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Repro > Male Infertility > Flashcards

Male Infertility Flashcards

1
Q

What do fetal testes secrete?

A

Testosterone and Mullerian inhibiting factors

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2
Q

What are the two primitive genital tracts?

A

Wolffian and Mullerian ducts

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3
Q

In males, which duct degenerates, Wolffian or Mullerian?

A

Mullerian

The wolffian becomes the repro tract

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4
Q

What occurs if no male testicular hormones are present?

A

Fetus will develop female internal genital tract

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5
Q

In females, which duct degenerates, Wolffian or Mullerian?

A

Wolffian

The Mullerian becomes the repro tract

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6
Q

What is Androgen Insensitivity syndrome? (Testicular feminisation)

A

Congenital insensitivity to androgens
X-linked karyotype (46XY)
Testes develop but don’t descend

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7
Q

What happens in Androgen Insensitivity syndrome?

A

Androgen induction of wolffian inhibition does not occur, Mullerian inhibition does occur
born phenotypically external geneitalia female, absence of a uterus and ovaries with short vagina

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8
Q

When does Androgen Insensitivity syndrome commonly present?

A

At puberty with primary amenorrhoea, lack of pubic hair

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9
Q

How do the testes descend?

A

In utero, testes develop in abdominal cavity of foetus and drop into scrotal sac before birth (androgen dependant)

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10
Q

Why is it important that the testes descend?

A

Lower temperature outside the body to facilitate spermatogenesis

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11
Q

How do the testes raise and lower according to external temperature?

A

Nervous reflexes trigger dartos muscle contraction in scrotal sac

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12
Q

What is Cryptorchidism?

A

Undescended testes

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13
Q

What are the clinical implications of Cryptorchidism?

A

Reduced sperm count, if unilateral usually infertile

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14
Q

What procedure helps to reduce risk of testicular germ cell cancer?

A

Orchidopexy (done before age 14 years

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15
Q

If testes are undescended as an adult, what procedure should be considered and why?

A

Orchidectomy because cancer risk is X6

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16
Q

Where does spermatogenesis occur?

A

Seminiferous tubules

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17
Q

Where is testosterone produced?

A

Leydig cells

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18
Q

What part of the sperm contains enzymes for penetrating the ovum?

A

The acrosome

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19
Q

Why does the sperm have many mitochondria?

A

To power the tail

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20
Q

What is a spermatozoon?

A

A sperm cell

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21
Q

What is present in the tail?

A

Microtubules

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22
Q

What are the 6 roles of Sertoli cells?

A 
Forms a blood-testes barrier
Provides nutrients
Phagocytosis
Secrete seminiferous tubule fluid
Secrete androgen binding globulin
Secrete inhibin and activin hormones
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23
Q

What can a lack of testosterone lead to?

A

Osteoporosis

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24
Q

Why is a blood-sperm barrier important?

A

Protects sperm from antibody attack

Provides suitable fluid composition which allows later stages of sperm development

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25
Q

Where are cells carried to via the seminiferous tubule fluid?

A

Epididymis

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26
Q

What does androgen binding globulin do?

A

Binds testosterone so concentration remains high in lumen

Essential for sperm production

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27
Q

What inhibin and activin hormones are secreted?

A

FSH secretion is regulated and controls spermatogenesis

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28
Q

What does dihydrotestosterone cause?

A

Enlargement of male sex organs
Secondary sexual characteristics
Anabolism

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29
Q

What does testosterone decrease the release of?

A

GnRH and LH

30
Q

What stimulates the testosterone secretion?

A

LH

31
Q

What stimulates spermatogenesis?

A

Testosterone and FSH

32
Q

Describe Gonadotrophin Releasing Hormone

A

Decapeptide

Released from hypothalamus in bursts every 2-3 hours (begins age 8-12 years)

33
Q

What does Gonadotrophin Releasing Hormone stimulate?

A

Anterior pituitary to produce LH and FSH

34
Q

What controls Gonadotrophin Releasing Hormone via negative feedback?

A

testosterone

35
Q

What does LH act upon?

A

Leydig cells

36
Q

What does FSH act upon?

A

Sertoli cells

37
Q

How is FSH and LH different in males compared to females?

A

Non-cyclical in males

38
Q

Describe testosterone

A

Produced in Leydig cells
Steroid hormones derived from cholesterol
Secreted into blood and seminiferous tubules for sperm production
Negative feedback on hypothalamus and pituitary gland

39
Q

What are the effects of testosterone before birth?

A

Masculinises reproductive tract and promotes descent of testes

40
Q

What are the effects of testosterone during puberty?

A

Promotes puberty and male characteristics (growth and maturation male repro system)

41
Q

What is the effect of testosterone in an adult?

A

Controls spermatogenesis, secondary sexual characteristics (male body shape, deep voice, thickens skin), libido, erection, aggressive behaviour

42
Q

What is inhibin and activin?

A

peptides
Secreted by Sertoli cells
Feedback on FSH

43
Q

What does inhibin descrease secretion of?

A

FSH

44
Q

What happens to spermatozoa after ejaculation?

A

Liquified by enzymes from prostate gland

45
Q

What does the spermatozoa have a chemoattraction to?

A

Oocyte and bind to zona pellucida of oocyte

46
Q

What is the function of the epididymis and vas deferens?

A

Exit route from testes to urethra, concentrate and sperm storage.
site for sperm maturation

47
Q

What is the function of the seminal vesicles?

A

Produce semen into ejaculatory duct, supply fructose, secrete prostaglandins (stimulate motility), secrete fibrinogens (clot precursor)

48
Q

What are the functions of the prostate gland?

A

Produces alkaline fluid (neutralises vaginal acidity), produces clotting enzymes to clot semen within female

49
Q

What is the function of the Bulbourethral glands?

A

Secrete mucus to act as lubricant

50
Q

What is the route of sperm?

A

testes - epididymis - vas deferens - ejaculatory duct - urethra

51
Q

What pathway controls ejaculation?

A

Sympathetic control

52
Q

What is the most common cause of male infertility?

A

Idiopathic

53
Q

What are the obstructive causes of male infertility?

A

Cystic fibrosis
vasectomy
Infection

54
Q

What are the congenital and infectuous causes of male infertility?

A

C - Cryptorchadism

I - Mumps, orchitis

55
Q

What are the latrogenic and pathological causes of male infertility?

A

I - Chemo/radio therapy

P - Testicular tumour

56
Q

What are the genetic causes of male infertility?

A

Kleinfelters
Microdeletions of Y chromosome
Robertsonian translocation

57
Q

What is the specific semen abnormality?

A

Globozoospermia

58
Q

What are the pituitary causes of male infertility?

A

Acromegaly
Cushings
Hyperprolapctinaemia
Decreased LH, FSH and testosterone

59
Q

What are the hypothalmic causes of male infertility?

A

Idiopathic tumours
Kallman’s
Anorexia
decreased LH, FSH and testosterone

60
Q

What are the Thyroid causes of male infertility?

A

Hyper/hypo

61
Q

What other endocrine disorders can cause male infertility?

A

Diabetes
CAH
Androgen insensitivity
Steroid abuse

62
Q

How do you examine male infertility?

A 
Look for gynaecomastia and secondary sexual characteristics
testicular volume
Vas deferens and epididymis present
Penis
Varicocele etc
63
Q

What is the normal testicular volume?

A

Pre-pubertal 1-3mls
Adulrts 12-25mls
If below 5mls then unlikely to be fertile

64
Q

How do you measure testicular volume?

A

Orchidometer

65
Q

What do you measure with a semen sample?

A 
Volume
Density
Motility
Progression
Morphology
66
Q

How long prior to ejaculation should a mans health be considered?

A

3 months

67
Q

What are the further assessments for semen analysis?

A

Repeat 6 weeks later
Endocrine profile (LH, FSH, testosterone, PRL, TSH)
Chromosome analysis
Cystic fibrosis screening
Depending on results - testicular biopsy, scrotal scan

68
Q

How do you treat male infertility?

A 
Frequency of sexual characteristics
Alcohol < 4 units per day
No smoking
BMI <30
avoid tight underwear
Antioxidants (Vit C or zinc)
69
Q

What is Intra-uterine Insemination?

A

Indication of mildly low sperm count
Semen prepared to produce concentrated sperm sample
Inseminated into uterine cavity around time of ovulation
15% pregnancy rate

70
Q

What is Intracytoplasmic sperm injection?

A

Indications are very low sperm count
Procedure is sperm injected into stripped oocyte obtained during IVF
Pregnancy rate is 30% per cycle

71
Q

What is surgical sperm aspiration?

A

Indication is azoospermia
Sperm aspirated surgically
Sperm injected into oocyte
95% in azoospermia and 50% in non-obstructive azoospermia

72
Q

What is donor sperm insemination?

A

Azzospermia or very low count, genetic conditions or infective conditions
Sperm donors matched for recipient characteristics and screened for genetic diseases and STI’s
Sperm quarantined by cryopreservation and rescreened
Prepared thawed semen sample inserted into intrauterine at time of ovulation
15% success rate

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