Male Infertility Flashcards
GnRH is produced by _______; GnRH then stimulates production of LH and FSH by _______; LH acts upon ______ resulting in ______, whereas FSH stimulates ______ within the ______ via ______
the hypothalamus; the anterior lobe of the pituitary gland; Leydig cells; production of testosterone; spermatogenesis; seminiferous tubules; Sertoli cells
spermatogenesis: mitosis is responsible for ______, whereas meiosis is involved in ______
replenishing immature germ cells; the maturation of germ cells
spermatogenesis begins at ______ with _______, occurs in _______
puberty; spermatogonia; seminiferous tubules
spermatogenesis produces ______ that undergo ______ (______, ______) to form mature ______
spermatids; spermiogenesis; loss of cytoplasmic contents; gain of acrosomal cap; spermatozoon
ploidy: spermatogonium, primary spermatocyte, secondary spermatocyte, spermatid, mature spermatozoon
spermatogonium: diploid primary spermatocyte: diploid secondary spermatocyte: haploid spermatid: haploid mature spermatozoon: haploid
spermatogenesis: ____ months
entire time course from immature germ cell to mature sperm ready for ejaculation: ____ months
2; 3
difference between emission and ejaculation
emission: release of seminal fluid from prostate and ejaculatory ducts in posterior urethra (sympathetic nervous system; hypogastric nerve)
ejaculation: transport of seminal fluid from the prostatic urethra into the anterior urethra and meatus (visceral and somatic nerves; pudendal nerve)
what is the classic pretesticular cause of infertility?
hypogonadotrophic hypogonadism (failure of GnRH and/or gonadotropin production, leading to lack of testosterone production and germ cell stimulation)
most common cause of testicular cause of infertility
varicocele (abnormal dilation of the pampiniform plexus of the internal spermatic veins, which typically occurs on the left side, although they may be bilateral)
male infertility: endocrine studies should include ______ to evaluate Leydig cell function, and ______ to evaluate Sertoli cell/germ cell function
total testosterone; FSH
how does varicocele lead to infertility?
it increases intratesticular temperature due to the loss of venous valvular function –> pooling of warm blood in testis –> altered spermatogenesis, Leydig cell dysfunction, and subsequent infertility
what is the criteria for male patients who should be offered karyotypic and genetic testing?
men with azoospermia or severe oligospermia (<2 million/mL)
2 major genetic alterations that have been associated with male infertility
Klinefelter’s syndrome, Y chromosome deletions
Klinefelter’s syndrome: clinical presentation, pathogenesis
classic triad: small firm testes, azoospermia, and gynecomastia
pathogenesis: 47 XXY
Y chromosome is responsible for ______ and ______
testis formation; spermatogenesis
dx: male with infertility, small firm testes, azoospermia, and gynecomastia
Klinefelter’s syndrome
congenital bilateral absence of the vas deferens (CBAVD): genetic cause
mutation of the cystic fibrosis transmembrane receptor (CFTR) gene; combination of a cystic fibrosis mutation on one chromosome with a CF mutation or 5T variant on the other chromosome
if a patient has congenital bilateral absence of the vas deferens (CBAVD) without genetic deletion, what is the most likely etiology? what test is indicated?
insult to mesonephric (Wolffian duct); renal ultrasound
compare symptoms of obstructive vs. irritative lower urinary tract problems for males
obstructive: decreased force of stream, hesitancy, incomplete emptying, nocturia, straining
irritative: urgency, frequency, dysuria
BPH is characterized by ________. _____ is the major hormonal stimulus for this process.
proliferation of benign stromal and glandular elements; DHT
what is the most appropriate next step when you suspect prostate cancer in a patient?
trans-rectal ultrasound of the prostate with 12 core biopsies
dx: testicular tumor with Schiller-Duval bodies (resemvling primitive glomeruli), elevated AFP
yolk sac tumor
what testicular tumors can you rule out if there is elevated AFP?
pure seminomas or choriocarcinomas
ddx: testicular tumor, elevated hCG
choriocarcinoma, teratoma, embryonal carcinoma
