Male Factor Infertility Flashcards
Give genetic causes
Klinefelters
Y chromosome deletions
Congenital absence of vas deferens
Give pretesticular causes
IHH and Kallman’s
Klinefelter’s
Medications e.g. anti dopamine causing a high prolactin, steroid use, chemotherapy
Endocrine causes - pituitary adenoma, prolactinoma
Y chromosome deletions
Give testicular causes
hydrocele varicocoele Epidydimo-orchiditis /mumps cryptorchidism testicular torsion trauma testicular cancer radiotherapy to testes
Give post testicular causes
Absence of vas deferens Erectile/ejaculatory problem - may be neurological e.g. spinal cord injury, endocrine, vascular or psychological in nature Retrograde ejaculation Hypospadius Inflammation e.g. prostatisis Vas deferens blockage
What is the incidence of Klinefelters
about 1 in 500 male births
most common genetic abnormality in infertile men and accounts for around 13 percent of azoospermic men
What are Y chromosome deletions
specific microdeletions in the AZF region of Y chromosome
account for 8 percent of subfertile men
Depends on type of deletions as to the severity of azoospermia - AZFc is particularly bad
What is Kallmans
Dysfunction of GNrH pulses caused by failure of the gnrh neurons to migrate to the hypothalamus during embryonic development - 1/3 of cases are inherited and specifc genes have been found to be causative such as mutations of Kall1 gene have been shown to cause x linked kallmans
Give examples of medications that can cause subfertility
anabolic steroids chemotherapy agents spironolactone sulfasalazine - reduces sperm motilility antipsychotics - increases prolactin levels
What is cryptochidism
failure of one or both testes to descend into scrotum by birth - more common in premature babies
most will descend in first year of like (80 percent)
How is cryptochidsm treated? What is the guidance?
in child - orchidoplexy - ideally as soon as possible if testes have not descended themselves by 3 months with the vies to having surgery within the first year of life to optimise chances of normal fertility
in adults - typically remove completely to reduce risk of malignancy however some case will opt just to leave it - fertility will not return if testes is still undescended in adult hood
what is a varicocoele
essentially varicose veins in the testes - blood pools in pampiniform plexus
causes by obstruction of valve dysfunction
why are varicocoeles associated with infertility
increased temperature is detrimental for normal spermatogenesis
what is the incident of varicocoeles
15-20 percent of normal men will have them
40 percent of infertile men
which side do most varicocoeles occur in and why
left - because left testicular vein connects to left renal vein at a 90 degree angle whereas on right hand side testicular vein connects to the IVC
what is nutcracker syndrome
SMA compresses left renal vein causing blood to pool in pampiniform plexus
Treatment options for varicocoele
draining will not typically result in increased fertility and as such it is not recommended by NICE as a fertility treatment option
can remove is causing pain or other symptoms
What usually causes congenital absence of vas deferens
mutations in CFTR gene in cystic fibrosis
typically bilateral
occurs in 90 percent of CF patients
spermatogenesis is normal
describe the physiology of an erection
Erection is triggered by the parasympathetic division of the autonomic nervous system (ANS), causing nitric oxide (a vasodilator) levels to rise in the trabecular arteries and smooth muscle of the penis. The arteries dilate causing the corpora cavernosa of the penis (and to a lesser extent the corpora spongiosum) to fill with blood; simultaneously the ischiocavernosus and bulbospongiosus muscles compress the veins of the corpora cavernosa restricting the egress and circulation of this blood. Erection subsides when parasympathetic activity reduces to baseline
describe the physiology of ejaculation
look this up
what are common causes of erectile/ejaculatory dysfunction
neurological - MS, spinal cord injury, complications of diabetes
medications - lithium, paroxetine
vascular disease
chronic alcoholism
what is retrograde ejaculation
Retrograde ejaculation occurs when semen, which would, in most cases, be ejaculated via the urethra, is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least resistance. When the bladder sphincter does not function properly, retrograde ejaculation may occur
give causes of retrograde ejaculation
anthythung whcih causes a malfunctioning bladder sphincter e.g
operation on the prostate and other surgeries
diabetes due to neuropathy
MS
medications eg tamsulosin used to treat BPH
When is ICSI recommended
significant abnormality on semen analysis e.g severe oligozoospermia
previous failed fertisation
clear male factor infertility e.g. klinefelters
BBV
PIGD
How many sperm are needed to be able to do IVF
80,000-100,000 sperm per four eggs after sperm prep and need a total motile count of 5 million/ml before prep
if this is not met then ICSI is required
