Male infertility + ED Flashcards
How long for changes in semen to be reflected after tratment?
74-76 day cycle + 12 day sperm travel ~ 3 months
Genetic causes of Impotence
- Karyotypic: Klinefelters, Microdeletion on Y
- Congenital absence of Vas Deferens: CF/CFTR gene; Wolfian duct anomaly
- 46 XX Male Syndrome
Ejaculation reference Values
- Volume: 1.5 - 5.0 ml
- pH: > 7.2
- Concentration > 20 mil/ml
- motility > 50%
- Normal Morph (Strict Kruger > 14%)
Hormonal Treatment of infertility in men
- Low Test, High prolactin -> prolactinoma -> Bromocriptine
- anti-estrogens: Clomiphene, Tamoxiphen
- **Exogenous Androgenic steroids DEC LH + Testicular testosterone
Pt comes in with low sperm volume, painful ejac, acidic pH, and tests neg for fructose, Transrectal US reveals_______
Ejaculatory duct obstruction
ART
Assisted Reproductive Technology
ICSI
Intra‐Cytoplasmic Sperm Injection
IUI
Intra‐Uterine Insemination (Artificial Insemination)
GPD
Genetic Pre‐implantation Diagnosis
TESE
Testicular/Epididymal Sperm Extraction
Oligospermia
Azoospermia
Aesthenospermia
Teratospermia
- Oligospermia‐Low Sperm Concentration
- Azoospermia ‐NO Sperm seen
- Aesthenospermi ‐Poor Motility
- Teratospermia ‐Low Percentage of Normal Morphology
Neural Controls Erection/Ejaculation
PSNS S2-4 for erection
SNS T10-L2 for emission w/ some pudendal nerve involvement
Testosterone supplementation SE
- Irritability
- Liver Toxicity
- Gynecomastia
- Sleep apnea
- BPH + Prostate Cancer
- CV Dx
- INC hematocrit
Priapism Tx
- Usual
- SCD
- Other low Flow
- High Flow
- Usual: Stop sexual activity, sudafed, cold shower, + DEC stimulation
- SCD: Analgesics, hydration, O2, + alkalinize
- Other: Aspiration/irrigation w/ vasoconstrictors
- High Flow: Embolization or Sx ligation
Medications A/S ED
- Anti-HTN
- Hormonal Agents
- Cardiac Medication
- H-2 Receptor antagonists
- Psychoactives
- Cytotoxic agents
- Lipid-lowering
SHIM Questions
- How do you rate you confidence to get and keep an erection?
- When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
- During sexual intercourse, how often were you able to maintain erection after penetration?
- During intercourse, how difficult was it to maintain your erection to completion?
- When you attempted sexual intercourse, how often was it satisfactory for you?
Erection molecule mediator + PDE-5
NO -> GC-> INC cGMP -> Erection
PDE5 breakds down cGMP,
Contra for PGE5 inhibitors
Nitrates
