Male reproductive disorders

Question 1

What values are expected for testosterone, LH/FSH in pituitary causes of male infertility

Answer 1

• testosterone is low/ low-normal

- LH/ FSH are not elevated- inappropriate pituitary response

Question 2

Describe clinical findings of pre-pubertal onset of pituitary disease

Answer 2

dx during workup for growth retardation or delayed puberty
pts undergo adrenarche and develop small amount of pubic hair
testes remain small and soft

Question 3

Describe clinical findings in post-pubertal onset of pituitary disease

Answer 3

sx of hormone deficiency or excess
mass effects
normal secondary sex characteristics
testes are firm due to fibrosis

Question 4

The most common form of Kallman syndrome involves a mutation in a gene with what function?

Answer 4

neuron adhesion molecule responsible for guiding migration of GnRH-secreting neurons to the medial basal hypothalamus.

Question 5

Kallman syndrome is an example of __________ hypogonadism

Answer 5

hypogonadotropic

Question 6

List clinical findings in Kallmann syndrome

Answer 6

delayed puberty, cryptorchidism, gynecomastia,
micropenis
testes are prepubertal
due to delay in the sex hormone-dependent closure of the epiphyseal plates, the arms and legs are long for height

Question 7

What is the effect of administering exogenous testosterone on male fertility?

Answer 7

Feeds back on hypothalamus and pituitary, leading to reduction of both intratesticular testosterone and FSH, impairing spermatogenesis

Question 8

All forms of CAH are characterized by excess ________ production

Answer 8

adrenal androgen

Question 9

How do endogenous androgens produced in CAH affect male fertility

Answer 9

excess adrenal androgens have a negative feedback effect on pituitary gonadotropin secretion, leading to low testicular testosterone production

Question 10

Describe treatment for CAH

Answer 10

Glucocorticoid therapy results in a reduction of ACTH levels and a decrease in adrenal androgen production.
Gonadotropin secretion can then resume and trigger testicular normal steroidogenesis.

Question 11

What are some causes of estrogen excess in men

Answer 11

• estrogen secreting tumor
• hepatic dysfunction- decreased clearance of androstendione which is converted in peripheral fat
• obesity

Question 12

What are symptoms of estrogen excess

Answer 12

ED
gynecomastia
testicular atrophy
low LH, FSH, testosterone

Question 13

Defects in androgen synthesis and 5α-reductase deficiency commonly result in ________.

Answer 13

ambiguous genitalia

Question 14

AIS is caused by abnormalities in the _________

Answer 14

androgen receptor

Question 15

What is the classic presentation of Klinefelter’s syndrome?

Answer 15

small firm testes
gynecomastia
elevated gonadotropins
azoospermia

Question 16

____________ is commonly identified on testicular biopsy in Klinefelters syndrome

Answer 16

seminiferous tubular sclerosis

Question 17

In Klinefelters, there is a decreased _____:______ ratio due to increased SHBG production

Answer 17

testosterone to estrogen

Question 18

Many men with azoospermia are ultimately found to have _____ microdeletions

Answer 18

Y chromosome- specifically AZF region

TESE may be helpful in AZFc microdeletions

Question 19

After _______ of age, the undescended testis is unlikely to descend on its own.

Answer 19

6 months

Question 20

What is the most common correctable cause of male infertility

Answer 20

vericocele

Question 21

Why are most varicoceles left sided?

Answer 21

the left testicular vein drains into the left renal vein which can be compressed under the SMA
the right testicular vein drains into the inferior vena cava

Question 22

What is concerning about a unilateral right varicocele

Answer 22

possibility of thrombosis or occlusion of the vena cava or situs inversus

Question 23

Permanent testicular atrophy may develop within months of infection with ______

Answer 23

mumps- orchitis

Question 24

Men should bank sperm before treatment with _______ or ______

Answer 24

chemotherapy or radiation

Question 25

What is the effect of spironolactone on semen quality?

Answer 25

acts as an antiandrogen through peripheral antagonism of androgens

Question 26

What is the effect of CCBs on sperm quality?

Answer 26

reversible functional defect in sperm, interfering with the ability of sperm to fertilize eggs

Question 27

________ tx for UC causes reversible defects in sperm concentration, mobility, morphology

Answer 27

sulfasalazine

Question 28

_______ has been found to cause degeneration of germ cells and impair spermatogenesis by interrupting pulsatile LH secretion

Answer 28

cimetidine

Question 29

What is the most common cause of obstructive azoospermia?

Answer 29

CBAVD, associated with CFTR mutation

Question 30

What treatment can be used for infertility due to CBAVD

Answer 30

surgical sperm retrieval combined with IVF using ICSI + genetic testing and counseling

Question 31

What are the characteristics of ejaculates from men with CBAVD

Answer 31

low volume, acidic ejaculates

seminal vesicles are absent or hypoplastic

Question 32

For men with spinal cord injuries above T10, ____ can result in ejaculation/ sperm retrieval.

_______ is more effective if the spinal cord injury is lower

Answer 32

penile vibratory stimulation

electroejaculation

Question 33

What are characteristics of primary ciliary dyskinesia?

Answer 33

• flagella defects in sperm
• respiratory ciliary defects

+ situs inversus- Kargagener’s