male infertility

Question 1

which factor causes development of the male internal genital tract

Answer 1

mullerian inhibiting factor

Question 2

what are the two primitive genital tracts

Answer 2

wolffian (male)

mullerian (female)

Question 3

what is androgen insensitivity syndrome also known as

Answer 3

testicular feminisation

Question 4

what karyotype does androgen insensitivity syndrome have

Answer 4

46XY

Question 5

what happens in androgen insensitivity syndrome

Answer 5

androgen induction of wollfian does not occur, mullerian inhibition does occur; born phenotypically external genitalia female, absence of uterus and ovaries, whit short vagina

Question 6

how does androgen insensitivity syndrome present

Answer 6

at puberty with primary amenorrhoea and lack of pubic hair

Question 7

why is it important for the testes to descend

Answer 7

lower temperature outside the body is needed for spermatogenesis

Question 8

which muscle can raise/lower testes according to temperature

Answer 8

dartos muscle

Question 9

what is cryptorchidism

Answer 9

undescended testes

Question 10

implications of cryptorchidism

Answer 10

reduces sperm count

higher chance of seminoma

Question 11

how is cryptorchisdism managed

Answer 11

orchidopexy

Question 12

roles of Sertoli cells

Answer 12

form a blood-testes barrier
provide nutrients 
phagocytosis 
secrete seminiferous tubule fluid
secrete androgen binding globulin
secrete inhibit and activin hormones

Question 13

FSH acts of which testicular cells

Answer 13

Sertoli cells

enhance spermatogenesis

Question 14

LH acts of which testicular cells

Answer 14

Leydig cells

regulate testosterone secretion

Question 15

where is testosterone produced

Answer 15

leydig cells

Question 16

effects of testosterone before brith

Answer 16

masculinises reproductive tract and promotes descent of testes

Question 17

effects of testosterone during puberty

Answer 17

promotes puberty and male characteristics (growth and maturation male reproductive system)

Question 18

testosterone effects in adults

Answer 18

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

Question 19

when is the fertilised egg ready for implantation

Answer 19

when a blastocyst is formed

Question 20

functions of epididymis and vas deferens

Answer 20

exit route from testes to urethra
concentrate and store sperm
site for sperm maturation

Question 21

functions of seminal vesicles

Answer 21

produce semen into ejaculatory duct 
supply fructose 
secrete prostaglandins (stimulate motility)
secretes fibrinogen (clot precursor)

Question 22

functions of prostate gland

Answer 22

produces alkaline fluid (neutralises vaginal acidity)

produce clotting enzymes to clot semen within female

Question 23

function of bulbourethral glands

Answer 23

secrete mucus to act as lubricant

Question 24

what is male infertility

Answer 24

infertility resulting from failure of the sperm to normally fertilise the egg

Question 25

aetiology of male infertility

Answer 25

``` idiopathic (most common) obstructive - cystic fibrosis - vasectomy - infection non-obstructive - congenital - infection - iatrogenic - pathological - genetic - specific semen abnormality - systemic disorder - endocrine ```

Question 26

endocrine causes of infertility

Answer 26

``` PITUITARY acromegaly, Cushing's disease, hyperprolactinaemia HYPOTHALAMIC idiopathic, tumours, kallman's syndrome, anorexia THYROID hyper- or hypothyroidism DIABETES CAH ANDROGEN INSENSITIVITY STEROID ABUSE ```

Question 27

general examination of male infertility

Answer 27

secondary sexual characteristics | presence of gyanecomastia

Question 28

genital examination of male infertility

Answer 28

testicular volume presence of vas deferens and epididymis penis (urethral orifice) presence of any varicocele/other scrotal swelling

Question 29

semen analysis

Answer 29

``` volume density - numbers of sperm motility - what proportion are moving progression - how well they move morphology ```

Question 30

factors affecting results of semen analysis

Answer 30

``` completeness of sample period of abstinence condition during transport time between production and assessment (deteriorates if after 1 hour) natural variations between samples health of man 3 months before production ```

Question 31

further assessment of male infertility

Answer 31

``` repeat semen analysis 6 weeks later endocrine profile chromosome analysis testicular biopsy scrotal scan ```

Question 32

clinical features of obstructive infertility

Answer 32

normal testicular volume normal secondary sexual characteristics vas deferens may be absent normal LH, FSH, testosterone

Question 33

clinical features of non-obstructive infertility

Answer 33

low testicular volume reduced secondary sexual characteristics vas deferens present high LH/FSH +/- low testosterone

Question 34

stages of ICSI

Answer 34

sperm prepared from semen (or tissue from surgical sperm aspiration) each egg is stripped sperm immobilised single sperm injected

Question 35

success rate at obtaining sperm during surgical sperm aspiration

Answer 35

95% in obstructed azoospermia | 50% in non-obstructive

Question 36

indications for donor sperm insemination

Answer 36

azoospermia or very low count failed ICSI treatment genetic conditions infective conditions