Infertility Flashcards
Where does spermatogenesis occur?
Seminiferous tubules
Where is testosterone produced?
Leydig cells
How is androgen insensitivity syndrome inherited?
X linked recessive
Describe Androgen insensitivity syndrome
Testes develop but do not descend, commonly presents at puberty with primary amenorrhoea and lack of pubic hair
What happens they are insensitive to testosterone?
Induction of mesonephric duct does not occur
What happens in mullerian insensitivity function?
Absent uterus and ovaries
What happens if they are insensitive to dihydroxytestosterone?
Female external genitalia with short vagina
Where do the testes originate?
Abdominal cavity
Describe the origin of the arterial/venous/lymphatic supply to the testes
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
Why are the testes outside the body?
Lower temperature
What two muscles are involved in the contraction as a result of temperature change?
Dartos - smooth muscle
Cremaster - skeletal muscle
What is the name given to undescended testes?
Cryptorchidism
When should the testes have descended by?
6-9 months
What treatment is available for cryptorchidism?
Orchidoplexy - performed by 12 months because of association with infertility (azoospermia)
Why must orchidoplexy be completed by 12 years of age?
Risk of testicular cancer is 6 times higher
State the functions of sertoli cells
- forms blood-testes barrier
- provides nutrients
- phagocytosis
- secrete seminiferous tubule fluid
- secrete androgen binding globulin
- secrete inhibin and activin
Describe the hormonal pathway from hypothalamus
GnRH
- FSH to sertoli cell which enhances spermatogenesis
- LH to leydig cell which regulates testosterone secretion
What male factors aid fertilisation?
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
Name four accessory tissues in males what do each of them do
- epididymis and vas deferens (concentrates/stores sperm)
- seminal vesicles (produces semen)
- prostate glands (clot semen and neutralise vagina)
- bulbourethral glands (lubricant)
Describe the process of ejaculation
Erection - blood fills with corpus cavernosa
Emission - contraction accessory glands/VD to expell semen
Ejaculation - smooth muscle contraction of urethra and erectile muscles
Define infertility
Inability to conceive after 12 months regular intercourse without contraception
What percentage of fertility problems are related to the male?
30%
What causes male infertility?
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
Define the terms; azoospermia asthenozoospermia oligozoospermia teratozoospermia
no sperm
low motility
low density
abnormal morphology
What examination should be done in male infertility?
General
Genital - testicular volume, presence of vas deferens/epididymis, penis, presence of varicocele/other scrotal swelling
What is the average testicular volume?
Pre-pubertal 1-3mls
Adults 12-25mls
What things does semen analysis assess?
Volume, density, motility, progressive motility, morphology
Describe the treatment options for male infertility
Lifestyle
Intra-cytoplasmic sperm injection
Donor insemination
When can you establish ovulation?
Day 21 progesterone should be >30
What investigation should be done in female infertility?
TSH, rubella immunity, chlamydia screen, smear test, hormone levels, transvaginal ultrasound, hysterosalpingogram (X-ray like test), diagnostic laparoscopy/hydrotubation, hysteroscopy
What lifestyle advice should be given at an infertility clinic?
Smoking cessation, BMI 18.5-30, reduce/stop alcohol, moderate caffeine, stop drugs/methadone, folic acid
Name four ovulation treatments
- clomifene citrate
- tamoxifen
- gonadotrophin injections
- laparoscopic ovarian diathermy
Can tubal blockage be treated?
IVF
Cannulation with guide wire for proximal occlusion
Name three assisted reproductive technology
- IVI +/- superovulation
- IVF
- ICSI
What is the criteria for eligibility for assisted reproduction technology?
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
How many cycles of IVF can a couple undergo?
3 cycles
