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REPRODUCTION & GYNAECOLOGY > Male Infertility > Flashcards

Male Infertility Flashcards

(45 cards)

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1
Q

What 3 things can define our sex?

A
  • Chromosomes (XX/ XY)
  • Gonads (ovaries/ testes)
  • External Genitalia (Vagina/Penis etc)
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2
Q

What are the two primitive reproductive tracts and how do they differentiate into Male and Female?

A
  • Wolffian (mesonephric) and Mullerian (paramesonephric) ducts
  • Testosterone and AMH cause the development of the male reproductive tract
  • Absence of AMH in females causes the mullerian duct to persist and form the female reproductive tract
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3
Q

What does the hormone Dihydrotestosterone (DHT) stimulate?

A

Formation of external genitalia

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4
Q

When do the external genitalia of the foetus begin to differentiate and when are the 2 different sexes recognisable on a scan?

A
  • differentiate from 9 weeks

- able to recognise sex of foetus on scan from 16 weeks

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5
Q

What abnormalities occur during reproductive development if a patient has Androgen insensitivity syndrome?

A
  • X linked insensitivity to androgens
  • Chromosomal Male 46XY
  • Testis develop (but do not descend)
  • AMH present => female internal tract regresses
  • BUT born with female external genitalia
    => Present at puberty with Primary Amenorrhoea/ absent pubic hair
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6
Q

What is the purpose of the corpus spongiosum layer in the penis?

A

Maintains patency of urethra during erection to allow for ejaculation of sperm to pass through

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7
Q

Where do the testis descend from before birth and why is it important that they do this?

A
  • from posterior abdominal wall

- temperature regulation to facilitate spermatogenesis

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8
Q

What is cryptorchidism?

A
  • Patient has reached adulthood and testes have not descended
  • Reduces sperm count
  • If unilateral then patient is usually fertile
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9
Q

What surgical procedures can be used to treat undescended testes?

A

Orchidopexy
- performed below age 14 years to minimise risk of testicular germ cell cancer

Orchidectomy
- consider if undescended as adult (As risk of cancer increases 6X)

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10
Q

What cells are found INSIDE the seminiferous tubules of the testes and what is their role?

A

Sertoli cells

Spermatogenesis

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11
Q

What cells make up the interstitium between the seminiferous tubules of the testes and what is their role?

A

Leydig cells

Secrete testosterone

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12
Q

What covers the head of the sperm to aid entrance into the egg?

A

Acrosome

- filled with enzymes which help to degrade the outer layers of oocyte

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13
Q

What is contained in the neck of the sperm cell?

A

Lots of mitochondria

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14
Q

What are the various roles of the sertoli cells?

A
  • Forms blood-testes barrier (protects sperm from Ab)
  • Provide nutrients for the developing cells
  • Phagocytosis
  • Secrete seminiferous tubule fluid (to carry cells to epididymis)
  • Secrete androgen binding globulin
  • Secrete inhibin and activin hormones (regulates FSH and spermatogenesis)
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15
Q

Explain how GnRH is released from the hypothalamus in males

A
  • Released in bursts every 2-3 hours (begins age 8-12 years) => NON-CYCLICAL unlike females
  • Stimulates anterior pituitary to produce FSH/LH
  • Under negative feedback from testosterone
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16
Q

What effect does testosterone have on a male before birth?

A
  • masculinises reproductive tract

- promotes descent of testes

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17
Q

What effect does testosterone have on a male during puberty?

A

promotes puberty and male characteristics

=> growth and maturation

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18
Q

What effect does testosterone have on a male during adulthood?

A
  • controls spermatogenesis
  • secondary sexual characteristics (male body shape, deep voice, thickens skin)
  • libido, penile erection?
  • SOMETIMES - Aggressive behaviour
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19
Q

What is the role of the inhibin and activin peptides secreted by the sertoli cells?

Study These Flashcards
A

Activin - stimulates FSH production

Inhibin - inhibits FSH production

20
Q

What is meant by Capacitation of the sperm?

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A
  • series of biochemical events before fertilisation
    e. g.
  • Chemoattraction to oocyte to bind to zona pellucida
  • Acrosome reaction
  • Hyperactivated motility
21
Q

Where in the fallopian tube does fertilisation normally occur?

22
Q

What structures are known as the accessory tissues of the male reproductive tract?

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A
  • Epididymis and Vas Deferens
  • Seminal vesicles
  • Prostate Gland
  • Bulbourethral Glands
23
Q

Why do sperm pause in the epididiymis before continuing through the male reproductive tract?

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A

concentrates and matures the sperm

24
Q

Describe the route of the sperm during erection, emission and ejaculation from male to female.

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A

Erection : blood fills corpora cavernosa

Emission: contraction of accessory sex glands and vas deferens => semen expelled to urethra

Ejaculation: contraction of smooth muscles of urethra and erectile muscles (shoot = sympathetic control)

25
When can problems with premature or retrograde ejaculation occur?
neuropathy prostate surgery anticholinergic drugs
26
What percentage of infertility is due to male factor?
around 30% => 1/3
27
As sperm count is decreasing, the incidence of what other conditions relating to male infertility are increasing?
Hypospadias | Testicular cancer
28
What are the 3 groups of causes of Male Infertility?
Idiopathic: most common (>50%) Obstructive: (CF, vasectomy, infection) Non-Obstructive (MANY causes)
29
Name some non-obstructive causes of male infertility
- Congenital (undescended testes) Cryoptorchadism - Infection: mumps - Iatrogenic: chemo - Pathological: tumour - Genetic: XXY, Y microdeletions - Semen abnormality - Endocrine problem
30
What endocrine disorders cause male infertility
Pituitary tumours: - acromegaly - cushings - hyperprolactin Hypothalmic: - idiopathic - tumours - Kallman’s Thyroid Disorders - hyper/hypothyriodism Diabetes - decreased sexual function and testosterone Congenital Adrenal Hyperplasia - increased testosterone Androgen insensitivity Steroid abuse (decreased LH/ FSH/ testosterone)
31
How should male infertility be assessed?
- See patient in their couple - History (including andrology hx) - Examination (general and genital) - Investigations (semen analysis + others depending on results)
32
What is involved in a genital examination for investigation of male infertility?
- testicular volume - presence of vas deferens and epididymis - penis (urethral orifice) - presence of any varicocele/other scrotal swelling
33
What is a normal testicular volume (pre-pubertal and adult)?
pre-pubertal: 1-3mls | adults: 12-25mls
34
What testicular volume would indicate infertility?
below 5ml unlikely to be fertile
35
What should be analysed in a semen sample?
``` Volume Density - numbers of sperm Motility - what proportion are moving Progression - how well they move Morphology ```
36
What factors can affect a semen analysis sample?
- Completeness of sample (1st part of ejaculate is best for sample) - Abstinence e.g. <3 days - Kept warm during transport (sperm immobile if too cold) - Health of man 3 months before production
37
What further investigations can be done after a semen analysis?
- repeat semen analysis 6 weeks later - endocrine profile (LH, FSH, testosterone, PRL, TSH) - chromosome analysis (including karyoptype, Y microdeletions) CF screen - Testicular biopsy - Scrotal US scan
38
What features may be relevant on examination if a patient has obstructive male infertility?
- normal testicular volume - normal secondary sexual characteristics - vas deferens may be absent - endocrine profile will also be normal
39
What features may be relevant on examination if a patient has non-obstructive male infertility?
- low testicular volume - reduced secondary sexual characteristics - vas deferens present Endocrine = High LH, FSH +/- low testosterone
40
Give examples of specific types of male infertility that can be treated
- reversal of vasectomy if present (75% success rate if reversed within 3 years) - carbegoline tx if hyperprolactinamia - psychosexual tx if erectile dysfunction (e.g. Sildenafil)
41
What forms of ACT are commonly used for patients with male infertility?
- Intracytoplasmic sperm injection ICSI (may require surgical sperm aspiration) - Donor Insemination (DI)
42
What general advice is given to help with male infertility?
- Frequency sexual intercourse: 2-3 X per week - Avoid lubricants toxic to sperm - Alcohol: < 4 units per day - Stop smoking - BMI: < 30 - Avoid tight fitting underwear - Avoid prolonged hot baths/sauna - Warn about occupations: overheating/exposure to chemicals
43
When is donor sperm insemination indicated?
- azoospermia or very low count - failed ICSI treatment - genetic conditions - infective conditions
44
Describe the procedure of donor sperm insemination
- Sperm donors (not anonymous) matched for recipient characteristics - ALSO screened for genetic conditions and STIs - Sperm quarantined - Prepared semen sample inserted intrauterine at time of ovulation
45
What is the pregnancy rate after donor insemination?
15%

REPRODUCTION & GYNAECOLOGY (58 decks)

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