male infertility Flashcards
which factor causes development of the male internal genital tract
mullerian inhibiting factor
what are the two primitive genital tracts
wolffian (male)
mullerian (female)
what is androgen insensitivity syndrome also known as
testicular feminisation
what karyotype does androgen insensitivity syndrome have
46XY
what happens in androgen insensitivity syndrome
androgen induction of wollfian does not occur, mullerian inhibition does occur; born phenotypically external genitalia female, absence of uterus and ovaries, whit short vagina
how does androgen insensitivity syndrome present
at puberty with primary amenorrhoea and lack of pubic hair
why is it important for the testes to descend
lower temperature outside the body is needed for spermatogenesis
which muscle can raise/lower testes according to temperature
dartos muscle
what is cryptorchidism
undescended testes
implications of cryptorchidism
reduces sperm count
higher chance of seminoma
how is cryptorchisdism managed
orchidopexy
roles of Sertoli cells
form a blood-testes barrier provide nutrients phagocytosis secrete seminiferous tubule fluid secrete androgen binding globulin secrete inhibit and activin hormones
FSH acts of which testicular cells
Sertoli cells
enhance spermatogenesis
LH acts of which testicular cells
Leydig cells
regulate testosterone secretion
where is testosterone produced
leydig cells
effects of testosterone before brith
masculinises reproductive tract and promotes descent of testes
effects of testosterone during puberty
promotes puberty and male characteristics (growth and maturation male reproductive system)
testosterone effects in adults
controls spermatogenesis secondary sexual characteristics (male body shape, deep voice, thickens skin) libido penile erection aggressive behaviour
when is the fertilised egg ready for implantation
when a blastocyst is formed
functions of epididymis and vas deferens
exit route from testes to urethra
concentrate and store sperm
site for sperm maturation
functions of seminal vesicles
produce semen into ejaculatory duct supply fructose secrete prostaglandins (stimulate motility) secretes fibrinogen (clot precursor)
functions of prostate gland
produces alkaline fluid (neutralises vaginal acidity)
produce clotting enzymes to clot semen within female
function of bulbourethral glands
secrete mucus to act as lubricant
what is male infertility
infertility resulting from failure of the sperm to normally fertilise the egg
aetiology of male infertility
idiopathic (most common) obstructive - cystic fibrosis - vasectomy - infection non-obstructive - congenital - infection - iatrogenic - pathological - genetic - specific semen abnormality - systemic disorder - endocrine
endocrine causes of infertility
PITUITARY acromegaly, Cushing's disease, hyperprolactinaemia HYPOTHALAMIC idiopathic, tumours, kallman's syndrome, anorexia THYROID hyper- or hypothyroidism DIABETES CAH ANDROGEN INSENSITIVITY STEROID ABUSE
general examination of male infertility
secondary sexual characteristics
presence of gyanecomastia
genital examination of male infertility
testicular volume
presence of vas deferens and epididymis
penis (urethral orifice)
presence of any varicocele/other scrotal swelling
semen analysis
volume density - numbers of sperm motility - what proportion are moving progression - how well they move morphology
factors affecting results of semen analysis
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
further assessment of male infertility
repeat semen analysis 6 weeks later endocrine profile chromosome analysis testicular biopsy scrotal scan
clinical features of obstructive infertility
normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent
normal LH, FSH, testosterone
clinical features of non-obstructive infertility
low testicular volume
reduced secondary sexual characteristics
vas deferens present
high LH/FSH +/- low testosterone
stages of ICSI
sperm prepared from semen (or tissue from surgical sperm aspiration)
each egg is stripped
sperm immobilised
single sperm injected
success rate at obtaining sperm during surgical sperm aspiration
95% in obstructed azoospermia
50% in non-obstructive
indications for donor sperm insemination
azoospermia or very low count
failed ICSI treatment
genetic conditions
infective conditions
