Male Infertility Flashcards
1
Q
Which is not affected by age? Semen volume Morphology Motility Concentration Pregnancy rates
A
Concentration
2
Q
Is prostate gland T or DHT dependent?
A
DHT
3
Q
What is acrosome?
A
Lysosome containing about 20 different enzymes which are needed for the penetration of the ovum during fertilization
4
Q
What is spermiogenesis?
A
Round spermatids are transformed into elongated spermatozoa with tails
5
Q
What % of chronic opioid users have low T?
A
74%
6
Q
How long does spermatogenesis take?
A
74 days
7
Q
What is the average life expectancy for males in the US?
A
75 years
8
Q
What is the max age limit for sperm donation in the US?
A
40
9
Q
What is T converted into in embryonic development?
A
Dihydrotestosterone - DHT
10
Q
What is the role of prolactin in male reproductive and sexual function?
A
It’s unknown
11
Q
When should a US of male genital tract be performed?
A
Azoospermia, low volume, normal vasa
12
Q
How much higher are infra testicular T levels compared serum T levels?
A
40x
13
Q
Are secondary spermatocytes 1n or 2n?
A
1n
14
Q
What makes prostate gland and urethra?
A
Urogenital sinus
15
Q
Why do obese men have impaired spermatogenesis?
A
Aroma tase from fat cells converts T into estradiol therefore lowering T/E ratio
16
Q
Where do Y chromosome microdeletions occur?
A
Long arm of the Y chromosome (Yq11) azoospermia (AZF) region
17
Q
Are primary spermatocytes 1n or 2n?
A
2n
18
Q
What % of men have azoospermia?
A
1%
19
Q
How much more likely are men with diabetes to have ED?
A
4x
20
Q
Klinefelter karyotype
A
47 XXY
21
Q
What is spermiation?
A
Fully developed but non-motile spermatozoa are released from the Sertoli cells into rete testis and then into the epi
22
Q
What % of infertility is male fertility the sole cause?
A
20%
23
Q
Globospermia
A
Sperm without acrosome
24
Q
What are the 3 etiologies of azoospermia?
A
Pre-testicular - endocrine abnormalities (rare) - secondary testicular failure
Testicular - disorders of spermatogensis; primary testicular failure
Post-testicular - ejaculatory dysfunction or obstruction. Obstructive azoospermia
25
Bioavailabile T levels
50-250 ng/dL
26
% of infertile men with karyotypic chromosome abnormalities
7%
27
What secretes T?
Mostly Leydig cells, some by adrenal cortex
28
What is the normal size of a testicle?
19 ml
29
What happens in corpus epididymis?
Fertilization potential
30
Is seminal vesicle T or DHT dependent?
T
31
What does seminal vesicle produce?
Alkaline secretion and fibrin. Fibrin (protein) is responsible for coagulation. Also fructose to nourish sperm and prostaglandins for motility
32
What is required for the dx of azoospermia?
Examination of the pellet of a centrifuged semen sample x2, at least one month apart
33
What are the signs of Cushing syndrome?
ED, decreases libido and decreases androgen production
34
What are requirements for IUI?
Ovulation
Tubal patency
Adequate sperm parameters. TMC greater than 5 million
35
What are the AZF regions?
AZFa - proximal
AZFb - central
AZFc - distal
36
What ducts male male genitalia? Wolffian or Mullerian?
Wolffian
37
What can scrotal US be used for?
Dx varicoceles
Epididymal dilations
Testicular rumors
38
What hormone do inhibit and activin regulate?
FSH
39
What is most circulating T bound by?
Sex hormone binding globulin (SHBG)
40
What happens in caput epididymis?
Motility potential
41
Most of testicular cancer is what kind?
Germ cell neoplasm
42
Asthenospermia
Reduced sperm motility
43
How much does T decrease per year in men over 40?
1-2% per year
44
With age does SHBG increase or decrease? What about free T?
Free T decreases while SHBG increases
45
Who should get a post ejac urinalysis?
Low volume, <1ml
Normal hormone levels
Normal vasa
46
What does prostate gland secrete?
Slightly acidic secretion, is rich in minerals and sodium. Also produces fibrinolysin
47
What’s in sperm mid piece?
Mitochondria to provide energy
48
What secretes GnRH
Hypothalamus
49
Testicular dysgenesis syndrome hypothesis
Is thought to occur as a result of abnormal testicular development. Manifests as developmental abnormalities, hypospadias and cryptorchidism, poor semen quality and reproductive tract cancers
50
What does Cushing syndrome cause?
Increased cortisol production
51
What is cryptorchidism?
Failure of the testicles to descend
52
What does GnRH do?
Acts on pituitary to synthesize LH and FSH
53
How does Graves’ disease affect fertility?
Hyperthyroidism. Increases SHBG and therefore decreases free T. Also increases aromatization to estradiol
54
What is hypospadias?
A birth defect where the opening of the urethra is on the underside of the penis instead at the tip.
55
What % of men with azoospermia or severe oligospermia have Y chromosome microdeletions?
10-15%
56
What happens in cauda epididymis?
Sperm storage
57
What is cryptorchidism?
When one or both testicles fail to descend
58
Pyospermia
>1 million leukocytes per ml
59
When to testes descend during embryonic development?
7 month
60
What do Sertoli cells secrete?
Inhibit and activin
61
% of OA
40%
62
What % of men fathering children are over 35?
25%
63
What does the IUI prep remove from the sample?
Prostaglandins
ROS
Capacitation inhibitors
64
How many days do the spermatozoa spend in the epididymus?
5-6 days
65
If total T is <300 ng/mL, what tests should be done?
LH
Prolactin
Bioavailabile T in the AM
66
How many times does time to pregnancy increase if male is over 45?
5 fold
67
How does diabetes mostly cause infertility?
Causes ejaculatory dysfunction, retrograde ejaculation and anejaculation
68
Normal levels of total T
240-950 nag/dL
69
What % of couples are unable to conceive after 1 year of trying?
15%
70
What does FSH act on?
Sertoli cells
71
What conc is recommended for basic wash for IUI?
<20mil/ml in the initial sample
72
What is thought to be the cause in increase in prostate cancer?
Fetal and adult exposure to nataur of synthetic estrogens
73
Aspermia
Absence of seminal fluid
74
Free T levels
5-20 ng/dL
75
What makes the acrosome?
The Golgi apparatus
76
Where can anti sperm antibodies be found?
Serum, seminal plasma, sperm
77
What % per year does overall male sperm conc decline in the US?
1.5%
78
Which AZF deletion has the best outcome with sperm retrieval?
AZFc
79
What do bulbourethral glands secrete?
Small amount of mucus prior to ejac
80
What is the chance of finding sperm from someone with AZFc?
80%
81
What makes penis and scrotum?
Urogenital tubercle
82
Where is vasectomy performed?
Proximal vas
83
What does increased LH, increased FSH and decreased T indicate?
Testicular failure
84
What does low volume or absent ejaculate indicate?
```
Retrograde ejac
Lack of emission
Ejac duct obstruction
Hypogonadism
CBAVD
```
85
What can be used instead of T to increase T levels for hypogonadism?
HCG
Recombinant LH
Clomiphene citrate
86
When in gestation genitalia differentiate?
Week 7 of intrauterine life
87
What does LH act on?
Leydig cells
88
What happens in vas deferens?
Rapid transport of sperm during ejaculation
| Slow transport and removal of sperm during sexual rest
89
What % of men with obesity have low T levels?
50%
90
What % of men with diabetes have low T?
50%
91
What % of men with AIDS have low T?
50%
92
What % of anabolic steroid users remain azoospermia after discontinuation?
4-10%
93
Sperm concentrations rebound how quickly after discontinuation of anabolic steroids?
6-18 months
94
How quickly after starting anabolic steroids does azoospermia occur?
About 10 weeks
95
How does hypothyroidism affect fertility?
Androgen and estrogen metabolism gets altered, androgen secretion and SHBG binding activity gets decreased. Total T decreases but free and bioavailable T stay constant
96
Ways that infections can affect male fertility
```
Impaire spermatogenesis
Disrupt sperm function
Cause obstruction
Inhibit accessory gland function
Cause an inflammatory response
```
97
What are the predominant leukocytes found in men with leukocytospermia?
Granulocytes
98
What are the majority of round cells found in semen?
Immature germ cells
99
What does WHO 5th recommend for detection of leukocytes in semen?
Peroxidase test
100
What is the most sensitive way to detect leukocytes in semen?
Immunological tests. Cd45 antigen
101
What is orchitis?
Testicular infection
102
Which virus has been shown to affect male fertility?
Herpes simplex 1 and 2
103
How does herpes affect male fertility?
Decreased sperm concentration
104
What does ROS cause?
Cellular damage. Lipid peroxidation of the sperm membrane and DNA damage
105
What are testicular sources of ROS?
Spermatozoa
| Seminal leukocytes
106
What % of men seeking fertility treatment have antiserum antibodies?
3-12%
107
Antisperm antibodies can cause:
Sperm agglutination
Prevents cervical mucus penetration
Inhibits sperm oocyte interaction and fusion
108
What causes ASA?
Breakdown of blood testis barrier
Failure of immunosuppression
Infections
109
What produces ASAs?
T-helper cells and B lymphocytes
110
What % of infertile men have CBAVD? What % of men with OA have CBAVD?
1% and 6%
111
How are Y chromosome microdeletions identified?
Using multiplex PCR
112
What is used to analyze CNVs?
Array comparative genomic hybridization (aCGH)
113
What is the frequency of hypospadias in general population?
1. 1:10,000
2. 1:100
3. 1:300
4. 1:1000
3. 1:300
114
Where else besides the nucleus do you find chromosomes?
In the mitochondria in the cytoplasm
115
How is wilms tumor suppressor gene involved in fertility?
Initiates development of the gonads and when absent, gonadal a genesis occurs.
116
How is steroidogenic factor-1 (SF1) gene involved in fertility?
It’s an orphan receptor and important regulator of embryonic gonadal development as well as the development of the adrenals
117
Antimullerian hormone defects in males results in what?
Makes with oviducts, a uterus, vagina with a complete male reproductive system. Testicular descent is prevented by the presence of remnants of the mullerian derivatives
118
What is the frequency on KS?
1 to 500 births
119
What % of boys have cryptorchidism?
3%
120
How many genes are on the Y chromosome?
70-80
121
How many genes are on the X chromosome?
Over a 1000
122
What are the three arteries of the testis?
Testicular artery
Cremasteric artery also called external spermatic artery
Deferential artery
123
What does the testicular artery supply?
The testis
124
What does the cremasteric artery supply?
Scrotal sac and covering of the spermatic cord
125
What does the deferential artery supply?
Vas deferens and epididymis
126
What is the normal size of a testicle in cm?
4-5 cm x 3cm x 2.5 cm
127
What is the length of head of the epididymis?
10-12 mm
128
What is the lengths of body of epididymis?
2-4 mm
129
What is the size of the tail of the epididymis?
2-5 mm
