Male Infertility Flashcards
what, at gonadal level, indicates that you will become female?
absence of a Y chromosome
name the 2 primitive genital tracts?
wolffian duct
mullerian duct
what 2 chemicals cause the development of the male internal genital tract?
testosterone
mullerian inhibiting factor
what do the wolffian ducts form?
male genital tract
what do the mullerian ducts form?
female genital tract
when is the earliest time on a scan that you can tell if its a male or female?
16 weeks
patient presents with amenorrhoea and lack of pubic hair in puberty…
suspect androgen insensitivity syndrome
what is androgen insensitivity syndrome?
congenital insensitivity to androgens
what is the karyotype in androgen insensitivity syndrome?
46XY
inheritance of androgen insensitivity syndrome?
x linked recessive
what happens to the testes in androgen insensitivity syndrome?
testes develop but dont descend
when do the testes descend into the scrotal sac?
before birth
why is it important that testes descend?
need a lower temp outside body to facilate spermatogenesis
what muscle facilitates the descent of the testes?
dartos
what should be done with testes at birth?
checked to see that 2 are present and if they arent they should be found on a scan and child should have surgery before puberty
what is cryptorchidism?
undescended testest
male will usually remain fertile in unilateral cryptorchidism T or F
T
Tx of cryptorchidism and why?
orchidopexy before age 14
orchidectomy
risk of cancer
what structures are responsible for spermatogenesis?
seminiferous tubules
what structures are responsible for testosterone production?
leydig cells
when are LH and FSH made in men?
constantly
what does FSH do in men?
tells sertoli cells to make testosterone
sertoli cells secrete….
seminiferous tubule fluid
androgen binding globulin
inhibin and activin
what do inhibin and activin do?
regulate FSH secretion and controls spermatogenesis
LH acts on __ cells
leydig
where is testosterone secreted?
blood
seminiferous tubules
what does testosterone do before birth?
masculinises male RT
promotes descent of testes
site for sperm maturation?
epididymis
vas deferens
what do seminal vesicles secrete?
fructose
prostaglandins
fibrinogen
how does the prostate gland aid fertilisation?
produces an alkaline fluid that clots semen in the female
what part of the male RT is responsible for lubrication?
bulbourethral gland
what drugs can cause retrograde ejaculation?
anticholinergics
what is hypospadias?
urethra is deep down in the scrotum
most common cause of male infertility?
idiopathic
obstructive causes of male infertility?
CF
vasectomy
infection
non-obstructive male infertility is also known as…
testicular failure
causes of testicular failure?
cryptorchadism infection chemo/radiotherapy tumour klinefelter's semen abnormality systemic disorder endocrine
endocrine causes of male infertility?
pituitary tumours eg acromegaly, cushings, prolactin hypothalamic eg kallmans, anorexia thyroid diabetes CAH androgen insensitivity steroid abuse
pituitary tumours have what effect on LH, FSH and testosterone?
all low
thryoid disorders have __ prolactin
increased
CAH has a ___ effect on testosterone
incremental
normal male testicular volume range?
12-25mls
what measures testicular volume?
orchidometer
what should be tested on genital examination?
testicular volume
presence of vas deferens, penis and epididymis
presence of varicoceles and scrotal swellings
what is tested on semen analysis?
volume density motility progression morphology
Ix of male infertility?
semen analysis- repeat after 6 weeks endocrine profile - LH/FSH, testosterone, prolactin, TSH chromosome analysis CF screening testicular biopsy scrotal scan
what is testicular volume like in obstructive male infertility?
normal
if the vas deferens is absent on examination of a man with male infertility what could have happened?
man could have had a vastectomy
what are hormone levels like in obstructive infertility?
all normal
what are LH/FSH and testosterone levels like in non obstructive infertility?
high LH/FSH
low testosterone
vas deferens is present/absent in non obstructive infertility
present
Tx of hyperprolactinaemia
cabergoline
Tx of male infertility
treat cause (eg reverse vasectomy) ICSI sperm donor
how often should infertility patients have sex per week?
2-3 times
how much alcohol should be drunk?
<4 units
indication for surgical sperm aspiration?
azoospermia
