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3 Reproduction > Male Infertility > Flashcards

Male Infertility Flashcards

1
Q

what determines the development of the testis from biopotential gonad

A

Sex determining region on the Y chromosome

testosterone and mullerian inhibiting factor cause the development of the male internal genital tract

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2
Q

what determines the female reproductive tracts

A

wolffian ducts degenerate

mullein ducts give rise to repro tract

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3
Q

how doest androgen insensitivity syndrome (testicular feminisation) occur

A

X linked recessive disorder

No androgens so male reproductive system does not develop

XY chromosomes so should be male

born phenogenically female with absence of uterus and ovaries with short vagina

commonly present at puberty with primary amenorrhoea and lack of pubic hair

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4
Q

where do testes develop in the foetus

A

abdominal cavity

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5
Q

when do testes descend into the scrotal sac

A

before birth

imports as there is a lower body temp outside to facilitate spermatogenesis

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6
Q

what is the name for undescended testes

A

Cryptorchidism

(usually would descend between 6-9 months of age_

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7
Q

what is orchidopexy and when should it be done

A

surgical descend of the testes

should be performed by 12 months because of strong association with infertility and risk of testicular germ cancer

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8
Q

what are the 3 main tubes in the penis

A 
corpus cavernous 
corpus spongiosum (has urethra in it)
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9
Q

what cells are responsible for spermatogenesis

A

Sertoli cells

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10
Q

what is the blood-testes barrier

A

barrier formed by Sertoli cells
protects the sperm from antibody attack
provides suitable fluid composition which allow later stages of development of sperm

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11
Q

what are the functions of Sertoli cells

A 
Form blood-testes barrier 
Provide nutrients 
Phagocytosis 
Secrete seminiferous fluid 
Secrete androgen binding globulin 
Secreted inhibit and activin hormones
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12
Q

what hormones control spermatogenesis

A

FSH and testosterone

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13
Q

what is gonadotrophin releasing hormone

A

decapeptide
released from hypothalamus in bursts
stimulates LH and FSH release from anterior pituitary

negative feedback control by testosterone

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14
Q

what does LH do

A

acts on leydig cells to regulate testosterone secretion

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15
Q

what does FSH do

A

acts on Sertoli cells to enhance spermatogenesis

regulated by negative feedback from inhibin

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16
Q

what hormone triggers LH and FSH release from the pituitary

A

GnRH - gonadotrophin-releasing hormone

17
Q

what are the effects of testosterone

A

Before birth:
-masculinises repro tract and promotes testes descent

puberty:
- promotes puberty and male characteristics

adult:
-controls spermatogenesis, secondary sexual characteristics, libido, penile erection, aggressive behaviour

18
Q

what are inhibit and activin

A

peptides secreted by Sertoli cells

feedback on FSH

(inhibit inhibits and avtivin stimulates)

19
Q

after ejectulation, where does the sperm go

A

chemoattraction to oocyte

binds to zone pellucid

penetration and fusion with oocyte membrane

20
Q

what is the function of the epididymis and vas deferent

A

exit route from testes to urethra
concentrates and stores sperm
site for sperm maturation

21
Q

function of the seminal vesicles

A

produce semen into ejaculatory duct
supply fructose
secrete prostaglandins
secrete fibrinogen

22
Q

function of the prostate gland

A

produces alkaline fluid

produces clotting enzymes to clot semen within female

23
Q

function of bulbourethral glands

A

secrete mucus to act as lubricant

24
Q

what is male infertility

A

infertility resulting from failure of sperm to normally fertilise the egg

usually associated with abnormalities in semen

25
Q

causes of male infertility

A

Idiopathic

Obstructive

  • cystic fibrosis
  • vasectomy
  • infection

non-obstructive

  • congenital
  • infection (mumps)
  • iatrogenic (chemo/radio)
  • genetic
  • specific semen abnormality
  • systemic disorder
  • endocrine
26
Q

what are some endocrine causes of male infertility

A 
Pituitary tumours
Hypthalmic causes 
Thyroid disorders 
Diabetes 
CAH 
Androgen insensitivity 
Steroid abuse (decreases testosterone)
27
Q

how do you assess male infertility

A

see as couple
history (andrology history)
examination
investigations

28
Q

how do you examine a male with infertility

A

General exam
- secondary sexual characteristics/presence of gynacomastia

genital exam:

  • testicular volume
  • presence of vas deferent and epididymis
  • penis (urethral orifice)
  • presence of any varicocele/other scrotal swelling
29
Q

what is normal testicular volume pre-pubertal

A

1-3mls

30
Q

what is normal testicular volume in adults

A

12-25mls

if below 5ml unlikely to be fertile

measure using an orchidometer

31
Q

how do you analyse semen

A 
look at:
volume 
density (numbers of sperm) 
motility (what proportion are moving) 
progression (how well they move) 
morphology
32
Q

what factors affect the result of semen analysis

A 
Completeness of sample 
Period of abstinence 
Condition during transport 
Time between production and assessment 
Natural variations between samples 
Health of man 3 months before production
33
Q

what further investigations can be done for male infertility

A

Repea semen analysis 6 weeks later

Endocrine profile

Chromosome analysis, cystic fibrosis screening

depending on results:

  • biopsy
  • scotal scan
34
Q

what is obstructive infertility

A

normal volume
normal secondary sexual characteristics

vas deferent may be absent

35
Q

what is non-obstructive infertility

A

low testicular volume

reduced secondary sexual characteristics

vas deferens present

high LH, DSH +/- low testosterone

36
Q

how do you treat male infertility

A

treat any specific cause eg. reversal of vasectomy, carbegoline if hyperprolactinaemia

Intracytoplasmic sperm injection

Donor insemination

37
Q

general advice for male infertility

A 
frequent intercourse - 2-3x per week 
<4 units of alcohol per day 
stop smoking 
BMI<30 
Avoid tight fitting underwear and prolonged hot baths/saunas 
Certain occupations 
Complementary therapies and non-prescription drugs 
benefits of antioxidants
38
Q

when would you use surgical sperm aspiration

A

azoospermia
sperm aspirated surgically
sperm then injected into oocyte (ICSI)

3 Reproduction (49 decks)

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