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Andrology > Male Infertility > Flashcards

Male Infertility Flashcards

1
Q 
Which is not affected by age?
Semen volume
Morphology 
Motility
Concentration
Pregnancy rates
A

Concentration

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2
Q

Is prostate gland T or DHT dependent?

A

DHT

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3
Q

What is acrosome?

A

Lysosome containing about 20 different enzymes which are needed for the penetration of the ovum during fertilization

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4
Q

What is spermiogenesis?

A

Round spermatids are transformed into elongated spermatozoa with tails

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5
Q

What % of chronic opioid users have low T?

A

74%

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6
Q

How long does spermatogenesis take?

A

74 days

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7
Q

What is the average life expectancy for males in the US?

A

75 years

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8
Q

What is the max age limit for sperm donation in the US?

A

40

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9
Q

What is T converted into in embryonic development?

A

Dihydrotestosterone - DHT

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10
Q

What is the role of prolactin in male reproductive and sexual function?

A

It’s unknown

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11
Q

When should a US of male genital tract be performed?

A

Azoospermia, low volume, normal vasa

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12
Q

How much higher are infra testicular T levels compared serum T levels?

A

40x

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13
Q

Are secondary spermatocytes 1n or 2n?

A

1n

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14
Q

What makes prostate gland and urethra?

A

Urogenital sinus

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15
Q

Why do obese men have impaired spermatogenesis?

A

Aroma tase from fat cells converts T into estradiol therefore lowering T/E ratio

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16
Q

Where do Y chromosome microdeletions occur?

A

Long arm of the Y chromosome (Yq11) azoospermia (AZF) region

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17
Q

Are primary spermatocytes 1n or 2n?

A

2n

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18
Q

What % of men have azoospermia?

A

1%

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19
Q

How much more likely are men with diabetes to have ED?

A

4x

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20
Q

Klinefelter karyotype

A

47 XXY

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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

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22
Q

What % of infertility is male fertility the sole cause?

A

20%

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23
Q

Globospermia

A

Sperm without acrosome

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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

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25
Q

Bioavailabile T levels

A

50-250 ng/dL

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26
Q

% of infertile men with karyotypic chromosome abnormalities

A

7%

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27
Q

What secretes T?

A

Mostly Leydig cells, some by adrenal cortex

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28
Q

What is the normal size of a testicle?

A

19 ml

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29
Q

What happens in corpus epididymis?

A

Fertilization potential

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30
Q

Is seminal vesicle T or DHT dependent?

A

T

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31
Q

What does seminal vesicle produce?

A

Alkaline secretion and fibrin. Fibrin (protein) is responsible for coagulation. Also fructose to nourish sperm and prostaglandins for motility

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32
Q

What is required for the dx of azoospermia?

A

Examination of the pellet of a centrifuged semen sample x2, at least one month apart

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33
Q

What are the signs of Cushing syndrome?

A

ED, decreases libido and decreases androgen production

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34
Q

What are requirements for IUI?

A

Ovulation
Tubal patency
Adequate sperm parameters. TMC greater than 5 million

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35
Q

What are the AZF regions?

A

AZFa - proximal
AZFb - central
AZFc - distal

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36
Q

What ducts male male genitalia? Wolffian or Mullerian?

A

Wolffian

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37
Q

What can scrotal US be used for?

A

Dx varicoceles
Epididymal dilations
Testicular rumors

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38
Q

What hormone do inhibit and activin regulate?

A

FSH

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39
Q

What is most circulating T bound by?

A

Sex hormone binding globulin (SHBG)

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40
Q

What happens in caput epididymis?

A

Motility potential

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41
Q

Most of testicular cancer is what kind?

A

Germ cell neoplasm

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42
Q

Asthenospermia

A

Reduced sperm motility

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43
Q

How much does T decrease per year in men over 40?

A

1-2% per year

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44
Q

With age does SHBG increase or decrease? What about free T?

A

Free T decreases while SHBG increases

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45
Q

Who should get a post ejac urinalysis?

A

Low volume, <1ml
Normal hormone levels
Normal vasa

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46
Q

What does prostate gland secrete?

A

Slightly acidic secretion, is rich in minerals and sodium. Also produces fibrinolysin

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47
Q

What’s in sperm mid piece?

A

Mitochondria to provide energy

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48
Q

What secretes GnRH

A

Hypothalamus

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49
Q

Testicular dysgenesis syndrome hypothesis

A

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

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50
Q

What does Cushing syndrome cause?

A

Increased cortisol production

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51
Q

What is cryptorchidism?

A

Failure of the testicles to descend

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52
Q

What does GnRH do?

A

Acts on pituitary to synthesize LH and FSH

53
Q

How does Graves’ disease affect fertility?

A

Hyperthyroidism. Increases SHBG and therefore decreases free T. Also increases aromatization to estradiol

54
Q

What is hypospadias?

A

A birth defect where the opening of the urethra is on the underside of the penis instead at the tip.

55
Q

What % of men with azoospermia or severe oligospermia have Y chromosome microdeletions?

56
Q

What happens in cauda epididymis?

A

Sperm storage

57
Q

What is cryptorchidism?

A

When one or both testicles fail to descend

58
Q

Pyospermia

A

> 1 million leukocytes per ml

59
Q

When to testes descend during embryonic development?

60
Q

What do Sertoli cells secrete?

A

Inhibit and activin

61
Q

% of OA

62
Q

What % of men fathering children are over 35?

63
Q

What does the IUI prep remove from the sample?

A

Prostaglandins
ROS
Capacitation inhibitors

64
Q

How many days do the spermatozoa spend in the epididymus?

65
Q

If total T is <300 ng/mL, what tests should be done?

A

LH
Prolactin
Bioavailabile T in the AM

66
Q

How many times does time to pregnancy increase if male is over 45?

67
Q

How does diabetes mostly cause infertility?

A

Causes ejaculatory dysfunction, retrograde ejaculation and anejaculation

68
Q

Normal levels of total T

A

240-950 nag/dL

69
Q

What % of couples are unable to conceive after 1 year of trying?

70
Q

What does FSH act on?

A

Sertoli cells

71
Q

What conc is recommended for basic wash for IUI?

A

<20mil/ml in the initial sample

72
Q

What is thought to be the cause in increase in prostate cancer?

A

Fetal and adult exposure to nataur of synthetic estrogens

73
Q

Aspermia

A

Absence of seminal fluid

74
Q

Free T levels

A

5-20 ng/dL

75
Q

What makes the acrosome?

A

The Golgi apparatus

76
Q

Where can anti sperm antibodies be found?

A

Serum, seminal plasma, sperm

77
Q

What % per year does overall male sperm conc decline in the US?

78
Q

Which AZF deletion has the best outcome with sperm retrieval?

79
Q

What do bulbourethral glands secrete?

A

Small amount of mucus prior to ejac

80
Q

What is the chance of finding sperm from someone with AZFc?

81
Q

What makes penis and scrotum?

A

Urogenital tubercle

82
Q

Where is vasectomy performed?

A

Proximal vas

83
Q

What does increased LH, increased FSH and decreased T indicate?

A

Testicular failure

84
Q

What does low volume or absent ejaculate indicate?

A 
Retrograde ejac 
Lack of emission
Ejac duct obstruction
Hypogonadism 
CBAVD
85
Q

What can be used instead of T to increase T levels for hypogonadism?

A

HCG
Recombinant LH
Clomiphene citrate

86
Q

When in gestation genitalia differentiate?

A

Week 7 of intrauterine life

87
Q

What does LH act on?

A

Leydig cells

88
Q

What happens in vas deferens?

A

Rapid transport of sperm during ejaculation

Slow transport and removal of sperm during sexual rest

89
Q

What % of men with obesity have low T levels?

90
Q

What % of men with diabetes have low T?

91
Q

What % of men with AIDS have low T?

92
Q

What % of anabolic steroid users remain azoospermia after discontinuation?

93
Q

Sperm concentrations rebound how quickly after discontinuation of anabolic steroids?

A

6-18 months

94
Q

How quickly after starting anabolic steroids does azoospermia occur?

A

About 10 weeks

95
Q

How does hypothyroidism affect fertility?

A

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
Q

Ways that infections can affect male fertility

A 
Impaire spermatogenesis 
Disrupt sperm function
Cause obstruction
Inhibit accessory gland function
Cause an inflammatory response
97
Q

What are the predominant leukocytes found in men with leukocytospermia?

A

Granulocytes

98
Q

What are the majority of round cells found in semen?

A

Immature germ cells

99
Q

What does WHO 5th recommend for detection of leukocytes in semen?

A

Peroxidase test

100
Q

What is the most sensitive way to detect leukocytes in semen?

A

Immunological tests. Cd45 antigen

101
Q

What is orchitis?

A

Testicular infection

102
Q

Which virus has been shown to affect male fertility?

A

Herpes simplex 1 and 2

103
Q

How does herpes affect male fertility?

A

Decreased sperm concentration

104
Q

What does ROS cause?

A

Cellular damage. Lipid peroxidation of the sperm membrane and DNA damage

105
Q

What are testicular sources of ROS?

A

Spermatozoa

Seminal leukocytes

106
Q

What % of men seeking fertility treatment have antiserum antibodies?

107
Q

Antisperm antibodies can cause:

A

Sperm agglutination
Prevents cervical mucus penetration
Inhibits sperm oocyte interaction and fusion

108
Q

What causes ASA?

A

Breakdown of blood testis barrier
Failure of immunosuppression
Infections

109
Q

What produces ASAs?

A

T-helper cells and B lymphocytes

110
Q

What % of infertile men have CBAVD? What % of men with OA have CBAVD?

111
Q

How are Y chromosome microdeletions identified?

A

Using multiplex PCR

112
Q

What is used to analyze CNVs?

A

Array comparative genomic hybridization (aCGH)

113
Q

What is the frequency of hypospadias in general population?

  1. 1:10,000
  2. 1:100
  3. 1:300
  4. 1:1000
114
Q

Where else besides the nucleus do you find chromosomes?

A

In the mitochondria in the cytoplasm

115
Q

How is wilms tumor suppressor gene involved in fertility?

A

Initiates development of the gonads and when absent, gonadal a genesis occurs.

116
Q

How is steroidogenic factor-1 (SF1) gene involved in fertility?

A

It’s an orphan receptor and important regulator of embryonic gonadal development as well as the development of the adrenals

117
Q

Antimullerian hormone defects in males results in what?

A

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
Q

What is the frequency on KS?

A

1 to 500 births

119
Q

What % of boys have cryptorchidism?

120
Q

How many genes are on the Y chromosome?

121
Q

How many genes are on the X chromosome?

A

Over a 1000

122
Q

What are the three arteries of the testis?

A

Testicular artery
Cremasteric artery also called external spermatic artery
Deferential artery

123
Q

What does the testicular artery supply?

A

The testis

124
Q

What does the cremasteric artery supply?

A

Scrotal sac and covering of the spermatic cord

125
Q

What does the deferential artery supply?

A

Vas deferens and epididymis

126
Q

What is the normal size of a testicle in cm?

A

4-5 cm x 3cm x 2.5 cm

127
Q

What is the length of head of the epididymis?

128
Q

What is the lengths of body of epididymis?

129
Q

What is the size of the tail of the epididymis?

Andrology (2 decks)

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