Male Factor Infertility Flashcards
What is used to assess male factor infertility?
Semen analysis is used to examine the quantity and quality of semen and sperm. It assesses for male factor infertility.
What instructions should be given to men providing a semen sample?
Men should be given clear instructions for providing a sample:
Abstain from ejaculation for at least 3 days and at most 7 days
Avoid hot baths, sauna and tight underwear during the lead up to providing a sample
Attempt to catch the full sample
Deliver the sample to the lab within 1 hour of ejaculation
Keep the sample warm (e.g. in underwear) before delivery
What factors affect semen analysis?
Several lifestyle factors may affect the results of semen analysis and the quality and quantity of sperm:
Hot baths Tight underwear Smoking Alcohol Raised BMI Caffeine
Repeat sample of sperm?
A repeat sample is indicated after 3 months with borderline results or earlier (2 – 4 weeks) with very abnormal results.
What are normal semen analysis results?
Semen volume (more than 1.5ml)
Semen pH (greater than 7.2)
Concentration of sperm (more than 15 million per ml)
Total number of sperm (more than 39 million per sample)
Motility of sperm (more than 40% of sperm are mobile)
Vitality of sperm (more than 58% of sperm are active)
Percentage of normal sperm (more than 4%)
What are abnormal semen analysis results?
Polyspermia (or polyzoospermia) refers to a high number of sperm in the semen sample (more than 250 million per ml).
Normospermia (or normozoospermia) refers to normal characteristics of the sperm in the semen sample.
Oligospermia (or oligozoospermia) is a reduced number of sperm in the semen sample. It is classified as:
Mild oligospermia (10 to 15 million / ml) Moderate oligospermia (5 to 10 million / ml) Severe oligospermia (less than 5 million / ml) Cryptozoospermia refers to very few sperm in the semen sample (less than 1 million / ml).
Azoospermia is the absence of sperm in the semen.
What are pre-testicular causes of male infertility?
Testosterone is necessary for sperm creation. The hypothalamo-pituitary-gonadal axis controls testosterone. Hypogonadotrophic hypogonadism (low LH and FSH resulting in low testosterone), can be due to:
Pathology of the pituitary gland or hypothalamus
Suppression due to stress, chronic conditions or hyperprolactinaemia
Kallman syndrome
What are testicular causes of male infertility?
Testicular damage from:
Mumps Undescended testes Trauma Radiotherapy Chemotherapy Cancer
Genetic or congenital disorders that result in defective or absent sperm production, such as:
Klinefelter syndrome
Y chromosome deletions
Sertoli cell-only syndrome
Anorchia (absent testes)
What are post-testicular causes of male infertility?
Obstruction preventing sperm being ejaculated can be caused by:
Damage to the testicle or vas deferens from trauma, surgery or cancer
Ejaculatory duct obstruction
Retrograde ejaculation
Scarring from epididymitis, for example, caused by chlamydia
Absence of the vas deferens (may be associated with cystic fibrosis)
Young’s syndrome (obstructive azoospermia, bronchiectasis and rhinosinusitis)
What are the investigations for abnormal semen analysis?
The initial steps for investigating abnormal semen analysis include a history, examination, repeat sample and ultrasound of the testes.
Patients with abnormal semen results are referred to a urologist for further investigations. Further investigations that may be considered include:
Hormonal analysis with LH, FSH and testosterone levels
Genetic testing
Further imaging, such as transrectal ultrasound or MRI
Vasography, which involves injecting contrast into the vas deferens and performing xray to assess for obstruction
Testicular biopsy
How is male factor infertility managed?
Management depends on the underlying cause, and can involve:
Surgical sperm retrieval where there is obstruction
Surgical correction of an obstruction in the vas deferens
Intra-uterine insemination involves separating high-quality sperm, then injecting them into the uterus
Intracytoplasmic sperm injection (ICSI) involves injecting sperm directly into the cytoplasm of an egg
Donor insemination involves sperm from a donor
