Male Infertility Flashcards
Where is the sex determining region
Y chromosome
What causes the development of the male reproductive tract and genitalia
Testosterone (and mullerian inhibiting factor)
What primitive duct becomes the male reproductive tract
wolffian
What primitive duct becomes the female reproductive tract
Mullerian
What does the mullerian duct become
the fallopian tubes
what does the wolffian duct become
the ductus deferens
What is androgen insensitivity syndrome
Congenital insensitivity to androgens
What happens in congenital androgen insensitivity syndrome
Male karyotype however due to being insensitive to testosterone they do not develop male genitalia and their testes remain undescended.
What are the features of the reproductive system in someone with AIS
testes develop but do not descend
female external genitalia
short vagina
absence of ovaries or uterus
what muscle in the scrotal sac lowers/raises the testes according to external temp
dartos muscle
What is cryptochidism
undescended testes
What is the treatment of cryptochidism
orchidoplexy before age 14 or orchidectomy in adults
What is the risks of undescended testes left until adulthood
6 x increased risk of testicular cancer
where does spermatogenesis occur
seminiferous tubules
Where does testosterone production occur
leydig cells
what is contained in the acrosome of a sperm
enzymes to help penetrate the ovum
What is the role of sertoli cells
Form a blood testes barrier Provides nutrients Phagocytosis Secrete seminiferous tubule fluid Secrete androgen binding globulin Secrete inhibin and activin
What is the function of androgen binding globulin
binds testosterone so that concentration remains hgh
What do inhibin do
decreases FSH secretion to control spermatogenesis
What stimulates spermatogenesis
fsh and testosteron
what stimulates testosterone secretion
LH
what is the effect of testosterone on GnRH and LH
decreases the release of both
What is GnrH
decapeptide
releases in bursts every 2-3 hours from hypothalamus
Stimunlates anterior pituitary to produce LH and FSH
Negative feedback control from testosterone
What are LH and FSH
glycoproteins
What does FSH act on
sertoli cells to enhance spermatogenesis
What does LH act on
Leydig cells - to produce testosterone
What are the effects of testosterone
Before birth - masculinise repro tract and testicular descent
Puberty - male characteristics
Adult - controls spermatogenesis, secondary sexual characteristics, libido
What is capacitiation
A series of biochemical and electrical events that occur before fertilisation in the sperm.
where does the sperm initially bind to the oocyte
zona pellucida
What is the function of the epididymis
exit route from testes to urethra, concentrate and stores sperm, site of sperm maturtion
What is the function of the seminal vesicles
Produce semen in ejaculatory duct, suppe fructose, secrete prostaglandins (stimulates motility), secrete fibrinogen
What does the prostate do
alkaline fluid is produces and clotting enzymes
What does the bulbourethral glands do
secrete mucus to act as lubricant
What can cause male infertility
Low sperm count or quality - usually idiopathic Obstruction Non obstruction Endocrine cause Erectile cause
What are obstructive causes
Congenital absence of vas deferens due to cystic fibrosis
infection
vasectomy
What are non obstructive causes
kleinfelters chemotherapy radiotherapy undescended testes idiopathic
endocrine causes
acromegaly
cushings
hyperprolactinaemia anorexia
hyper/hypo thyroid
What would be defined as small testes
less than 15mls
When is IUI indicated to treat male infertility
low sperm count
When is surgical aspiration of sperm indicated
azoospermia
sperm in aspirated and then ICSI can be performed
What is the success rate in surgical sperm aspiration
95 percent obstructive
50 percent non obstructive
define azoospermia
when there is little or no sperm present in the semen
oligoasthenospermia
low sperm count + low motility
teratoasthenospermia
low motility and abnormal forms
