Male Infertility Flashcards
What does the Wolffian ducts develop into?
male reproductive tract
What do the mullerian ducts devlop into?
female repro tract
What do the fetal testes secrete?
testosterone and mullerian inhibiting factors
What occurs during androgen insensitivity syndrome?
androgen induction of Wolffian duct does not occur, Mullerian inhibition does occur: born phenotypically external genitalia femal, ansence uterus and ovaries with short vagin
What does testosterone do?
undifferentiated extenral genitalia develop along male lines; transforms wolffian ducts into male reprod tract
What does the mullerian-inhibiting factor cause?
degeneration of mullerian ducts
How do patients with androgen insensitivity syndrome usually present?
at puberty with primary amenorrhoea and lack of pubic hair
Why do testes need to descend?
lower temp outside body to facilitate spermatogenesis
What muscle contracts to lower or raise the testes?
dartos muscle
What is undescended testes called?
cryptorchidism
When should orchidopexy be performed with cryptorchidism?
below age 14
What is the risk with undescened testes?
testicular germ celll cancer x6 as adult
What cells produce testosterone?
leydig cells
What cell produces sperm?
sertoli cells
What is found within the acrosome of the sperm?
enxymes for penetrating the ovum
What are the functions of sertoli cells?
blood-testes barrier; provide nutriets; phagocytosis; secrete seminiferous ubule fluid ;secrete androgen binding globulin and secretes inhibin and activin
What si the function of a blood-testes barrier?
protects sperm from antibody attack; provides a suitable fluid composition allowing later stage sof speram development
what is the function of seminiferous tubule fluid?
carry cells to epididymis
What is the function of androgen binding globulin?
binds testosterone so conc. remains high in the lumen, essential for sperm production
What is the function of inhibin adn activin?
regulates FSH secretion and controls spermatogenesis
What hormone stimulates spermatogenesis?
FSH
What hormone stimulates production of testosterone?
LH
What is the function of GnRH?
stimulates anterior pituitary to produce LH and FSH
What are the effects of testosterone in the adult?
contorols spermatogeneiss; secondary sexual characterisitsc; libido; penile erection; aggressive behaviour?
What type of molecule is inhibin nad activin?
peptides
What is capacitation?
the function changes that lead to hyperactive motility and which later allow the spermatozoa to undergo acrosome reaction
How are sperm attracted to the oocyte?
chemoattraction
What is the function of the seminal vesicles?
produce semen into ejaculatory duct, supply fructose, secrete PGs and secrete fibrinogen
What is the function of PGs in sperm?
stimulate motility
What is the funcion of the prostate gland?
produces alkaline fluid and clotting enzymes to clot semen within the female
What is the function of the bulbourethral glands?
secrete mucus to act as lubricant
What nervous system controls erection?
parasympathetics
What nervous system controls ejaculation?
sympathetics
What is emission?
contraction of accessory sex glands and vas deferens so semen expelled to urethra
What is male infertility?
infertility resulting from failure of the sperm to normall fertilise the egg
What is male infertility usually caused by?
abnormalities in semen analysis
Why is male infertility incresing?
environmental oestrognes?
What are the obstructive causes of male infertility?
CF; vasectomy; infection
What infection is implicated in non-obstructive male infertility?
mumps orchitis
Why do thyroid disorders cause male infertility?
decrease sexual function and decrease testosterone
What are hypothalamic causes of male infertility?
idiopathetic, tumours, Kallman’s syndrome, anorexia
How is diabetes implicated in male infertility?
decrease sexual function and decrease testosterone
What DMARD is associated with male infertility?
sulfasalazine
What is normal pre-pubertal testicular volume?
1-3mls
What is normal testicular volume in adults?
12-25mls
Under what testicular volume is someone unlikely to be fertile?
below 5mls
What extrinsic factors can cause abnormalities in semen analysis?
completeness of sample; period of abstinence; condition during transport; time between production and assessment; natural variations between samples; health of man 3 months before production
What are the clinical features of obstructive male infertility?
normal testicular volume; normal secondary sexual characteristics; vas deferens may be absent; normal hormones
What are the features of non-obstructive male infertility?
low testicular volume; reduces secondary sexual characteristics; vas deferens present; high LH and FSH; low testosterone
How many times per week should patients with male infertility have sex?
2-3 times per week
What is the indication for intra-uterine insemination
mildly reduced sperm count
What is the procedure for intrauterine insemination?
semen sample prepared to produce conc. sperm sample; inseminated into uterine cavity around ovulation
What is the pregnancy rate iwth intra-uterine insemination?
15% per treatment cycle
What is the indication for intracytoplasmic sperm injection?
very low sperm count
What is the proedure for ICSI?
sperm injected into strippeed oocyte obtained during IVF
What is the pregnancy rate with ICSI?
30% per treatment cycle
What is the indication for surgical sperm aspiration?
azoospermia
What is the proceure with surgical sperm aspiration?
sperm aspirated surgically, sperm then injected into oocyte(ICSI)
What is the success rate at obtaining sperm with surgical aspiration?
95%- obstructive
50% non-obstructive
What are the indications with donor sperm insemination?
azoospermia or very low sperm count; genetic conditions; infection conditions
What is the pregnancy rate with donor sperm insemination?
15%
