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urology final boss > Male infertility > Flashcards

Male infertility Flashcards

1
Q

definition of Infertility according to WHO 2019

A

couples failing to acheive spontaneous pregnancy within one year of unprotected sexual intercourse

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2
Q

What are the 2 factors of infertility

A
  1. Male factors
  2. Female factors
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3
Q

definition of male factor infertility

what are the 2 types

A

couples failing to achieve pregnancy d/2 a problem in the male part

  • 10 MALE INFERTILITY: past and present failure of a man to impregnate a woman
  • 20 MALE INFERTILITY: present faliure of a man to impregnate a woman even though he did so in the past
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4
Q

what is the definition of DYSPERMIA

A

dyspermia is defined as

General term for any quantitative or quantitative changes in ejaculate

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5
Q

what are the four stages of SPERMATOGENESIS

A
  1. Spermatogenonia undergo mitosis to form
  2. Spermatocytes undergo meiosis to form
  3. Spermatids undergo spermatogenesis form
  4. Spermatozoa which by spermiation enters the

lumen of the Seminiferious tubules

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6
Q

how do male contraceptives work

A

they block spermatogenesis at any of the 4 stages

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7
Q

important definitions to know for Male infertility

A

Azoospermia

Oligospermia

Asthenospermia

Teratospermia

OAT syndrome

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8
Q

Azoospermia

types

how is obs azoo dg

A

Abscence of spermatozoa un ejaculate below one million

  1. Obstructive Azoospermia
    • obs at any level of sperm transport
    • dg by FSH lvl corr w/ no of sperm
  2. Non-Obstructive Azoospermia
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9
Q

Oligospermia

A

Low number of spermatozoa

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10
Q

Asthenospermia

A

Low sperm mobility w/ total mobility rate below 50%

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11
Q

Teratozospermia

A

Altered sperm morphology

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12
Q

OAT syndrome

A

a combo syndrome of Oligo-Astheno-Teratozospermia

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13
Q

Sperm Transport PW

A

Testis→Epididymis→Vas Deferens→Prostate gland→Prostatic Urethra→External Sphincter→Penile urethra→External orifice

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14
Q

5 causes of Male Infertility

COM In It

A
  1. Congenital anomalies
  2. Other reasons
  3. Malignancies
  4. Inflamm diseases of male repro organs
  5. Increased scrotal temp
    6.
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15
Q

what are the 5 C.A of reproductive organs causing male repro orgnas

A
  1. Genetic testicular Dysgenesis syndromes
  2. BCAVD
  3. Obs of the Ejac Duct
  4. Cryptoorchidism
  5. Hypospadias
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16
Q

Genetic Testicular Dyesgenesis Syndromes

AKA

(C.A of testis in size & number)

A
  • Kleinfelter’s
  • Kallman’s
  • Pmds
  • Del castillo
17
Q

Kleinfelter’s

A
  • Karyotype: 47 XXY, rarely 48 XXXY and 48 XXYY ]
  • Etiology: most commonly due to nondisjunction of sex chromosomes during meiosis of parental germ cells
  • Clinical features
    • Male phenotype; symptoms rarely observed during childhood
    • Testicular dysgenesis and subsequent testosterone deficiency become apparent at the onset of puberty.
    • Eunuchoid growth pattern : tall, slim stature with long extremities [6]
    • Gynecomastia, reduced body hair
    • Testicular hypoplasia with a normal sized penis
    • Reduced fertility, frequent azoospermia
    • Osteoporosis frequently observed in adulthood
    • Associations:
    • Mitral valve prolapse
    • Diagnostics: primarily a clinical diagnosis; karyotyping confirms the diagnosis
  • Complications:
    • Increased risk of breast cancer development due to decreased levels of testosterone and increased levels of estrogen.
    • Testicular hypoplasia → ↓ testosterone → loss of negative feedback on gonadotropins → ↑ FSH → ↑ aromatase activity → ↑ testosterone to estradiol conversion
  • Therapy: life-long testosterone substitution
18
Q

Kallman’s

A
  • Rare genetic form of hypogonadotropic hypogonadism caused by decreased secretion of GnRH
  • More common in men
  • Characterized by delayed onset of puberty and hyposmia/anosmia
  • Often associated with structural/developmental abnormalities: cryptorchidism, cleft palate, scoliosis, renal agenesis
19
Q

Persistent Mullerian duct syndrome (PMDS

relation w/ cryptoorchidism

A

disorder of sexual development that affects males is caused by mutations in the AMH gene (PMDS type 1) or AMHR2 gene (PMDS type 2). It is inherited in an autosomal recessive manner.

Males with PMDS have normal male reproductive organs and normal male external genitalia.

However, they also have a uterus and fallopian tubes (female reproductive organs).

The uterus and fallopian tubes develop from a structure called the Müllerian duct, which is present in both male and female fetuses. It typically breaks down in males, but it remains in those with PMDS.

Early signs of PMDS may include undescended testes (cryptorchidism) or inguinal hernias. The uterus and fallopian tubes are often incidentally noticed during surgery to treat these conditions.

Other features of PMDS may include abnormal positioning of the testes and female reproductive organs; transverse testicular ectopia (when both testicles descend on the same side); and infertility.

Treatment may involve surgery to place the testes within the scrotum and remove Müllerian structures.[1][2][3] If not treated, undescended testes may degenerate or develop cancer.

20
Q

Del castillo / sertoli cell only syndrome

A

a condition of the testes in which only Sertoli cells line the seminiferous tubules

  • present between age 20-40 years for evaluation of infertility and are found to be azoospermic,
  • physical examination findings are often unremarkable, and the diagnosis is made on the basis of testicular biopsy findings.
  • rx = Testicular sperm extraction (TESE) may be offered to couples considering IVF/ICSI.
21
Q

2) Malignancies causing Infertility

the 2 types

A

Testicular tumors

  • mech of infertility = hormonal imbalances
    • blood-testicular barrier prevetns ab pduction against spermatozoa, this barrier is damaged in TT forming antisperm ab’s = immune male infertility

Other tumors e.g. Pca, Verrucous carcinoma of the penis

  • Penis sparing surgery & partial Penectomies leaves enough penis to allow atanding urination = Infertility?
22
Q

the 2 inflammatory conditions causing infertility

A
  1. STI’s
  2. Chronic Prostatitis/ Chronic Pelvic PainSyndrome

KNOW NIH 1995 world wide classification

23
Q
A
  • Category I – Acute bacterial prostatitis (ie, acute infection of the prostate)
  • Category II – Chronic bacterial prostatitis (ie, recurrent urinary tract infection and/or chronic infection of the prostate)
  • Category III – Chronic abacterial prostatitis/chronic pelvic pain syndrome (ie, discomfort or pain in the pelvic region for at least 3 mo with variable voiding and sexual symptoms and/or no demonstrable infection; by definition, the syndrome becomes chronic after 3 mo)
    • Category IIIA – Inflammatory chronic pelvic pain syndrome (ie, white blood cells in semen and/or expressed prostatic secretions and/or third midstream bladder specimen)
    • Category IIIB – Noninflammatory chronic pelvic pain syndrome (ie, no white blood cells in semen and/or expressed prostatic secretions)
  • Category IV – Asymptomatic inflammatory prostatitis (ie, evidence of inflammation in biopsy samples, semen and/or expressed prostatic secretions, but no symptoms)
24
Q

4) increased Scrotal Temperatures

2 distuinguishing features

A

d/2 a varicocele

  • idiopathic = left varicocele
    • 40% of cases have broken sperm parameters = infertility
  • symptomatic = right varicocele
  • palpable = strong indication for surgery
  • non palpable
25
Q

5)Other reasons = MEE

A

Male hypogonadism

Erectile dysfunction

Ejaculatory disorders

26
Q

SIX rx for infertility

DAS GRT

rx of obs azoo

rx of non obs azoo

rx of androgen insuff

rx of del castillo

A
  • Donor insemination
    • rx of Non obs azoo and Del castillo
  • ART
    • IVF & ICSI
  • Sperm cryopreservation b4 cryo/ gonadotoxic therapy
  • Gonadotoxic therapy
    • _​_chemo/ radio/ immuni
  • Refertilising Methods = Microsurgical Reversal Methods
    • rx of Obs azoo
    • reversal of vasectomy w/ Vaso-vasectomy
    • Reimplantation of VD into epidid = Epididmo-vaso anastomosis
  • Testosterone replacement therapy
    • _​_rx of male hypogonadism/ androgen deficiency

urology final boss (22 decks)

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