Male Infertility And Sterilization Flashcards
Definition and etiology of male infertility
Inability to conceive despite at least 1 year of frequent and unprotected intercourse
- if >35 yrs old, can consider cut off at 6 months
Occurs in 8-15% of couples
50% infertile couples dont really require treatment and will be able to conceive within 2 yrs
Etiologies of male infertility
Spermatogenesis defects (70-80%)
Idiopathic (10%)
Transportation defects (5%)
Endocrine issues (2-5%)
Average normal spermatogenesis
1,000-1,500 sperm is produced per second
- although takes 74 days for spermatozoa to fully mature
4-10% of sperm are “100% normal”
- usually are head/mid piece/tail defects or acrosomeless
Causes of abnormal spermatogenesis
abnormal spermatogenesis accounts for 70-80% of male infertility
Cryptochidism
Chronic disease
Untreated STDs
Obesity
Cancer treatments
Iron overload/ hemochromatosis
Medications (BBs, SSRIs, TCAs, ketoconazole, spironolactone, cimetidine, etc)
Tobacco, alcohol, anabolic steroid consumption
Heat exposure
How does alcohol affect spermatogenesis
Impaired both leydig and serotli cell affects = decreased testosterone and sperm production respectively
Chronic use = testicular atrophy and loss of 2nd male characteristics
- also increases adipose tissue buildup
Genetic abnormalities impacting spermatogenesis
20% of men with azoosperma and 4% of infertile men have identifiable genetic abnormalities
Klinefelter syndrome
- highest rates (95-99%)
46-XX disorder
- translocation of the SRY gene onto X chromosome
Examples of Transportation defects of infertility
Cystic fibrosis
- often male patients with this can present with congenital bilateral absence of vas deferens (CBAVD)
Retrograde ejaculation
Prostatic obstruction (BPH most common)
Premature ejaculation
Abnormal sperm motility
Direct trauma or scarring to the grain region
Common endocrine causes of infertility in males
Primary hypogonadism (testies dont work)
Secondary hypogonadism (pituitary does secrete FSH/LH well - common to head trauma, metastatic disease and anabolic steroid use
Hypothyroidism untreated
Cushing syndrome (exogenous or endogenous)
Hyperprolactinemia
- suppresses GnRH and prevents FSH/LH release
Labs to get for infertility
Testosterone=, LH, FSH, prolactin, TSH, morning cortisol
WHO reference range for normal semen analysis
Total sperm count = 39-938 million
Ejactulate volume = 1.5-7.6 mL
Sperm concentration = 15-259 million/mL
Progressive motility = 32-75%
Sperm morphology = 4-48%
Additional tests to consider
Scrotal ultrasound
Transrectal ultrasound
Post-ejaculate urine analysis
Genetic testing (only with clinical suspicion)
Testicular biopsy (only with clinical suspicion)
Sperm antibodies
- note both males and females can make these
Is intra-uterine insemination recommended for male infertility?
NO
- In vitro fertilization (sperma nd petri dish) and ICSI are far more effective
only given if female infertility due to non-ovary reasons
Assisted reproductive technology used based on male infertility testing results
Normal limit semen analysis with normal morphology
- idiopathic infertility and use IVF
Normal limit semen analysis with abnormal morphology/ motility
- use Intracyctoplasmic sperm injection (ICSI)
Decreased sperm concentrations with normal morphology
- first evaluate for Klinefelter and test FSH/LH and testosterone levels
- then consider TESE/IVF or ICSI assuming he testing above comes back normal
Very low sperm counts with either azoospermia or normal morphology
- evaluate for Klinefelter and obstruction first
- then use TESE, IVF or ICSI ,
Vasectomy
Cut the vas deferns
There are two methods
1) no-scapel = expose only one of the two tubes and requires no stitches. Easier to reverse but also isnt 100% effective (closer to 90%)
2) tractional = two scalpel incisions to cut the vas deferns. near 100% effective but harder to reverse and also show scars
Reversible inhibition of sperm under guidance (RISUG)
“Vasalgel
Vasalgel fills the interior of the vas defens with a gel barrier that presents larger stem to cross and instead get absorbed by the body and degraded
Is removed via injection of a dissolving solution allowing normal fertility again
- *is very noval and has shown effectiveness in small animals**
- there are likely unknown side effects though
