Infertility - Men

Question 1

What are the major causes of infertility in men? [4]

Answer 1

Semen abnormality
Azoospermia
Immunological
Coital

Question 2

Semen abnormalities causes [4]

How does CF cause infertility? [1]

Answer 2

Idiopathic oligoasthenoteratoazoospermia
Testicular ca
Alcohol
Smoking

Leads to mutations in the Vas Deferens

Question 3

What is varicocele?

NB Surgically repairing it doesn’t actually help pregnancy rate so we often don’t for fertility reasons

Answer 3

Dilatation of pampiniform venous plexus

Question 4

Azospermia classification of causes:
Pretesticular [3]
Non-obstructive [3]
Obstructive [6]

Answer 4

o Pretesticular: anabolic steroids, hypogonadotropic hypogonadism, Kalman’s syndrome
o Non-obstructive: cryptorchidism, orchitis mumps, Klinefelter’s syndrome (47XXY)
o Obstructive: congenital bilateral absence of vas deferens, vasectomy, chlamydia, gonorrhoea, testicular trauma, CF (mutated vas def)

Question 5

Immunological causes of infertility [3]

Coital related causes of infertility [4]

Answer 5

• Immunological:
- anti-sperm antibodies, idiopathic, infective (rubella)
• Coital:
- erectile dysfunction (e.g. drugs (beta blockers, anti-depressants))
- hypospadias, phimosis
- retrograde ejaculation
- failure of ejaculation (MS, spinal cord injury)

Question 6

Male fertility history - questions to ask [6]

Answer 6

• Change in body hair
• Testicular Descent
• PMH relating testicles, chemo or radiotherapy.
• Occupational history
• Sexual history
• Drugs and Environmental

Question 7

What do we look for on male fertility examination/ what type of examinations should we do [4]

Answer 7

BMI
Fat/Hair distribution (hair loss due to hypoandrogenism)
Abdo and inguinal Exam
Genital Exam

Question 8

Give some rough reference values for sperm concentration? [4]

Answer 8

Lower reference value is 15million/ml
<15 is oligospermia
<5 is severe
0 (or close) is termed Azoospermia

Question 9

How do we manage a male whos infertile? [3]

Answer 9

If they are in fact producing sperm we can do Surgical Sperm Retrieval for IVF by either:

• Micro-epididymal Sperm Aspiration
• Testicular Sperm Extraction

Question 10

Azoospermia investigations [3]

Answer 10

Clinical exam for presence of VD
Basal hormonal profile
CF screen, karyotype

Question 11

Baseline hormonal profile for men [6]

Answer 11

FSH
LH
Testosterone
PRL
Estradiol
Sex hormone binding globulin