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Reproductive - Reproductive Gynaecology > Male Infertility - Clinical > Flashcards

Male Infertility - Clinical Flashcards

1
Q

Male infertility is responsible for what percentage of cases of infertility?

A

1/3rd

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2
Q

Male infertility is usually associated with abnormalities in what?

A

Semen analysis

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3
Q

What is the most common reason for male infertility?

A

Unknown (idiopathic)

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4
Q

If there is a known cause for male infertility, what are the two categories these causes can be split into?

A

Obstructive and non-obstructive

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5
Q

What are some obstructive causes of male infertility?

A

CF (absence of vas deferens), infections e.g. chlamydia, vasectomy

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6
Q

What is a congenital, non-obstructive cause of male infertility?

A

Cryptorchidism

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7
Q

What is an infective cause of non-obstructive male infertility?

A

Mumps orchitis

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8
Q

What are the two main iatrogenic causes of non-obstructive male infertility?

A

Chemo and radiotherapy

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9
Q

What is the major pathological cause of non-obstructive male infertility?

A

Testicular tumour

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10
Q

What is a genetic cause of non-obstructive male infertility?

A

Kleinfelter’s (XXY)

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11
Q

What are some more general causes of non-obstructive male infertility?

A

Specific semen abnormality, systemic illness, endocrine conditions

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12
Q

What are the 7 main things to ask about in a history of male infertility?

A

Infertility history/sexual function, general health, genitourinary infections, surgery to the genital tract, medications and therapies, environmental exposures, recreational drugs

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13
Q

What are some medications which may adversely affect spermatogenesis?

A

Hormone therapy, steroids, sulphasalazine, alpha blockers, 5 alpha reductase inhibitors

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14
Q

What are some environmental exposures that may contribute to male infertility?

A

Pesticides, excessive heat on the testicles

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15
Q

What recreational drugs are particularly bad for causing male infertility?

A

Marijuana and excessive alcohol

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16
Q

What are some endocrine causes of male infertility?

A

Pituitary tumours, hypothalamic problems, thyroid disorders, diabetes, CAH, androgen insensitivity, steroid abuse

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17
Q

What will happen to the levels of LH, FSH and testosterone if there is a pituitary tumour?

A

They will all decrease

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18
Q

What are some more specific features that a pituitary tumour may cause depending on its type?

A

Acromegaly, Cushing’s, hyperprolactinaemia

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19
Q

What will happen to the levels of LH, FSH and testosterone if there is a hypothalamic cause for male infertility?

A

They will all decrease

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20
Q

What are some examples of hypothalamic causes for male infertility?

A

Idiopathic, Kallmann’s, tumours, anorexia

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21
Q

What may be some changes associated with a thyroid disorder (either hyper or hypo) causing male infertility?

A

Decreased sexual function and increased prolactin

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22
Q

What may be some changes associated with diabetes being the cause for male infertility?

A

Decreased sexual function and decreased testosterone

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23
Q

What happens to testosterone levels in congenital adrenal hyperplasia?

A

Increased

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24
Q

What will happen to the levels of LH and testosterone in androgen insensitivity syndrome?

A

Normal or increased

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25
Q

What will happen to the levels of LH, FSH and testosterone if steroid abuse is the cause of male infertility?

A

They will all be decreased

26
Q

What forms the first part of assessment of a couple with infertility?

A

See as a couple and take a history

27
Q

What two examinations should you do on a male with suspected infertility?

A

General and genital

28
Q

What are you looking for on general examination of a man with suspected infertility?

A

The presence of secondary sexual characteristics, any gynaecomastia

29
Q

What do you look for on genital examination of a man with suspected infertility?

A

Testicular volume, presence of vas deferens and epididymis, urethral oriface, any swellings

30
Q

How do you measure testicular volume? What is norma;?

A

Orchidometer - normal is 12-25ml

31
Q

A testicular volume of < 5ml suggests what?

A

The male is unlikely to be fertile

32
Q

What things are you looking for with semen analysis?

A

Volume, density, motility, progression, morphology

33
Q

When should semen analysis be taken?

A

After 3-4 days abstinence from ejaculation

34
Q

What are some factors the may affect the quality of semen analysis?

A

< 3 days abstinence, not kept cool during transport, > 1 hour between production and assessment, not a complete sample, ill health in the last 3 months

35
Q

If semen analysis is abnormal, what should be done? Why?

A

Repeat in 6 weeks as it may only be abnormal as a result of current illness

36
Q

The presence of what in a semen sample indicated prompt investigation into the cause?

A

Azoospermia

37
Q

What are some investigations (other than semen analysis) that can be used for male infertility?

A

Endocrine profile, chromosomal analysis, testicular biopsy, scrotal scan

38
Q

What hormones are tested in an endocrine profile for male infertility?

A

LH, FSH, testosterone, PRL, TSH

39
Q

What could you test for as part of chromosomal analysis for male infertility?

A

Karyotype, Y chromosome microdeletions, CF screening

40
Q

What are the clinical features of obstructive male infertility?

A

Normal testicular volume and secondary sexual characteristics

41
Q

What structure may be absent in obstructive male infertility? What condition is this especially associated with?

A

Vas deferens - CF

42
Q

What are the endocrine features of obstructive male infertility?

A

Normal LH, FSH and testosterone

43
Q

What are the clinical features of non-obstructive male infertility?

A

Low testicular volume and reduced secondary sexual characteristics

44
Q

Will the vas deferens be present in non-obstructive male infertility?

45
Q

What are the endocrine features of non-obstructive male infertility?

A

High LH/FSH +/- low testosterone

46
Q

What is the first line treatment for male infertility if possible?

A

Treat the underlying cause

47
Q

If there is no underlying cause for male infertility that can be treated, what are the options?

A

ICSI or donor insemination

48
Q

Reversal of a vasectomy has a poor outcome after how long?

49
Q

What is the treatment for hyperprolactinaemia?

A

Cabergoline

50
Q

What is the treatment for anejaculatory conditions?

A

Psychosexual treatment

51
Q

What are some general ways you can treat an underlying cause of male infertility?

A

Treat chronic illness, change any medications

52
Q

When is ICSI used as a treatment for male infertility?

A

If sperm are available

53
Q

Where are sperm taken for to be used in ICSI?

A

Either from the semen or from surgical aspiration

54
Q

When is surgical sperm aspiration indicated for ICSI?

A

If there is azoospermia

55
Q

Surgical sperm aspiration for ICSI has better outcomes in which type of male infertility?

A

Obstructive (95% chance of obtaining sperm)

56
Q

How does ICSI work?

A

Each egg is stripped, sperm are immobilised and a single sperm is injected

57
Q

What is the success rate of ICSI?

58
Q

When is donor insemination used as a treatment for male infertility?

A

If there is azoospermia or a very low count, ICSI has failed, genetic or infective conditions

59
Q

How are sperm donors chosen?

A

They are matched for recipient characteristics and screened for genetic disease and STIs

60
Q

When is a donor sperm sample inserted into the uterus?

A

At ovulation

61
Q

What is the success rate of donor insemination?

A

15% each cycle

Reproductive - Reproductive Gynaecology (12 decks)

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