Male Infertility Flashcards
What is defined as sex?
- genotypical sex (XX = Female)
- GENDER Identity
- Gonadal Sex (presence of gonads)
- Genital Sex
What do the sertoli cells secret?
mULLERIAN INHIBITING factor (inhibits female reproductive tract prodn)
What makes up a Wolffian ducts?
- MALE reproductive system: epidymis, vas deferense and seminal vesicles
What occurs in females?
- Wolffian ducts DEGENRATE
- Mullerian ducts develop into female reprod. tract
What does DHT bring about?
dht STIMULATES the development of the male EXTERNAL genitalia structures
- so absence of DHT: no penile formation
When can you differentiate sex of a baby?
16 week
—TRIPLE sign in female
What is ANDROGEN INSENSITIIVTY SYNDROME?
- female fetus with y chromosome
- –female phenotypic external genitalia
WHy does AIS occur?
- D/T congenital insensitivity to androgens - ANDROGEN induction of WOLFFIAN duct DOES NOT occur.
- —-mullerian inhibition occurs (MIF remains sensitive)
How does AIS present as?
- at PUBERTY with PRIMARY amenorrhoea
- lack of pubic hair
What supplies the testis?
- tesiticular artery from the aorta
- —L drains into left renal vein
- R into IVC
Malignancy to testis, involves which lymph nodes?
-paraaortic lymph node
The descent of the testis depends on which hormone?
- androgen
What is undescended testes called? When should it ideally descend?
- Cryptorchidsm
- —should come down by 6-9 months of age
Why may cryptorchidsm cause infertility?
—at body temperature
—-reduced spermatogenesis - poor sperm count
(if unilateral undescended teste–still fertile)
What is associated with reduced penile size?
- smoking
- obesity
- tesiticular failure (undescended/Klinefelter)
- environmental
- endocrine
Where is the gene package in the sperm?
Head of the sperm
What drives the sperm?
- mitochondria in the midpiece of the sperm
ROle of sertoli cells?
- sertoli forms tight jxns between themselves
- creates ALKALINE fluid
- secrete seminiferous tubulue fluid and androgen binding globulin
- secret INHIBIN AND ACTIVIN
- PROVIDES nutrients for developing cells
How is the action of the GnRH diff. in males ?
—-continuous release (still pulsatile; not cyclic)
WHat does LH act on?
- LEYDIG cells
- REGULATES TESTOSTERONE release
What regulates the release of LH and FSH?
- GnRH
WHat helps the sperm to get through the Zona Pellucida?
- Acrosome
What is the EXIT route from testes to urethra ?
- Epidydimis
- vas defrens
Define infertility.
- inability for a couple to become pregnant after trying for 12 months
Causes for male infertility.
- Testicular cancer
- breast cancer
- hypospadias
- sperm counts
What are causes of obstructive male infertility?
- normal sperm function
- inability of sperm to exit the body (Vasectomy, cystic fibrosis, infection, scar tissue)
Causes of Non- Obstructive infertility.
- most common GENTIC cause (Klinefelter’s $)
- GLOBOZOOSPERMIA (large sperm head)
- Congenital: Cryoptorchadism
- Infection: mumps orchitis
- Iatrogenic: chemotherapy/radiotherapy
- Pathological: testicular tumour
- Genetic: microdeletions of Y chromosome, Robertsonian translocation
Systemic disorder
Endocrine
Pituitary causes of male infertility?
- Hyperprolactinemia (FSH and LH prodn affected)
- Acromegaly
- Cushing’s disease
WHich 3 autoimmune conditions cause male infertility?
- Hyper/Hypo-Thyroidism
- DM (reduced tesosterone )
Why does steroid abuse cause M infertility?
—decreases LH, FSH and testorsterone
How to enquire about reduced testosterone?
- ASK about how often you need to shave beard
- ask about LIBIDO
- ask about EARLY morning ERECTION
What examinations to follow?
- external genitalia (compare with orchidometer); adults is 12-25mls…LOW volume= LOW tesiticular quantity
- sperm analysis in LAB
What is Hypospadiasis?
- urethral orifice is found earlier on, on the shaft of the penis (underside)
WHat is evaluated in Sperm analysis ?
- morphology
- progressions
- motility (what proportion MOVES)
- density - # of sperms
- volume
How to dx obstructive male infertility?
- normal testicular volume
- normal seoncdary characteristics
- ABSENT vas deferens
- NORMAL LH, FSH and TESTOSTERONE
What is advised for need to concieve for males?
- 2-3x/ week of sex
- reduce SMOKING (a/w decr. SEMEN quality and decr. health) and reduce alcohol intake to <4 units/week
- <30 BMI (improves fertility)
- avoid TIGHT underwear
- long hot baths help
- hazardous job (chems)
- anti-oxidants benefits (Vit. C and Zinc)
What occurs i n ICSI?
- sperm prepared from SEMEN
- each egg is STRIPPED
- single sperm INJECTED
- —physically put the sperm into the egg
- —-1 in 3 chance of success rate
What triggers the development of the MALE internal genital tract?
- Testosterone
- Mullerian Inhibiting factor
Which erectile tissue maintains the patency of the urethra?
- Corpus Spongiosum
When do the testes descend and why?
- drops in the scrotal sac BEFORE birth (androgen-dependent)
- y?: LOWER T* outside body facilitates spermatogenesis
What risk does a man have for having undescended testis as an adult?
- cancer risk increases by 6x
do ORCHIDECTOMY
How often does GnRH concentration spike and when does it begin?
- released in BURSTS every 2-3 hours from hypothalamus
- starts at 8-12 years
What occurs to the spermatozoa after ejaculation?
Undergoes 6 processes: 1. Capacitation 2. Chemoattraction 3. Acrosome Rxn 4. Hyperactive Motility 5- penetration and fusion with oocyte membrane 6. zonal reaction
What form of azoospermia is Surgical Sperm aspiration indicative?
obstructive azoospermia in order to perform ICSI (intracytoplasmic sperm injection)
What secretions do the seminal vesicles produce?
- fructose
- secrete prostaglandins (stimulates motility)
- fibrinogen (CLOT prescursor)
What does the bublourethral gland secrete?
- MUCUS
- acts as a lubricant
WHat does the prostate gland secrete?
- alkaline fluid (to neutralize vaginal acidity)
- produces enzymes to CLOT semen in female
Hypothalamic causes of male infertility?
- tumors
- Kallman’s Syndrome
- Anorexia
(decrease LH and FSH > decr. test.)
What should you check for on general PE?
- gynaecomastia
- secondary sexual characteristics
What do you check for on genital examination?
- testicular volume
- presence of Vas Deferens and epididymis
- penis (orifice)
- presence of any varicocele/ scrotal swelling
FActors that affect semen analysis?
- completeness of sample
- > 3 days of abstinence…POOR sperm count if abstinence for more than a week
- condition during transport
- time between prodn and assessment (deteriorates after 1 hr)
- health of man 3 MONTHS before
What futher tests can be done for infertility?
- repeat semen analysis AFTER 6 weeks
- endocrine profile (LH, FSH, TESTOS., PRL and TSH)
- chromosome analysis (Y) , cystic fibrosis screening
- —–after: TESTICULAR biopsy and scrotal scan
What are the clinical fts of Non-obstructive Infertility?
- Low testicular volume - reduced IIary sexual characteristics
- Vas Deferens is present
- HIGH LH, FSH
- +/- LOW testosterone
How to treat hyperprolactinamia?
- with Carbegoline
- stimulates DOPAMINE receptors in the brain (inhibiting prolactin release)
How successful is the reversal of vasectomy if done within 3 years vs within 3-5 years?
- 3years: 75% success rate
- 3-8 years: 55%
- 9-19 years: 40%
What therapy should the patient take up if they have an anejaculatory condition?
psychosexual therapy
When is donor sperm insemination indicated?
- azoospermia
- FAILED ICSI rx
- genetic conditions
- infective conditions
What occurs in the procedure for DSI?
- sperm donors are MATCHED
- sperm quarantined by cryopreservation
3, prepared THAWED semen sample inserted INTRAUTERINE at time of ovulation
