Prevention & Treatment of Male Infertility Flashcards
[important attributes of history taking in evaluating male infertility] within the infertility history
- duration of infertility
- previous pregnancies and outcomes (primary vs secondary infertility)
- partner’s fertility history
- previous fertility investigation and treatment
[important attributes of history taking in evaluating male infertility] within the sexual history
- libido
- erectile dysfunction
- ejaculatory dysfunction
- type of lubricants
- frequency & timing of coitus
- STI
[important attributes of history taking in evaluating male infertility] within the surgical history
- orchidoplexy
- retroperitoneal or pelvic surgery
- herniorrhaphy
- vasectomy
- bladder neck
- prostate surgery
[important attributes of history taking in evaluating male infertility] within the family history
- infertility
- cystic fibrosis
- androgen receptor deficiency
[important attributes of history taking in evaluating male infertility] within the medical history
- cryptorchidism
- timing of puberty
- anosmia
- history of testicular torsion
- history of testicular trauma
- diabetes
- neurological conditions (SC injury, MS)
- infections (urinary infections, epididymitis, prostatitis, tuberculosis, mumps orchitis, recent febrile illness)
- renal disease
- cancer
[important attributes of history taking in evaluating male infertility] within the gonadotoxin exposures
- medications (endocrine modulators, antihypertensives, antibiotics, antipsychotics)
- environmental (pesticides, heavy metals)
- chemotherapy or radiotherapy
- lifestyle (obesity, tobacco, vaping, recreational drugs, anabolic steroids)
define secondary sexual characteristics
- physical features related to the sex of an organism
- arise during puberty
important parts of physical examination when assessing male infertility
- body habitus
- secondary sexual characteristics
- male genital examination
what can alternatively be performed for measurements other than male genital examination
- testicular size and volume
- testicular echogenicity and blood flow
- assessment of varicoceles and epididymal anatomy
hormonal assessment for male infertility should include
- follicle-stimulating hormone (FSH)
- total testosterone (T)
in hormonal assessment, if total testosterone levels are low what is next step / investigation
- conduct more thorough endocrine evaluation
- including LH, prolactin, sex hormone binding globulin, free T
[genetic assessment] genes are linked with male infertility phenotypes which result in what
- male subfertility / infertility presentations
[genetic assessment] what can be used to test for chromosomal abnormalities (eg/ Klinefelter syndrome 47)
karyotyping
[genetic assessment] Y chromosomal microdeletion can be used for patients with what 2 conditions
- azoospermia (no sperm)
- severe oligospermia (low sperm numbers)
clinical management to treat
men with azoospermia
- epididymal or testicular sperm retrieval for intracytoplasmic sperm injection
- more successful in obstructive cases
clinical management of men with
varicocele
- can be repaired thru surgical varicocele repair
- only recommended in patients presenting w abnormal sperm parameters
are there any direct medical treatments for male factor infertility
no
use of assisted reproductive technologies, surgical, lifestyle interventions
idiopathic causes of male infertility can be treated with which
assisted reproductive technologies
- in vitro fertilisation (IVF)
- intracytoplasmic sperm injection
acquired causes of male infertility can be treated with _______ _______ if there is an underlying medical issue such as ………….. (treatable)
- ## treated with medical therapy
- type II diabetes -> glucose modulation
- hormone impairment -> selective oestrogen modulators / aromatase inhibitors
idiopathic causes of male infertility can be treated with which
lifestyle modifications (reversible)
- nutrition
- light / moderate exercise
- cessation of smoking
- removal of environmental toxins
