocele affects?

A

Motility/morphology

46
Q

Infertility due to obesity, CV, thyroid, liver disease affects?

A

Decreased spermatogenesis

47
Q

Infertility due to DM affects?

A

Decreased spermatogenesis
Retrograde ejaculation
Anejaculation

48
Q

Infertility due to pituitary tumor affects?

A

Loss of libido
+
HA, visual disrupted, galactorrhea

49
Q

Infertility Hx basic thoughts

A 
Sexual fx
Freq/timing intercourse
Lubricant use
Previous fertility success
Previous infertility w/u
Age >35 partner age
50
Q

Infertility PE

A

hypogonadism features
Penis/scrotum inspection
Prostate examination

51
Q

hypogonadism features

A

Underdeveloped sexual characteristics
DEC male hair patterns
Body habitus/obesity
Gynecomastia

52
Q

Scrotal inspection includes

A

Testicular size
Check varicocele
Palpate vas deferens/epididymis

53
Q

How to check varicocele

A

Standing and w/ valsalva

54
Q

Infertility labs

A 
Semen analysis
\+- (endocrine)
Testosterone
FSH/LH
PRL
Estradiol
Genetic testing (10mil)
-CH-y microdeletions
55
Q

Analyze semen timeframe

A

2-3d after ejaculatory abstinence

W/in 1hr of collection

56
Q

Semen analysis criteria

A

Volume
Conc
Motility
Morphology

57
Q

Nl semen volume

A

1.5-5.0mL

58
Q

Low semen volume causes?

A

Retrograde ejaculation
Duct obstruction
Congenital bilateral vasa deferentia abscence
Androgen insufficiency

59
Q

Nl sperm conc?

A

> 15mil

60
Q

Nl sperm motility?

A

> 45% motile

61
Q

Reasons for ABNL motility

A 
Varicocele
Antisperm antibodies
Infection
Flagella ABNLs
Partial duct obstruct
62
Q

Reasons for ABNL Sperm morphology

A

varicocele
Infection
Gonadotoxins
Tob smoke

63
Q

For dx ensure semen analysis is conducted how many times?

A

2 samples on
2 seperate visits
At least 60d apart

64
Q

Low ejaculate volume reflex

A

<1.5mL
Obtain post-ejaculation urine samples
-centrifuge, R/O retrograde ejaculation

65
Q

Low sperm concentration reflex

A

<15mil
Repeat semen analysis
>ABNL -LH, FSH, PRL testosterone

66
Q

Semen analysis W/U bottom line

A

1st test > confirm w/ 2nd
=same result > done

2nd test different > 3rd

Req 2 like results for confirmation

67
Q

Special infertility test labs

A

-Low motility > test sperm viability and autoantibodies
-Round cells >1mil > stain for leukocyte esterase/peroxidase staining
Testicular Bx

68
Q

Infertility imaging

A

Scrotal U/S
TRUS (transrectal U/S)
MRI

69
Q

Purpose of Scrotal U/S for infertility

A

Chacterize testes

Detects subclinical varicocele

70
Q

Purpose of Transrectal U/S for infertility

A

Eval prostate/seminal vesicles

Low volume w/out retrograde evidence

71
Q

Purpose of MRI for infertility

A

Eval pelvis/scrotum for cryptorchidism

72
Q

Infertility TXT

A 
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
73
Q

Clinical infertility Pearl

A

25% of cases unresolved/unexplained after W/U

Urology (7 decks)

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