Sperm

Question 1

Define azoospermia

Answer 1

No sperm.

Question 2

Causes azoospermia (2)

Answer 2

Obstructive: Absent vas deferens, Vasectomy

Non-obstructive: testicular pathology primary hypogonadism, secondary hypogonadism

Question 3

Name 10 pre-testicular causes infertility

Answer 3

• General factors: viral illness, stress, age, local heat, nutrition, alcohol, smoking, marijuana, chronic illnesses eg chronic renal failure
• endocrine
• Hypothalamic eg Kallman’s syndrome
• hypopituitarism
• adrenal, thyroid
• klinefelter syndrome 47xxy
• hypogonadism, hyper prolactinaemia

• drugs

• h2 receptor antagonists
• calcium channel blockers
• antioxidants: allopurinol, colchicine
• anabolic steroids

. Chemotherapy

• environmental toxins

Question 4

Name 6 testicular causes infertility

Answer 4

• Varicocoele
• undescended testes
• previous testicular torsion, trauma
• mumps orchitis
. Radiotherapy
• previous surgery eg inguinal hernia repair

Question 5

Name 5 post-testicular causes infertility

Answer 5

• Congenital bilateral absence / agenesis vas deferens
• acquired ejaculatory ducal obstruction eg previous epididymitis
• retrograde ejaculation eg previous bladder neck surgery
• vasectomy
• sexual problems: premature ejaculation, ED, penile problems (Peyronie, hypospadias)
• cystic fibrosis
• inflammatory conditions eg chronic prostatitis

Question 6

Define oligospermia

Answer 6

<20 million/ml

Question 7

Term for impaired sperm motility in > 50% of sperm?

Answer 7

Asthenospermia

Question 8

Term for abnormal sperm in > 85 % of sperm?

Answer 8

Teratospermia

Question 9

Special serology test for seminal vesicles?

Answer 9

Fructose

Question 10

Treatment options male infertility? (8)

Answer 10

Treat cause.

Surgical
• varicocelectomy,
• vasovasostomy (reverse vasectomy)
• vaso-epididymostomy for epididymis obstruction.
• sperm aspiration for assisted reproduction
• transurethral resection ejaculatory ducts for ejaculatory duct obstruction

Medical
• pyospermia or prostatitis: antibiotics, treat partner if suspect STD
• antisperm antibodies treat with steroids
• empiric medical therapy eg clomifene where no cause can be found

Question 11

Differential diagnosis free fluid in scrotum? (4)

Answer 11

Varicocoele
Heart failure fluid overload
Nephrotic syndrome/renal failure
Liver cirrhosis