male infertility Flashcards
male infertility
male component in 50% of infertility couples, can be broke down into pre testicular, testicular, and post testicular causes, many are treatable
Causes of male infertility
Typically endocrinopathies (LH and FSH), highly treatable, may be associated with important medical problems (pituitary tumors, significant hypogonadism)
You need it before puberty to grow your testicles
Testicular most common and usually reversible, includes varicoceles, gonadotoxins, as well as primary testicular problems
Post testicular–> obstruction, ejaculation disorders
Multiple samples of semen, fluctuation normal, 305 days abstinence, collection (masturbation, coitus interruptus/ condim), container free of speramatoxic agents
FSH, testosterone
measure integrity of HPG
get T levels in the morning
Etiology of male infertility
Varicocele, Idiopathic, Testicular failure, obstruction, cryptorchidism, semen issues, Sex dysfunciton, ejac, endo
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Varicocele pathophysiology
Countercurrent heat exchange keeps testis 2-4 oC cooler than body temp
Varicocele destroys this system –> higher intratesticular temp, other factors– hormonal and genetic abnormalities
CFTR/ cystic fibrosis
bilateral agenesis of vasdeferens
CBAVD and incidence 1-2% of men presenting with infertility, most cases of CBAVD are genetic in origin and are autosomal recessive, 80- 90% are associated with one CFTR gene
pretty common , 25% have a mutation, the mutations cause involution of the genital ducts during embryogenesis, spermatogenesis is not impaires
Genetic counseling is essential for both partners
If CFTR testing is negative
renal anomalies are more common, mesonephric duct gives rise to ureteral bud, as well as SV, vas deferens, lower 2/3 of epididymis, defects in mesonephric duct early (6th week of gestation) leads to agenensis of genital ducts, and ipsilateral kidney, this if patient negative for CFTR/5T mutation, renal U/s indicated
Vasectomy
safe effective method of contraception, most common form male contraception, highly effective with minimal morbidity, minimally invasive approach appears to be the best
