Male Infertility Flashcards

1
Q

What is defined as sex?

A
  • genotypical sex (XX = Female)
  • GENDER Identity
  • Gonadal Sex (presence of gonads)
  • Genital Sex
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2
Q

What do the sertoli cells secret?

A

mULLERIAN INHIBITING factor (inhibits female reproductive tract prodn)

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3
Q

What makes up a Wolffian ducts?

A
  • MALE reproductive system: epidymis, vas deferense and seminal vesicles
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4
Q

What occurs in females?

A
  • Wolffian ducts DEGENRATE

- Mullerian ducts develop into female reprod. tract

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5
Q

What does DHT bring about?

A

dht STIMULATES the development of the male EXTERNAL genitalia structures

  • so absence of DHT: no penile formation
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6
Q

When can you differentiate sex of a baby?

A

16 week

—TRIPLE sign in female

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7
Q

What is ANDROGEN INSENSITIIVTY SYNDROME?

A
  • female fetus with y chromosome

- –female phenotypic external genitalia

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8
Q

WHy does AIS occur?

A
  • D/T congenital insensitivity to androgens - ANDROGEN induction of WOLFFIAN duct DOES NOT occur.
  • —-mullerian inhibition occurs (MIF remains sensitive)
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9
Q

How does AIS present as?

A
  • at PUBERTY with PRIMARY amenorrhoea

- lack of pubic hair

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10
Q

What supplies the testis?

A
  • tesiticular artery from the aorta
  • —L drains into left renal vein
  • R into IVC
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11
Q

Malignancy to testis, involves which lymph nodes?

A

-paraaortic lymph node

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12
Q

The descent of the testis depends on which hormone?

A
  • androgen
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13
Q

What is undescended testes called? When should it ideally descend?

A
  • Cryptorchidsm

- —should come down by 6-9 months of age

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14
Q

Why may cryptorchidsm cause infertility?

A

—at body temperature
—-reduced spermatogenesis - poor sperm count
(if unilateral undescended teste–still fertile)

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15
Q

What is associated with reduced penile size?

A
  • smoking
  • obesity
  • tesiticular failure (undescended/Klinefelter)
  • environmental
  • endocrine
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16
Q

Where is the gene package in the sperm?

A

Head of the sperm

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17
Q

What drives the sperm?

A
  • mitochondria in the midpiece of the sperm
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18
Q

ROle of sertoli cells?

A
  • 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
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19
Q

How is the action of the GnRH diff. in males ?

A

—-continuous release (still pulsatile; not cyclic)

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20
Q

WHat does LH act on?

A
  • LEYDIG cells

- REGULATES TESTOSTERONE release

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21
Q

What regulates the release of LH and FSH?

A
  • GnRH
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22
Q

WHat helps the sperm to get through the Zona Pellucida?

A
  • Acrosome
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23
Q

What is the EXIT route from testes to urethra ?

A
  • Epidydimis

- vas defrens

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24
Q

Define infertility.

A
  • inability for a couple to become pregnant after trying for 12 months
25
Q

Causes for male infertility.

A
  • Testicular cancer
  • breast cancer
  • hypospadias
  • sperm counts
26
Q

What are causes of obstructive male infertility?

A
  • normal sperm function

- inability of sperm to exit the body (Vasectomy, cystic fibrosis, infection, scar tissue)

27
Q

Causes of Non- Obstructive infertility.

A
  • 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

28
Q

Pituitary causes of male infertility?

A
  • Hyperprolactinemia (FSH and LH prodn affected)
  • Acromegaly
  • Cushing’s disease
29
Q

WHich 3 autoimmune conditions cause male infertility?

A
  • Hyper/Hypo-Thyroidism

- DM (reduced tesosterone )

30
Q

Why does steroid abuse cause M infertility?

A

—decreases LH, FSH and testorsterone

31
Q

How to enquire about reduced testosterone?

A
  • ASK about how often you need to shave beard
  • ask about LIBIDO
  • ask about EARLY morning ERECTION
32
Q

What examinations to follow?

A
  • external genitalia (compare with orchidometer); adults is 12-25mls…LOW volume= LOW tesiticular quantity
  • sperm analysis in LAB
33
Q

What is Hypospadiasis?

A
  • urethral orifice is found earlier on, on the shaft of the penis (underside)
34
Q

WHat is evaluated in Sperm analysis ?

A
  • morphology
  • progressions
  • motility (what proportion MOVES)
  • density - # of sperms
  • volume
35
Q

How to dx obstructive male infertility?

A
  • normal testicular volume
  • normal seoncdary characteristics
  • ABSENT vas deferens
  • NORMAL LH, FSH and TESTOSTERONE
36
Q

What is advised for need to concieve for males?

A
  • 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)
37
Q

What occurs i n ICSI?

A
  • 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
38
Q

What triggers the development of the MALE internal genital tract?

A
  • Testosterone

- Mullerian Inhibiting factor

39
Q

Which erectile tissue maintains the patency of the urethra?

A
  • Corpus Spongiosum
40
Q

When do the testes descend and why?

A
  • drops in the scrotal sac BEFORE birth (androgen-dependent)

- y?: LOWER T* outside body facilitates spermatogenesis

41
Q

What risk does a man have for having undescended testis as an adult?

A
  • cancer risk increases by 6x

do ORCHIDECTOMY

42
Q

How often does GnRH concentration spike and when does it begin?

A
  • released in BURSTS every 2-3 hours from hypothalamus

- starts at 8-12 years

43
Q

What occurs to the spermatozoa after ejaculation?

A
Undergoes 6 processes:
1. Capacitation 
2. Chemoattraction 
3. Acrosome Rxn
4. Hyperactive Motility
5- penetration and fusion with oocyte membrane
6. zonal reaction
44
Q

What form of azoospermia is Surgical Sperm aspiration indicative?

A

obstructive azoospermia in order to perform ICSI (intracytoplasmic sperm injection)

45
Q

What secretions do the seminal vesicles produce?

A
  • fructose
  • secrete prostaglandins (stimulates motility)
  • fibrinogen (CLOT prescursor)
46
Q

What does the bublourethral gland secrete?

A
  • MUCUS

- acts as a lubricant

47
Q

WHat does the prostate gland secrete?

A
  • alkaline fluid (to neutralize vaginal acidity)

- produces enzymes to CLOT semen in female

48
Q

Hypothalamic causes of male infertility?

A
  • tumors
  • Kallman’s Syndrome
  • Anorexia

(decrease LH and FSH > decr. test.)

49
Q

What should you check for on general PE?

A
  • gynaecomastia

- secondary sexual characteristics

50
Q

What do you check for on genital examination?

A
  • testicular volume
  • presence of Vas Deferens and epididymis
  • penis (orifice)
  • presence of any varicocele/ scrotal swelling
51
Q

FActors that affect semen analysis?

A
  1. completeness of sample
  2. > 3 days of abstinence…POOR sperm count if abstinence for more than a week
  3. condition during transport
  4. time between prodn and assessment (deteriorates after 1 hr)
  5. health of man 3 MONTHS before
52
Q

What futher tests can be done for infertility?

A
  • 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
53
Q

What are the clinical fts of Non-obstructive Infertility?

A
  • Low testicular volume - reduced IIary sexual characteristics
  • Vas Deferens is present
  • HIGH LH, FSH
  • +/- LOW testosterone
54
Q

How to treat hyperprolactinamia?

A
  • with Carbegoline

- stimulates DOPAMINE receptors in the brain (inhibiting prolactin release)

55
Q

How successful is the reversal of vasectomy if done within 3 years vs within 3-5 years?

A
  • 3years: 75% success rate
  • 3-8 years: 55%
  • 9-19 years: 40%
56
Q

What therapy should the patient take up if they have an anejaculatory condition?

A

psychosexual therapy

57
Q

When is donor sperm insemination indicated?

A
  • azoospermia
  • FAILED ICSI rx
  • genetic conditions
  • infective conditions
58
Q

What occurs in the procedure for DSI?

A
  1. sperm donors are MATCHED
  2. sperm quarantined by cryopreservation
    3, prepared THAWED semen sample inserted INTRAUTERINE at time of ovulation