Male reproductive disorders Flashcards
What values are expected for testosterone, LH/FSH in pituitary causes of male infertility
- testosterone is low/ low-normal
- LH/ FSH are not elevated- inappropriate pituitary response
Describe clinical findings of pre-pubertal onset of pituitary disease
dx during workup for growth retardation or delayed puberty
pts undergo adrenarche and develop small amount of pubic hair
testes remain small and soft
Describe clinical findings in post-pubertal onset of pituitary disease
sx of hormone deficiency or excess
mass effects
normal secondary sex characteristics
testes are firm due to fibrosis
The most common form of Kallman syndrome involves a mutation in a gene with what function?
neuron adhesion molecule responsible for guiding migration of GnRH-secreting neurons to the medial basal hypothalamus.
Kallman syndrome is an example of __________ hypogonadism
hypogonadotropic
List clinical findings in Kallmann syndrome
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
What is the effect of administering exogenous testosterone on male fertility?
Feeds back on hypothalamus and pituitary, leading to reduction of both intratesticular testosterone and FSH, impairing spermatogenesis
All forms of CAH are characterized by excess ________ production
adrenal androgen
How do endogenous androgens produced in CAH affect male fertility
excess adrenal androgens have a negative feedback effect on pituitary gonadotropin secretion, leading to low testicular testosterone production
Describe treatment for CAH
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.
What are some causes of estrogen excess in men
- estrogen secreting tumor
- hepatic dysfunction- decreased clearance of androstendione which is converted in peripheral fat
- obesity
What are symptoms of estrogen excess
ED
gynecomastia
testicular atrophy
low LH, FSH, testosterone
Defects in androgen synthesis and 5α-reductase deficiency commonly result in ________.
ambiguous genitalia
AIS is caused by abnormalities in the _________
androgen receptor
What is the classic presentation of Klinefelter’s syndrome?
small firm testes
gynecomastia
elevated gonadotropins
azoospermia
____________ is commonly identified on testicular biopsy in Klinefelters syndrome
seminiferous tubular sclerosis
In Klinefelters, there is a decreased _____:______ ratio due to increased SHBG production
testosterone to estrogen
Many men with azoospermia are ultimately found to have _____ microdeletions
Y chromosome- specifically AZF region
TESE may be helpful in AZFc microdeletions
After _______ of age, the undescended testis is unlikely to descend on its own.
6 months
What is the most common correctable cause of male infertility
vericocele
Why are most varicoceles left sided?
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
What is concerning about a unilateral right varicocele
possibility of thrombosis or occlusion of the vena cava or situs inversus
Permanent testicular atrophy may develop within months of infection with ______
mumps- orchitis
Men should bank sperm before treatment with _______ or ______
chemotherapy or radiation
What is the effect of spironolactone on semen quality?
acts as an antiandrogen through peripheral antagonism of androgens
What is the effect of CCBs on sperm quality?
reversible functional defect in sperm, interfering with the ability of sperm to fertilize eggs
________ tx for UC causes reversible defects in sperm concentration, mobility, morphology
sulfasalazine
_______ has been found to cause degeneration of germ cells and impair spermatogenesis by interrupting pulsatile LH secretion
cimetidine
What is the most common cause of obstructive azoospermia?
CBAVD, associated with CFTR mutation
What treatment can be used for infertility due to CBAVD
surgical sperm retrieval combined with IVF using ICSI + genetic testing and counseling
What are the characteristics of ejaculates from men with CBAVD
low volume, acidic ejaculates
seminal vesicles are absent or hypoplastic
For men with spinal cord injuries above T10, ____ can result in ejaculation/ sperm retrieval.
_______ is more effective if the spinal cord injury is lower
penile vibratory stimulation
electroejaculation
What are characteristics of primary ciliary dyskinesia?
- flagella defects in sperm
- respiratory ciliary defects
+ situs inversus- Kargagener’s
