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Urology > Male Infertility > Flashcards

Male Infertility Flashcards

1
Q

What is the definition of infertility?

A

Inability to achieve pregnancy after one year of unprotected sexual intercourse.

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2
Q

What percentage of infertility is due to male vs female factors?

A

50% female only
20% male only
30% male and female

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3
Q

What is the most common cause of male infertility?

A

Varicocele

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4
Q

What is the most common cause of low ejaculatory volume?

A

incorrect collection

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5
Q

What is Azoospermia?

A

No sperm in the ejaculate

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6
Q

What is Aspermia?

A

No ejaculate

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7
Q

What is oligospermia?

A

Sperm concentration

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8
Q

What is asthenospermia?

A

less than 40-50% sperm motility

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9
Q

What is teratospermia?

A

abnormal sperm morphology

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10
Q

What is the classification of causes of azoospermia?

A

Pre-testicular
Testicular
Post-testicular

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11
Q

What are the risk factors for obstructive azoospermia?

A

Surgery/instrumentation
GU infections
CF/CBAVD

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12
Q

What are the risk factors for non-obstructive azoospermia?

A

Gonadotoxin
Cryptorchidism
Torsion
Orchitis

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13
Q

Medical conditions that may cause infertility?

A 
Prostatitis, Orchitis, febrile illness
Hormonal disorders (hypogonadism, Thyroid disorders)
Cirrhosis
Diabetes
Myotonic dystrophy
Young's, Kartageners, CF, CBAVD
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14
Q

What genetic anomalies may lead to infertility?

A 
Karyotype abnormalities (6%)
CFTR mutations
Y chromosome microdeletions: AZF a, b, and c (10-15%)
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15
Q

What should be included in the reproductive history?

A

The reproductive history should include

1) coital frequency and timing;
2) duration of infertility and prior fertility;
3) childhood illnesses and developmental history;
4) systemic medical illnesses (e.g., diabetes mellitus and upper respiratory diseases) and prior surgeries;
5) sexual history including sexually transmitted infections;
6) gonadal toxin exposure including heat.

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16
Q

What should you look for on physical exam when working up male infertility?

A 
Visual fields
Skin pigmentation
Thyroid exam
Gynecomastia/galactorrhea
Liver exam
Secondary sexual characteristics, tanner stage
Testicular size, consistency, Vas, epididymis, vericocele
Sphincter tone/Prostate
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17
Q

What is normal ejaculate volume?

A

1.5-5 ml

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18
Q

What is normal semen pH?

A

> 7.2

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19
Q

What is normal sperm concentration?

A

> 20 million/ml

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20
Q

What is a normal total sperm count?

A

> 40 million/ejaculate

21
Q

What is normal sperm motility?

A

> 40-50%

22
Q

What is the normal amount of progressively motile sperm?

A

> 32%

23
Q

What is the normal forward progression scale?

A

> 2 out of 4

24
Q

What is normal morphology percent for semen analysis?

A

> 4%

25
Q

What is normal sperm agglutination for a semen analysis?

A
26
Q

what is normal viscosity/consistency for a semen analysis?

A
27
Q

What is the normal concentration of leukocytes in a semen analysis?

A
28
Q

What is the normal value for the immunobead test which looks at the normal percent of motile sperm adhered to particles?

A
29
Q

What is the normal value for a sperm vitality test?

A

> 58%

30
Q

What is the normal value for fructose in a semen analysis?

A

> 13 umol/ejaculate

31
Q

What is the initial minimum workup for male infertility?

A

History, physical exam, and 2 semen analyses at least 1 month apart.

32
Q

What is the next step if the vas deferens are present bilaterally?

A

Examine the Semen volume

33
Q

What is the next step if the vas is absent unilaterally?

A

Get renal ultrasound (11% have renal anomalies) and CFTR testing.

34
Q

What is the next step if there is azoospermia and bilateral absence of the vas deferens?

A

Workup for CF

35
Q

What are the treatment options for CBAVD with no CF?

A

CFTR, and genetic testing
LH, FSH, Testosterone
Renal ultrasound

36
Q

What are the treatment options for CBAVD?

A

Donor insemination
Adoption
SR with ICSI

37
Q

What is the next step if vas are present but semen volume is

A

Post ejaculation urinalysis: If sperm in urine –> retrograde ejaculation

No sperm in urine –> TRUS to look for EDO

38
Q

What is the treatment for EDO?

A

Trans urethral resection of ejaculatory ducts (TURED)

39
Q

What is the next step if vas are present and semen volume is > 1.5ml?

A

Evaluate the rest of the semen analysis:

If semen analysis is abnormal get a hormone workup

40
Q

What if Semen analysis if completely normal?

A
  1. Workup female partner
  2. Post coital test
  3. If normal post coital sperm function test
41
Q

What is the next step if shaking or low motility sperm are seen on post coital test?

A

Test for anti-sperm antibodies

42
Q

What is next step if no sperm are seen in mucus of post coital test?

A

evaluate coital technique

Consider intrauterine insemination

43
Q

What is the next step in patient with vas, abnormal semen analysis, but normal hormone evaluation?

A

Evaluate for ejaculation:

If ejaculation absent –> anejaculation

If ejaculation is present –> test for anti-sperm antibodies, rule out vericoele.

44
Q

What are the indications for an endocrine evaluation for male infertility?

A

An endocrine evaluation should be performed if there is: 1) an abnormal semen analysis, especially if the sperm concentration is less than 10 million/ml;

2) impaired sexual function; or
3) other clinical findings suggestive of a specific endocrinopathy.

45
Q

How should and endocrine evaluation for male infertility be conducted?

A

minimum initial hormonal evaluation should consist of measurements of serum (FSH) and serum testosterone levels. If the testosterone level is low, a repeat measurement of total and free testosterone (or bioavailable testosterone), as well as determination of (LH) and prolactin levels should be obtained

46
Q

Low T, Low/normal LH, Low/normal FSH, normal prolactin?

A

Hypogonadotropic hypogonadism

47
Q

Normal T, normal LH, High/normal FSH, normal prolactin?

A

abnormal spermatogenesis

48
Q

Low T, High FSH, High LH, normal prolactin?

A

Hypergonadotropic hypogonadism (i.e. testicular failure)

49
Q

Low T, low/normal FSH, Low/normal LH, high prolactin?

A

Prolactinoma

Urology (6 decks)

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