Male Infertility and ED -Gambone

Question 1

What is 90% of ED due to?

Answer 1

Physiologic causes (not psychological)

can be triggered by stress

Question 2

What is considered “infertility”?

Answer 2

Inability to conceive after 1 year of trying with frequent exposure

–> really sub-fertility

Question 3

What is the workup for the male in infertility?

Answer 3

Verify that frequent intercourse is occurring (properly) and at the times when his partner is fertile

Ask about a history of infections such as mumps which can cause an orchitis that may result in sterility (in males)

Order a semen analysis

Question 4

In a recent study, it was found that fertile men can have counts as low as _____ (__th percentile)

Answer 4

15million/mL (5th percentile)

Question 5

What is azospermia? How long should you take before you repeat the test?

Answer 5

absence of sperm (count < 1000) –> obstruction or failure of sperm production

90 days because sperm production takes 90 days

Question 6

How long are sperm donor specimens stored before use? why?

Answer 6

frozen and stored for 6 months to make sure do not have HIV (can remain dormant for that long)

Question 7

What is the current IVF treatment?

Answer 7

Current technique is to replace embryos in the stimulated cycle into an over-stimulated uterine environment

Now moving to freezing all embryos in a stimulated cycle and transferring a single thawed embryo at a later date into a more physiologic uterine environment (also allows for pre-implantation genetic testing)

Question 8

What factors allow for the formation of a penile erection? Maintenance?

Answer 8

nNOS (nerve stimulation)–> relax the penile artery –> fill sinusoids of corpora cavernosa

eNOS–> NO relax smooth mm surrounding sinusoids

dissension against the fibrous sheath then closes off the penile veins, maintaining the erection

Question 9

What does Viagra do?

Answer 9

inhibits PDE 5 which normally breaks down of cGMP –> maintain cGMP==>erection

Question 10

What can ED be an early sign of?

Answer 10

ischemic heart disease

–> “penile angina”

Question 11

What 3 things is ED correlated with?

Answer 11

• metabolic syndrome
• reduced HDL/cholesterol ratio
• coronary artery disease

Question 12

What are the two ways that eNOS works?

Answer 12

acts as an autocrine factor, reducing senescence of endothelium

as a paracrine factor==> diffuse into surrounding tissue, prevent atherosclerosis, inhibit platelet adhesion, and inhibiting proliferation of smooth mm of the vessel wall and vascular tone

Question 13

What is one problem with PDE 5 inhibitors?

Answer 13

they don’t fix the underlying problem of deficient NO

==> no reduction in atherosclerosis and clotting and decreasing in vascular tone and smooth mm proliferation

==> cover-up the underlying problem

Question 14

What are some of the most important factors interfering with NO production?

Answer 14

inactivity and obesity (esp in the abdomen)

insulin resistance blocks NO stimulation of insulin

Question 15

What is the single most important factor in protecting against loss of erectile and vascular health?

Answer 15

EXERCISE!

not extreme exercise which can actually decrease NO

Question 16

How does exercise improve NO production?

Answer 16

1. shear force of blood flow induces eNOS and NO production
2. exercise increases insulin sensitivity and insulin is a stimulator of NO

Question 17

What dietary supplements (5) are shown to be beneficial for CV health?

Answer 17

200-400 micrograms of folate (too much can inc colon cancer) –> co-factor in NO synthesis

calcium 1200 mg/day (not more–> deposit on arteries)–> required for NO synthesis, dec osteoporosis risk

omega-3 fatty acids (like EPA) –> 1 gram recommended for CV disease ==> inc NO

anti-oxidants (dark berries, 55% cocoa chocolate, green tea, red wine, fruits and veggies) –> helps with L-arginine and NO production

2 gm of L-citrulline (inc NO) and stronger antioxidant (pycnogenol)