Male infertility Flashcards
definition of Infertility according to WHO 2019
couples failing to acheive spontaneous pregnancy within one year of unprotected sexual intercourse
What are the 2 factors of infertility
- Male factors
- Female factors
definition of male factor infertility
what are the 2 types
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
what is the definition of DYSPERMIA
dyspermia is defined as
General term for any quantitative or quantitative changes in ejaculate
what are the four stages of SPERMATOGENESIS
- Spermatogenonia undergo mitosis to form
- Spermatocytes undergo meiosis to form
- Spermatids undergo spermatogenesis form
- Spermatozoa which by spermiation enters the
lumen of the Seminiferious tubules
how do male contraceptives work
they block spermatogenesis at any of the 4 stages
important definitions to know for Male infertility
Azoospermia
Oligospermia
Asthenospermia
Teratospermia
OAT syndrome
Azoospermia
types
how is obs azoo dg
Abscence of spermatozoa un ejaculate below one million
- Obstructive Azoospermia
- obs at any level of sperm transport
- dg by FSH lvl corr w/ no of sperm
- Non-Obstructive Azoospermia
Oligospermia
Low number of spermatozoa
Asthenospermia
Low sperm mobility w/ total mobility rate below 50%
Teratozospermia
Altered sperm morphology
OAT syndrome
a combo syndrome of Oligo-Astheno-Teratozospermia
Sperm Transport PW
Testis→Epididymis→Vas Deferens→Prostate gland→Prostatic Urethra→External Sphincter→Penile urethra→External orifice
5 causes of Male Infertility
COM In It
- Congenital anomalies
- Other reasons
- Malignancies
- Inflamm diseases of male repro organs
- Increased scrotal temp
6.
what are the 5 C.A of reproductive organs causing male repro orgnas
- Genetic testicular Dysgenesis syndromes
- BCAVD
- Obs of the Ejac Duct
- Cryptoorchidism
- Hypospadias
Genetic Testicular Dyesgenesis Syndromes
AKA
(C.A of testis in size & number)
- Kleinfelter’s
- Kallman’s
- Pmds
- Del castillo
Kleinfelter’s
- 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
Kallman’s
- 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
Persistent Mullerian duct syndrome (PMDS
relation w/ cryptoorchidism
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.
Del castillo / sertoli cell only syndrome
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.
2) Malignancies causing Infertility
the 2 types
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?
the 2 inflammatory conditions causing infertility
- STI’s
- Chronic Prostatitis/ Chronic Pelvic PainSyndrome
KNOW NIH 1995 world wide classification
- 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)
4) increased Scrotal Temperatures
2 distuinguishing features
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
5)Other reasons = MEE
Male hypogonadism
Erectile dysfunction
Ejaculatory disorders
SIX rx for infertility
DAS GRT
rx of obs azoo
rx of non obs azoo
rx of androgen insuff
rx of del castillo
-
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
