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Reproductive & Sexual Health > Male infertility > Flashcards

Male infertility Flashcards

1
Q

What determines gender?

A

Socially constructed roles and behaviours that a society typically associated with males and females

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2
Q

Genotype and phenotype are determined by

A

Sex

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3
Q

What is the phenotype of androgen insensitivity syndrome

A
  • female external genitalia

- lack of pubic hair

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4
Q

What is the common presentation of androgen insensitivity syndrome

A

Present with amenorrhoea

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5
Q

Androgen sensitivity is an _-______ ______ disorder

A

Androgen sensitivity is an x-linked recessive disorder

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6
Q

What is the karyotype of androgen insensitivity disorder?

A

46 XY

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7
Q

Describe the pathogenesis of androgen insensitivity disorder?

A

Testis develop but don’t descend, no androgen and so induction of wolffian duct does not occur. Absent uterus and ovaries with short vagina and female external genitalia

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8
Q

What is the function of the testis?

A
  • Spermatogenesis (seminiferous tubules)

- Production of testosterone (leydig cells)

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9
Q

Testicular artery is a branch of what artery?

A

The aorta

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10
Q

The left testicular vein joins the _____ _____ ____ and right testicular vein drains into _________ ____ ____

A

The left testicular vein joins the left renal vein and right testicular vein drains into inferior vena cava

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11
Q

Where is the lymphatic drainage of the testis?

A

Into the abdomen

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12
Q

Why is it important that the testes descend?

A

Lower temperature outside the body for spermatogenesis

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13
Q

______/______ muscle contraction in scrotal sac _____/______ testes according to external ______

A

dartos/cremaster muscle contraction in scrotal sac lowers/raises testes according to external temperature

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14
Q

The dartos muscle is ______ ______

A

The dartos muscle is smooth muscle

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15
Q

The cremaster muscle is _____ _______ and a continuation of the _______ _______

A

The cremaster muscle is skeletal muscle and a continuation of the internal oblique

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16
Q

What is contained in the spermatic cord?

A

Arteries, veins, nerves, lymphatics, vas deferens

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17
Q

What covers the testis

A

Tunica vaginalis- peritoneal remnant and then tunica albuingea (firm fibrous covering)

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18
Q

What is cryptorchidism?

A

Individual has reached adolescence/adulthood and testes have not descended

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19
Q

When do testes normally descend?

A

Between 6-9 months of age

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20
Q

When should orchidopexy be performed?

A

By 12 months because of strong association with infertility (azoospermia) and by 12 years to minimise risk of testicular germ cell cancer

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21
Q

What should be done if undescended testis are discovered as an adult?

A

Consider orchidectomy as risk of cancer is 6x baseline

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22
Q

What is corpus cavernosum?

A

Two columns of tissue running along the sides of the penis- blood fills to cause an erection

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23
Q

What is corpus spongiosum?

A

A column of sponge like tissue running along the front of the penis ending at the glans penis; it fills with blood during an erection keeping the urethra open

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24
Q

Spermatozoa contain ______ genetic material

A

Spermatozoa contain haploid genetic material

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25
Q

What are the roles of Sertoli cells?

A
  • form blood-testes barrier
  • provide nutrients
  • phagocytosis
  • secrete seminiferous tubule fluid
  • secrete androgen binding globulin
  • secrete inhibin and activin hormones
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26
Q

What is the function of the blood-testes barrier?

A
  • Protects the sperm from antibody attack

- Provides a suitable fluid composition which allows later stages of development of sperm- v different from blood.

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27
Q

What is the role of phagocytosis by Sertoli cells?

A

Remove surplus cytoplasm from packaging process & destroys defective cells

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28
Q

What is the role of seminiferous tubule fluid?

A

Carries cells to epididymis

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29
Q

What is the role of androgen binding globulin?

A

Binds testosterone so concentration remains high in lumen

Essential for sperm production

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30
Q

What is the role of inhibin and activin hormones?

A

regulates FSH secretion and controls spermatogenesis

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31
Q

GnRH is a ____peptide released from the ________ in ______ every ___ hours (beginning at age ____ years)

A

GnRH is a decapeptide released from the hypothalamus in bursts every 2-3 hours (beginning at age 8-12 years)

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32
Q

GnRH stimulates the anterior pituitary to produce __ and ____ and is under _______ ______ ____ from testosterone

A

GnRH stimulates the anterior pituitary to produce LH and FSH and is under negative feedback control from testosterone

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33
Q

Gonadotrophins are _______ secreted by the anterior pituitary

A

Gonadotrophins are glycoproteins secreted by the anterior pituitary

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34
Q

What is the role of LH in men?

A

Acts on leydig cells- regulates testosterone secretion

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35
Q

What is the role of FSH in men?

A

Acts on Sertoli cells to enhance spermatogenesis

Regulates by negative feedback from inhibin

36
Q

Production of gonadotrophins is ______ in females and __________ in males.

A

Production of gonadotrophins is cyclical in females and non-cyclical in males.

37
Q

Testosterone is a _____ hormone derived from cholesterol

A

Testosterone is a steroid hormone derived from cholesterol

38
Q

Testosterone has negative feedback on which glands?

A

Hypothalamus and pituitary

39
Q

What are the effects of testosterone before birth?

A

Masculinises reproductive tract and promotes descent of testes

40
Q

What are the effects of testosterone during puberty?

A

Promotes puberty and male characteristics and maturation of male reproductive system

41
Q

What are the effects of testosterone in adulthood ?

A

Controls spermatogenesis, secondary sexual characteristics (male body shape, deep voice, thickens skin), libido, penile erection, aggressive behaviour

42
Q

Inhibin and activin are what type of hormones

A

Peptides

43
Q

What secretes inhibin and activin?

A

Sertoli cells

44
Q

What do inhibin and activin do?

A

Feedback on FSH

45
Q

What liquefies the ejaculate?

A

Enzymes from the prostate gland

46
Q

What is capacitation?

A

Series of biochemical cellular events before fertilisation (hyper activated motility, ability to bind to ZP and AR)

47
Q

How does the spermatozoa find the oocyte?

A

By chemoattraction

48
Q

Describe the process of fertilisation?

A
  • Penetration of cumulus complex
  • acrosome reaction/zona binding
  • Fusion with oocyte membrane and fertilisation
49
Q

What are the functions of the epididymis and vas deferens?

A

Exit route from testes to urethra, concentrate and store sperm, site for sperm maturation

50
Q

What is the function of the seminal vesicles?

A

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

51
Q

What is the function of the prostate gland?

A

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

52
Q

What is the function of the bulbourethral glands

A

Secrete mucus to act as lubricant

53
Q

Describe the route of sperm

A

testes –> epididymis –> vas deferens –> ejaculatory duct –>urethra

54
Q

What controls erection?

A

Parasympathetic control

55
Q

What is emission

A

Contraction of accessory sex glands and vas deferens so semen is expelled to urethra

56
Q

What is ejaculation

A

Contraction of smooth muscles of urethra and erectile muscles

57
Q

What are the three aetiologies of MF infertility?

A

Idiopathic
Obstructive
Non-obstructive

58
Q

What causes obstructive MF infertility

A

Vasectomy
Cystic fibrosis- absence of vas
Infection

59
Q

What causes congenital non-obstructive MF infertility

A

cryptoorchidism

60
Q

What causes infectious non-obstructive MF infertility

A

Mumps orchitis

61
Q

What causes iatrogenic non-obstructive MF infertility

A

Chemotherapy/radiotherapy

62
Q

What causes pathological non-obstructive MF infertility

A

testicular tumour

63
Q

What causes genetic non-obstructive MF infertility

A

chromosomal (kleinfelter’s syndrome, micro deletions of Y chromosome, robertsonian translocation)

64
Q

What specific semen abnormality causes non-obstructive MF infertility

A

Globozoospermia

65
Q

What are the hypothalamic endocrine causes of male factor infertility?

A

Idiopathic, tumours, Kallman’s syndrome, anorexia

66
Q

What are the pituitary endocrine causes of male factor infertility?

A

Acromegaly, cushings disease, hyperprolactinaemia

67
Q

What are the thyroid endocrine causes of male factor infertility?

A

Hyper or hypothyroidism (decreases sexual function and increases prolactin)

68
Q

How does diabetes cause MF infertility?

A

Decrease sexual function and testosterone

69
Q

How does CAH cause MF infertility?

A

Increased testosterone

70
Q

How does steroid abuse cause MF infertility?

A

Decrease testosterone, LH and FSH

71
Q

How should an assessment of infertility be carried out?

A

See as couple
History (Andrology)
Examination (general and genital)
Investigations (semen analysis, others depending on results)

72
Q

Describe the examination of MF infertility

A

General

  • 2ry sexual characteristics
  • gynaecomastia?
Genital
-testicular volume
-presence of vas deferens and epididymis
-penis (urethral orifice)
presence of any varicocoele/other scrotal swelling
73
Q

What is normal testicular volume?

A

Pre-pubertal 1-3mls
Adults 12-25 mls
If <5mls unlikely to be fertile

74
Q

What is looked at when analysing semen?

A
  • Volume
  • Density (number of sperm)
  • Motility
  • Progressive motility
  • Morphology
75
Q

What needs to be taken into account for a valid semen analysis

A
  • Completeness of sample
  • Period of abstinence
  • Condition during transport
  • Time between production and assessment (deteriorates after 1 hr
  • Natural variation
  • Current health and health of man in 2-3 months before production
76
Q

What further tests should be done after initial semen analysis and examination

A

Repeat semen analysis if abnormal in 2-3months

Endocrine profile (LH, FSH, PRL, TSH, testosterone)

Chromosome analysis (including karyotpie, Y chromosome micro deletions) CF screening

Testicular biopsy or scrotal scan

77
Q

What are the clinical features of obstructive azoospermia?

A

Normal testicular volume
Normal 2ry characteristics
Absent vas deferens

78
Q

What are the endocrine features of obstructive azoospermia?

A

Normal LH, FSH and testosterone

79
Q

What are the clinical features of non-obstructive azoospermia?

A

Low testicular volume
Reduced 2ry characteristics
Vas deferens present

80
Q

What are the endocrine features of obstructive azoospermia?

A

High LH, FSH +/- low testosterone

81
Q

What is given for high PRL in MF infertility

A

Cabergoline

82
Q

What general advice should men be given if infertile?

A

-Frequency sexual intercourse: 2-3 X per week
-Avoid lubricants that are toxic to sperm
-Alcohol: < 5 units per week
-Smoking: associated decrease semen quality and decreased health
-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)

83
Q

What is the success rate of vasectomy reversal?

A

75% if vasectomy within 3 years
55% after 3-8 years
30-40% after 9-19 years

84
Q

What is the treatment for anejactulation?

A

Psychosexual treatment

85
Q

How can sperm be retrieved?

A
  • PESA (Percutaneous Epididymal Sperm Aspiration)
  • TESA (Testicular Sperm Aspiration)
  • testicular biopsy
86
Q

What is micro TESE?

A

Specialise urological surgery under high power magnification to dissect and direct examination of seminiferous tubules to identify regions with spermatogenesis

87
Q

What is the pregnancy rate of donor insemination?

A

15% per treatment cycle

Reproductive & Sexual Health (54 decks)

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