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Reproduction > Male Infertility > Flashcards

Male Infertility Flashcards

1
Q

what chromosomes are in a sperm

A

22 + x or Y

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2
Q

what chromosomes are in an oocyte

A

22 + x

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3
Q

how many chromosomes should you have

A

23 pairs = 46 in total

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4
Q

which chromosome has the sex determining region and what does it cause

A

Y

development of testis from the bipotential gonad

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5
Q

what do fetal testes secrete

A

testosterone and AMH (cause the development of the male internal genital tract)

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6
Q

what are the two primitive genital tracts

A

wolffian (male)

mullerian (female)

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7
Q

what happens the primitive genital ducts in males

A

wolffian ducts form epididymis, vas deferens, seminal vesicles
mullerian degenerates

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8
Q

what happens the primitive genital ducts in females

A

wolffian degenerates

mullerian forms uterus, fallopian tubes, cervix and upper 1/3rd of vagina

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9
Q

what happens to primordial germ cells during week 5-6

A

migrate to gonadal ridge

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10
Q

when do testis start to develop

A

week 7 onwards

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11
Q

what do leydig cells secrete

A

testosterone (converted to DHT)

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12
Q

what hormones do sertoli cells secrete

A

mullerian inhibiting factor

inhibin and activin (regulate FSH secretion)

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13
Q

what stimulates the formation of male external genitalia

A

dihydrotestosterone

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14
Q

when do external genitalia start to differentiate

A

week 9, able to recognise on scan at 16 weeks

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15
Q

what stimulates the formation of male external genitalia

A

absence of testosterone

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16
Q

what is androgen insensitivity syndrome

A 
(a.k.a testicular feminisation) 
Congenital insensitivity to androgens
X-linked recessive disorder
Male karyotype (46XY)
Testis develop (but do not descend)
No androgen (T) 
Androgen induction of Wolffian duct does not occur, Mullerian inhibition does occur: born phenotypically external genitalia female, absence uterus and ovaries, with short vagina
Commonly present at puberty with primary amenorrhoea, lack of pubic hair
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17
Q

where does spermatogenesis occur

A

seminiferous tubules

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18
Q

where do sperm mature

A

epididymis

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19
Q

what is the path of sperm

A 
seminiferous tubules 
epididymis 
vas deferens 
ejaculatory duct 
(seminal vesicles and prostate)
urethra 
meatus of penis
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20
Q

what cells are responsible for spermatogenesis

A

sertoli

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21
Q

what is the path of the testes

A

develop in abdominal canal - lower pole of kidney in retro peritoneum
internal ring
inguinal canal
scrotal sac

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22
Q

what is the descent of the testes dependent on

A

androgens

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23
Q

why do the testes need to descend

A

lower temp outside body to facilitate spermatogenesis

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24
Q

what does the dartos muscle do

A

lowers/ raises testes according to external termperature

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25
Q

what does the origin of testes mean for its anatomy

A

artery branch of aorta (gonadal)
veins: L testicular joins to L renal, R joins to IVC
lymphatic drainage to para aortic nodes

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26
Q

what does the cremaster muscle do

A

works in conjunction with the dartos muscle

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27
Q

what type of muscles are the dartos and cremaster

A

cremaster skeletal

dartos smooth

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28
Q

when do testes usually descend

A

6-9 months of age

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29
Q

what is cryptorchidism

A

undescended testes

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30
Q

what are the implications of cryptorchisism

A

reduces sperm count, if unilateral usually fertile

if undescended from 12 years onwards increased risk of ger cell cancer

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31
Q

what treatment for cryptorchidism

A

orchidopexy below to minimise risks

if adult consider orchidectomy

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32
Q

why does the corpus spongiosum not engorge with blood during erection

A

to maintain patency of urethra

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33
Q

what drives sertoli cell function

A

FSH

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34
Q

what is the steps of sperm production

A 
germinal cell (diploid totipotent) 
primary spermatocyte (diploid) 
(meiosis 1)
2x secondary spermatocytes (haploid) 
(meiosis 2)
4x spermatids (haploid)
spermatozoa
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35
Q

where is the genetic information in a sperm

A

nucleus in its head (has no cytoplasm)

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36
Q

what is in the neck of a sperm

A

mitochondria

37
Q

what is acrosome

A

enzyme covering head of sperm, used in penetrating ovum

38
Q

what are the roles of sertoli cells

A

form a blood testes barrier (protect the sperm from antibody attack, provides suitable fluid for sperm development)
provide nutrients
phagocytosis (removes surplus cytoplasm and destroys defective cells)
secrete seminiferous tubule fluid (carries cells to epididymis)
secretes androgen binding globulin (binds to testosterone)
secretes inhibin, AMH and activin hormones (regulates FSH secretion and controls spermatogenesis)

39
Q

describe the hormonal control of spermatogenesis

A

GnRH-> FSH and LH

LH stimulates testosterone secretion
testosterone then decreases GnRH and LH
DHT causes: enlargement of male sex organs, secondary sexual characteristics and anabolism

FSH stimulates spermatogenesis together with testosterone

inhibin decreases FSH secretion

40
Q

what type of hormone is GnRH and what releases it

A

decapeptide

released from hypothalamus in bursts every 2-3 hours from age 8-12 onwards

41
Q

what does GnRH do

A

stimulates ant pituitary to produce LH and FSH

42
Q

what is GnRH under negative feedback control from in males

A

testosterone

43
Q

what type of hormones are LH and FSH

A

gonadotrophins- glycoproteins secreted by anterior pituitary

44
Q

what is the role of LH

A

acts on leydig cells, regulates testosterone secretion

45
Q

what is the role of FSH

A

acts on sertoli cells to enhance spermatogenesis

46
Q

is production of gonadotrophins in males cyclical

A

no

47
Q

what produces testosterone

A

leydig cells

48
Q

what type of hormone is testosterone

A

steroid hormone- derived from cholesterol

49
Q

what structures does testosterone have negative feedback on

A

hypothalamus and pituitary gland

50
Q

what are the affects of testosterone from before birth to adult hood

A

before birth: masculinises repro tract, promotes descent of testes

puberty: promotes puberty and male characteristics
adult: controls spermatogenesis, secondary sexual characteristics (body shape, voice, thick skin), libido, penile erection

51
Q

what type of hormone are inhibin and activin and what secretes them

A

petides secreted by sertoli cells

52
Q

what liquifies sperm

A

enzymes from prostate gland

53
Q

what is capacitation

A

series of changes that allow sperm to be able to fertilise egg

54
Q

what are the steps of fertilisation

A 
Penetration of cumulus complex
bind to zona pellucida of oocyte
Acrosome reaction
Hyperactivated motility 
Zonal reaction
Fusion with oocyte membrane and fertilisation
55
Q

what do the seminal vesicles do

A

Produce semen into ejaculatory duct, supply fructose (energy supply), secrete prostaglandins (stimulates motility), secrete fibrinogen (clot precursor)

56
Q

what is the role of the prostate

A

Produces alkaline fluid (neutralizes vaginal acidity), produces clotting enzymes to clot semen within female

57
Q

what is the role of the bulbourethral glands

A

secretes lubricating mucous

58
Q

what are the accessory glands

A

seminal vesicles, prostate gland, bulbourethral

59
Q

what is responsible for erections

A

blood filling corpora cavernosa, under parasympathetic control

60
Q

what is responsible for ejaculation

A

contraction of smooth muscles of urethra and erectile muscles, sympathetic control

61
Q

how much of infertility is male factor

A

30%

same for female factor

62
Q

what is happening to the prevalence of male infertility

A

increasing (possibly due to environmental oestrogens)

63
Q

what is the most common cause of male infertility

A

idiopathic

64
Q

what are the causes of obstructive male infertility

A

: cystic fibrosis (one faulty gene causes congenital bilateral malformation of vas deferens), vasectomy, infection

65
Q

what are the non obstructive causes of male infertility

A 
Congenital: Cryoptorchadism
Infection: mumps orchitis
Iatrogenic: chemotherapy/radiotherapy
Pathological: testicular tumour
Genetic: chromosomal (Klinefelter’s syndrome 47 xxy, microdeletions of Y chromosome, Robertsonian translocation)
Specific semen abnormality e.g. globozoospermia
Systemic disorder
Endocrine
66
Q

which form of male infertility has normal spermatogenesis

A

obstructive

67
Q

what are the endocrine causes of male infertility

A

pituitary tumours: acromegaly, cushings, hyperprolactinaemia (all these decrease LH, FSH and testostrone)
hypothalamic: idiopathic, tumours, kallmanns (hypogonadotrophic hypogonadism, GnRH deficiency), anorexia (decrease LH, FSH and test)
thyroid: hyper or hypo (decreases libido increases prolactin)
diabetes (decreases sexual function and test)
CAH (increased testosterone)
androgen insufficiency (normal/ raised LH and test)
steroid abuse (decrease LH, FSH and test)

68
Q

what does prolactin have negative feedback on

A

GnRH

69
Q

what are you lacking if you dont get early morning erections

A

testosterone

70
Q

what should you include in male infertility Hx

A

infertility- duration, primary or secondary, any Tx so far, libid, sexual function and activity

general health: diabetes, resp, recent illnesses

any GU infections (proven or suspected)

surgery to repro tract

exposure to meds (hormonal, steroids, antibiotics (sulphasalazine), alpha blockers, 5 alpha reductase inhibitors, chemo or radiotherapy, finasteride, narcotics

enviroment: heat and pesticides

recreational drugs: alcohol, marjuana

genetic abnormalities in patient or family

71
Q

what are you looking for on exam

A

General examination:
- secondary sexual characteristics/ - presence of gynaecomastia

Genital Examination:

  • testicular volume
  • presence of vas deferens and epididymis
  • penis (urethral orifice)
  • presence of any varicocele/other scrotal - swelling- testicular cancer
72
Q

what is normal testicular volume

A

pre pubertal 1-3mls

adult 12-25 mls

73
Q

what are you looking for on semen analysis

A 
volume 
density (number of sperm) 
motility (how many are moving)
preogression (how well they move)
morphology
74
Q

what might cause low ejaculatory volume

A

problems with accessory glands

75
Q

what factors can affect result of semen analysis

A

completeness of sample
period of abstinence (less than 3 days or longer than a week)
condition during sample (cold)
time between production and assessment (deteriorates after an hour)
natural variations between samples
health 2-3 months before

76
Q

what further Ix are done into infertility

A

repeat semen analysis 6 weeks later if abnormal
endocrine profile (LH, FSH, testosterone, PRL, TSH)
chromosome analysis (including karyoptype, Y chromosome microdeletions), cystic fibrosis screening
Depending on results: testicular biopsy, scrotal scan

77
Q

what are the clinical features of obstructive infertility

A

normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent

78
Q

what are the endocrine features of obstructive infertilitt

A

normal LF, FSH and testosterone

79
Q

how much of male infertility is obstructive

A

20%

80
Q

what are the clinical features of non obstructive infertility

A

low testicular volume
reduced secondary sexual characteristics
vas deferens present

81
Q

what are the endocrine features of non obstructive infertility

A

high LH/ FSH +/- low testosterone

82
Q

what are the treatments for male infertility

A

General advice
Treat any specific cause e.g. reversal of vasectomy if vasectomy, carbegoline if hyperprolactinamia, psychosexual Tx, medication review
Intracytoplasmic sperm injection (ICSI: may require surgical sperm aspiration)
Donor Insemination (DI)

83
Q

what is the general advice for male infertility

A

Frequency sexual intercourse: 2-3 X per week and avoid lubricants that are toxic to sperm
Alcohol: < 5 units per day
Smoking: associated decrease semen quality and decreased health
Caffeine: nil evidence (<3/4 cups a day)
BMI: < 30 likely to improve fertility and health
Avoid tight fitting underwear and prolonged hot baths/sauna may improve
Certain occupations: overheating/exposure to chemicals
Complementary therapies and non-prescription drugs
Possible benefits of anti-oxidants (vitamin C or zinc)

84
Q

who would benefit most from a vasectomy reversal

A

person with young female partner, takes a while so sperm retrieval quicker if female older

85
Q

what is the process of ICSI

A

Sperm prepared from semen (or tissue from surgical sperm aspiration
Each egg is stripped
Sperm immobilised
Single sperm injected

86
Q

what is the indication for surgical sperm aspiration

A

azoospermia

87
Q

what are the indications for donor sperm insemination

A

azoospermia or very low count, failed ICSI treatment, genetic conditions, infective conditions

88
Q

what are the steps in donor sperm insemination

A 
Sperm donors (altruistic and not anonymous) matched for recipient characteristics and screened for genetic conditions and STIs
Sperm quarantined by cryopreservation and rescreened
Prepared thawed semen sample inserted intrauterine at time of ovulation

Reproduction (51 decks)

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