Male Infertility

Question 1

Inability to conceive via unprotected natural intercourse within 12 months

Answer 1

Infertility

Question 2

Major causes of Male Infertility

Answer 2

Varicocele (35%)
Idiopathic (25%)
GU Infection (10%)
Genetic (10%)

Question 3

Dilation of the Pampiniform Plexus; usually asymptomatic, but can cause atrophy, asymmetry or pain; seen in Infertile men due to hyperthermia and hypoxia

Answer 3

Varicocele

Question 4

How can Varicocele cause Infertility

Answer 4

Hyperthermia

Hypoxia

Question 5

Varicocele is more common on the (left/right) testes and why?

Answer 5

Left (longer vein towards the left renal vein)

Question 6

MOST common GENETIC cause of Male Infertility; men with 47 XXY karyotype; primary hypogonadism, small testes, tall stature and gynecomastia

Answer 6

Klinefelter Syndrome

Question 7

Karyotype for Klinefelter Syndrome

Answer 7

47 XXY

Question 8

Signs/Symptoms of Klinefelter Syndrome (47 XXY)

Answer 8

Small testes
Infertility
Tall stature
Gynecomastia

Question 9

Genetic causes of Male Infertility

Answer 9

Klinefelter Syndrome (most common)
Congenital Bilateral Absence of Vas Deferens (Cystic Fibrosis carrier)
Azoospermia (no sperm due to Y chromosome micro-deletion)

Question 10

Examples of Endocrine causes of Male Infertility

Answer 10

Exogenous testosteone

Prolactinoma (suppressed GnRH)

Question 11

Examples of Gonadotoxins

Answer 11

Pesticides
Solvents
Drugs (alcohol, steroids, cocaine, marijuana)
TESTOSTERONE

Question 12

Examples of physical obstructions of the Male Reproductive system

Answer 12

Spermatocele (epididymis)
Vasectomy
Inguinal Hernia/repair
Prostatic cyst
Urethral stricture

Question 13

Example of permanent sterilization; 99.9% effective; simple surgery through posterior scrotum; segmental excision and cauterization of ends

Answer 13

Vasectomy

Question 14

Twisting of testical on vasculature; most common in teenagers; SEVERE pain and swelling; surgical EMERGENCY

Answer 14

Testicular Torsion

Question 15

A SOLID testicular mass is ____________ until proven otherwise

Answer 15

Cancer

Question 16

Lab Work-Up for suspected Male Infertility

Answer 16

• 1st test after H &P: Semen analysis (abstinence for 2-5 days)

Hormone profile (FSH & Testosterone minimum)
Genetic testing

Question 17

Normal values for Semen Analysis

Answer 17

Volume: 2-5 mL
Conc: >15 million/mL

Question 18

Never give _____ since it can cause testis atrophy, cessation of spermatogenesis and infertility.

Answer 18

exogenous testosterone

Question 19

Tx for infertility due to varicocele

Answer 19

varicocele repair

• improvements in semen quality in most cases.

Question 20

Is vasectomy reversal?

Answer 20

yes!

Microsurgical vasectomy reversal can be done.

Question 21

An assisted reproductive technology that requires injection of a SINGLE sperm/egg; enabled men to be biologic fathers in cases of severe testicular damage/obstruction since very few sperms are needed.

Answer 21

ICSI (intracytoplasmic sperm injection)

Question 22

(T/F) Male factor infertility is present in half of infertile couples

Answer 22

True!