Male Fertility Flashcards
What factors influence sperm count?
- Size of testicles
- Hormonal changes (FSH produces sperm, and LH produces testosterone which is important for sperm count)
- Medications (e.g. anabolic steroids
- Smoking and alcohol can decrease
How is sperm motility measured? How does it relate to fertility?
- Motility is the proprtion of sperm with progressive motility (moving straight forward), non progressive (going in circles/ineffective flagellum movements), or no motiltiy
- Greater motility, higher fertility
Describe the morphology of a normal sperm
- Oval-shaped head, with well-defined acrosomal region (40-70% of the head)
- Mid region that isn’t too think or thick, inserted perpendicular to the tangent of the insertion site
- Long, thin, flagellum
- No excess cytoplasm
What are some genetic causes of male infertility (think purely genetic, and also structural causes)?
- Congenital bilateral absence of vas deferens, assoc with CF
- Kallman syndrome (what is this?)
- Kinefllter syndrome
- Y chromosome microdeletions (losing the war)
- Anorchia (what is this?)
- Cryptorchidism (what is this?)
- Obstruction
What are some acquired causes of male infertility (and what is the most common one?)
- Varicocele (most common) (What is this?)
- Trauma/torsion
- Germ cell tumours
- Recurrent urogenital infections
- Hypogonadism
- Inflammatory conditions (mumps)
- Medications/chemo
- Systemic diseases
What is the biggest cause of male infertility?
Idiopathic (!!!)
What are the aspects of an infertility consult?
- Infertility history (ever before? previous pregnancies?)
- Sexual history (libido, sex, ED in men, pain, STDs)
- Surgical history
- Family history infertility/CF
- Medical history (anosmia [?kallman], mumps, diabetes, trauma/torsion, kidney disease (?obstructive), cryptorchidism)
- Gonadotoxin exposure
What hormones should be assessed when checking male fertility? Reason from first principles
- Hormones can deplete count, not motility or morphology
- FSH produces sperm, so it’s relevant
- LH helps T production, but since T is also a hormone, wqe can just test T (added advantage of testing Leydig cells)
- Therefore: test T and FSH
How do we treat azoospermia and varicocele, respectively?
- Azoospermia (azoo = no life; no sperm in ejavulate). Treat with epididymal or testicular sperm retrieval, then IVF
- Varicocele: treat with surgical repair/watchful waiting
How do we treat idiopathic male factor infertility?
- Treat underlying medical issues (e.g. diabetes, obesity, stress, ED, hormone deficiencies etc.)
- Assisted reproduction (e.g. sperm retrieval and IVF)
- Lifestyle (exercise, smoking cessation, toxin removal)
(Idiopathic = generic treatment)
Prevention of male infertility
- Nutrition/weight (not too high/low)
- Smoking/alcohol cessation
- Removal of exposure to heat/toxins
- Treatment of underlying conditions like Diabetes
How does insulin affect fertility? Link this to some conditions
- High levels of insulin can disrupt sex hormones
- This explains the link between T2DM and PCOS (w/ insulin resistance) and infertility
