Infertility - Men Flashcards
What are the major causes of infertility in men?
- Epididymitis due to STDs
- CF
- Congenital bilateral absence of the vas deferens (CBAVD)
- Testicular Maldescent Varicocele Hypospadias Tumours
- Azoospermia
How does CF cause infertility?
Leads to mutations in the Vas Deferens
What is CBAVD?
Congenital Bilateral Absence of Vas Deferens
What is varicocele?
It is a dilatation of the pampiniform plexus of the spermatic veins in the scrotum. Most men with varicocele and presumptive infertility have abnormal semen parameters; including low sperm concentration.
Men should not be offered surgery for varicoceles as a form of fertility treatment because it does not improve pregnancy rates.
What are the types of Azoospermia?
Testicular:
- Normogonadotrophic
- Hypogonadism
- Hypergonadotrophic Post-testicular (Obstructive)
Give an example of hypogonadism causing Azoospermia?
Klinefelter syndrome
- Very small testes
- Caused by a chromosomal aneuploidy XXY
What could cause obstructive azoospermia?
- Iatrogenic
- Congenital e.g. CF
- Infection
What would we want to ask a man about fertility?
- Change in body hair
- Testicular descent
- Infections (mumps, STI)
- Occupational history
- Previous fertility
- Sexual history (libido and freq of intercourse)
- Chronic medical illness
- Drugs and environmental - alcohol, smoking, chemo, radiation
What do we look for on exam for man’s fertility?
- BMI
- Fat and hair distribution (hair loss due to hypoandrogenism)
- Abdo and inguinal exam
- Genital exam
Increased body fat and decreased muscle mass suggest androgen deficiency.
Loss of pubic, axillary and facial hair.
What sources of infertility could we spot on a genital exam?
- Undescended or too small testes
- Epididymitis
- Lack of Vas Deferens
- Varicocele
- Hypospadias
What investigations can we do for male infertility?
- History and exam
- FSH, LH, Testosterone and PRL
- Karyotyping CF screen
- Computerised Semen Analysis
Give some rough reference values for sperm concentration?
Lower reference value is 15million/ml <15 is oligospermia <5 is severe 0 (or close) is termed Azoospermia
How do we manage a male whos infertile?
If they are in fact producing sperm we can do Surgical Sperm Retrieval for IVF by either:
- Micro-epididymal Sperm Aspiration
- Testicular Sperm Extraction
How do we measure testicular size?
Orchidometer Anything smaller than 15ml is small
