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Module 203 > Subfertility, spermatogenesis > Flashcards

Subfertility, spermatogenesis Flashcards

1
Q

Requirements for conception

A

Progressively motile normal sperm able to reach and fertilise oocytes
Timely release of a competent oocyte
Free passage through vagina, cervix, uterus and fallopian tube for sperm to reach oocyte
Mature endometrium for implantation

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2
Q

Infertility

A

Inability to conceive after a period of time of frequent, unprotected intercourse requiring investigation and possible treatment
Affects 1 in 6

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3
Q

General causes of infertility

A 
Unexplained
Ovulatory
Male factor
Tubal abnormality
Endometriosis
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4
Q

Indications for referral or investigation in women

A

Aged over 35
Amenorrhoea/oligomenorrhoea
Previous PID/STD
Abnormal abdo/pelvic examination

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5
Q

Indications for referral or investigation in men

A

Previous genital pathology
Previous STD
Significant systemic illness
Abnormal genital examination

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6
Q

Semen analysis

A 
Sperm count>15 x 10^6/ml
Motility >40%
Morphology >4%
Vitality >58%
Volume 1.5-6.0ml
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7
Q

Abnormal semen analysis

A

Testicular failure
Obstructive or non-obstructive azoospermia
Y chromosome microdeletion
Cystic fibrosis - congenital bilateral absence of vas deferens

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8
Q

Female assessment

A

Screen for chlamydia and rubella
Ovarian reserve - LH, FSH, oestradiol, AMH, AFC
Ovulation tests - day 21 progesterone, LH surge testing kits
Tubal test

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9
Q

AMH in males

A

Produced by sertoli cells until reproductive maturity due to testosterone and FSH production

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10
Q

AMH in females

A

Produced by granulosa cells until early antral stage
Measures of ovarian reserve and response to ARTs
Increased AMH = Increased AFC = Increased OR

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11
Q

Causes for anovulation

A
  1. PCOS - normal FSH, LH and E2
  2. POF - high FSH and low E2
  3. Hypogonadotrophic hypogonadism - low FSH, LH & E2
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12
Q

Monitoring ovulation

A

Basal body temperature
Ovulation(LH) testing kits
Day 21 Progesterone/follicular tracking (USSS)

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13
Q

Hypogonadotrophic hypogonadism

A

complete shut down of ovaries as pituitary is not producing gonadotrophins

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14
Q

Causes of abnormal tubal patency

A 
PID due to chlamydia
Septic abortion
Ruptured appendix
Previous pelvic surgery
Ectopic pregnancy
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15
Q

Imaging for tubal patency

A

Hysterosalpingogram HSG
Hysterosalpingo contrast sonography (HyCoSy)
Laprascopic dye

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16
Q

HSG

A

Hysterosalpingogram
X-ray imaging of the uterine cavity and fallopian tubes using a dye
Performed 2-5 days after menstruation
Advantages: relatively safe, easy to use, clear delineation of uterine cavity and fallopian tubes
Disadvantages: unable to assess pelvic peritoneum
Ideal imaging for most women

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17
Q

HyCoSy

A

Hysterosalpingo contrast sonography
Speculum inserted into vagina with catheter, water then dye injected to check fallopian tube patency and check uterus during ultrasound scan
Disadvantages: time consuming and requires training
Used in fertility clinics rather than NHS

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18
Q

Laprascopic dye

A

GOLD STANDARD
Need to screen for chlamydia
Advantages: live imaging of uterus and fallopian tube with greater sensitivity and specificity, used to diagnoses adhesions and endometriosis
Disadvantages: Invasive procedure

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19
Q

Induction of ovulation

A

Clomifene/clomiphene (oestrogen receptor blocker to increase FSH)
FSH and LH injections (FSH for a few days to develop follicle then LH for ovulation)

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20
Q

Use of FSH and LH injections for ovulation induction

A

If resistant to clomifene

Hypogonadotrophic hypogonadism - no or low FSH production

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21
Q

ARTs

A

Intrauterine insemination treatment
In-vitro fertilisation
Controlled ovarian hyperstimulation

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22
Q

Controlled ovarian hyperstimulation

A

The use of fertility medications to induce ovulation by multiple ovarian follicles

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23
Q

IVF

A

Egg collection - may be frozen
Intra-cytoplasmic sperm injection - helpful for men with low sperm count
Embryo development - implanted into endometrium after day 5

24
Q

IVF live birth rate

A

national average 30-35% in under 35s

25
Q

IVF live birth rate

A

national average 30-35% in under 35s

26
Q

Function of testes

A

Spermatozoa and hormones

27
Q

Structure of seminiferous tubules

A

Surrounded by myoid cells and basement membrane

Within - sertoli cells and spermatogenic cells

28
Q

Pituitary control

A

LH stimulates Leydig to produce androgens

FSH stimulates Sertoli cells for spermatogenesis and conversion of testosterone to DHT by 5-alpha reductase

29
Q

Testosterone synthesis

A

From acetate and cholesterol in Leydig cells

4-10mg per day

30
Q

Hypophysectomy

A

Removal of pituitary gland causing shrinking of testes and spermatogenesis to arrest

31
Q

Areas of seminiferous tubules

A

Basal compartment for mitosis

Adluminal compartment meiosis

32
Q

Mitosis

A

Prospermatogonia reactivated at puberty
A1 and B spermatogonia
Primary spermatocyte

33
Q

A1 spermatogonia vs B spermatogonia

A

A1 spermatogonia replenish spermatogonia

B spermatogonia form mature sperm

34
Q

Meiosis

A

Meiosis I: secondary spermatocytes formed (2 cells with 2 pairs of chromosomes)
Meiosis II: haploid spermatids (4 cells with 1 chromosome in each new cell)

35
Q

Spermiation

A

Release of spermatozoa into lumen of seminiferous tubules

36
Q

Packaging

A 
Tail for propulsion
Mid-piece for mitochondrial energy
Nucleus to package chromosomes
Cap to aid sperm-oocyte fusion
Acrosome to penetrate oocyte
37
Q

Spermatogenesis

A

Mitosis
Meiosis
Packaging
Completed in 64 days

38
Q

Residual body

A

Dustbin for unwanted cytoplasm during packaging

Eaten by sertoli cells

39
Q

Final maturation of spermatozoa

A

Enter rete testis, pass through vasa efferentia and into epididymis
Physiological maturation of sperm between rete testis and epididymis to improve sperm motility - dependent on androgen stimulation

40
Q

Spermatogenic wave

A

Multiple spermatogenic processes are occurring simultaneously in the same seminiferous tubule

41
Q

Spermatogenic cycle

A

Time taken for appearance of the same stage within a given stage of the seminiferous tubule (16 days)

42
Q

Semen formed by…

A

Seminal vesicle
Prostate
Bulbourethral gland

43
Q

Cellular component of semen

A

Spermatogenic cells, spermatozoa, epithelial cells, leucocytes

44
Q

Fluid component of semen

A

Fructose
Buffer for vaginal acidity
Sorbitol
Antioxidant e.g. VitC

45
Q

Capacitation

A

Glycoproteins stripped from sperm surface as sperm travel through female reproductive tract to prepare the sperm for the acrosome reaction and fertilisation of egg
Causes hyperactive motility of sperm (from circular to whiplash movements)

46
Q

What does the endocervix offer the sperm?

A

Thin, watery mucus to allow easy passage
Protection from vagina
Reservoir within endocervical crypts
Supplementation of energy requirements

47
Q

Morphological variations of sperm

A

Head defects
Tail defects
Neck and midpiece defects

48
Q

Normozoospermia

A

normal sperm values

49
Q

Oligozoospermia

A

Low concentration

50
Q

Asthenozoospermia

A

Too little motility

51
Q

Teratozoospermia

A

Too many abnormals

52
Q

Oligoasthenoteratozoospermia

A

Mixture of low concentration, too little motility and abnormal sperm

53
Q

Azoospermia

A

No spermatozoa

54
Q

Aspermia

A

no ejaculate

55
Q

Biopsy of ST

A

Need to take 30 seminiferous tubules to fully understand the spermatogenesis

Module 203 (10 decks)

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