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Clinical Embryologist's exam samples. > Testicular and Semen Parameters- WHO 2010 > Flashcards

Testicular and Semen Parameters- WHO 2010 Flashcards

Author: Dr. Emad Sedeek, Senior Embryologist & IVF Lab Director

1
Q

The Lower Reference Limits for Semen Volume (ml)

  1. 1.2 (1.1-1.6)
  2. 1.3 (1.1-1.8)
  3. 1.4 ( 1.2-1.7)
  4. 1.5 (1.4-1.7)
  5. 1.6 (1.4-1.8)
A
  1. (WHO 2010)
    but according to WHO 6th edition 2021
    1.4
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2
Q

The lower reference limits for total sperm number (106 per ejaculate)

  1. 39 (33-46)
  2. 41 (33-48)
  3. 43(36-50)
  4. 45 (36-50)
  5. 47 (36-54)
A

1.

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3
Q

The Lower Reference Limits for Sperm Concentration (per ml)

  1. 8 (4-10)
  2. 10 (5-15)
  3. 13 (10-17)
  4. 15 (12-16)
  5. 20 (15-25)
A

4.
but according to WHO 6th edition 2021
16 million/ml

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4
Q

The Lower Reference Limits for Total Motility (PR + NP, %)

  1. 20 (18-22)
  2. 30 (28-32)
  3. 40 (38-42)
  4. 50 (48-52)
  5. 60 (58-62)
A

3.

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5
Q

The Lower Reference Limits for Progressive Motility (PR, %)

  1. 26 (25-27)
  2. 28 (27-29)
  3. 30 (29-31)
  4. 32 (31-33)
  5. 34 (33-34)
A

4.
but according to WHO 6th edition 2021
30%

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6
Q

The Lower Reference Limits for Vitality (Live Spermatozoa, %)

  1. 54 (52-56)
  2. 55 (53-57)
  3. 56 (54-58)
  4. 57 (55-59)
  5. 58 (56-60)
A

5.
but according to WHO 6th edition 2021
vitality 54%

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7
Q

The Lower Reference Limits for Sperm Morphology (Normal Forms, %)

  1. 2 (1-3)
  2. 4 (3-5)
  3. 6 (5-7)
  4. 8 (7-9)
  5. 10 (9-11)
A

2.

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8
Q

The Lower Reference Limits For PH

  1. >6.5
  2. >6.7
  3. >=6.9
  4. >7
  5. >=7.2
A

5.

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9
Q

Lower Reference Limits for MAR Test (Motile Spermatozoa with Bound Particles, %)

  1. <40%
  2. <50%
  3. <=60%
A

2.

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10
Q

The Lower Reference Limits for Immunobead Test (Motile Spermatozoa with Bound Beads, %)

  1. <40%
  2. <50%
  3. <=50%
  4. <=60%
A

3.

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11
Q

The Makler Chamber is Disposable

  1. Yes
  2. No
A

2.

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12
Q

The Working Volume on counter chamber is10um between Lid and Base.

  1. Yes
  2. No
A

1.

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13
Q

if you count on average 20 sperm per row, this is 20 million per/ml

  1. Yes
  2. No
A

1.

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14
Q

If You Count on Average 20 Sperm Over the Whole Grid, The Concentration is 20 Million/ml

  1. Yes
  2. No
A

2.

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15
Q

The Makler Chamber Loses Its Efficiency with Sample of Low or High Concentration.

  1. Yes
  2. No
A

1.

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16
Q

Sperm Cannot Swim Normally in The Makler Volume

  1. Yes
  2. No
A

1,

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17
Q

Motility and Morphology Can Be Estimated on The Makler Chamber

  1. Yes
  2. No
A

1.

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18
Q

WHO (2010) NOT Recommends the Use of The Makler Chamber.

  1. Yes
  2. No
A

1.

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19
Q

Bubbles Will Interfere with The Counting Accuracy

  1. Yes
  2. No
A

1

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20
Q

the Makler is a valuable tool for IVF laboratories because of its easy and lack of fixatives needed.

  1. Yes
  2. No
A

1

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21
Q

The Grid Is 1 mm X 1 mm

  1. Yes
  2. No
A

1

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22
Q

sperm maybe immobilized for counting by placing in a 50-60ºc water bath for several minutes.

  1. Yes
  2. No
A

1

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23
Q

Each Makler chamber needs to be calibrated against a Haemocytometer estimate for accreditation purposes

  1. Yes
  2. No
A

1

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24
Q

what information should be recorded on a semen sample for diagnostic or therapeutic purposes.?

A

Unequivocal identification of the patient

Duration of sexual abstinence

Completeness of collection

Time at sample was produced

Transport temperature conditions

Current medication

Collection container

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25
Q

what information should be recorded on a semen sample for post vasectomy semen analysis?

A
  • Unequivocal (unambiguous) identification of the patient
  • Completeness of collection
  • Collection container
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26
Q

what is the minimum requirement for patient identifiers at collection

  1. One
  2. Two
  3. Three
  4. Four
  5. Five
A

3.

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27
Q

which of these identifiers are suitable for identification of a sample?

  1. Title
  2. First Name
  3. Middle Name
  4. Surname [LastName]
  5. Date of birth
  6. Place of birth
  7. Age
  8. Passport Number
  9. Mothers Maiden Name
  10. Partners First Name
  11. Partners Last Name
A

2, 4, 5, 8

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28
Q

Rejection of Samples are Rare but The Reference Cites Another Study Suggesting the Rate of Rejection of Samples is in the order of:

  1. 0.2%
  2. 0.5%
  3. 0.8%
  4. 1.2%
  5. 1.9%
A

2.

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29
Q

which of the following statements on sexual abstinence is true:

  1. Abstinence has no bearing on volume, concentration and motility
  2. Prolonged abstinence could increase seminal volume
  3. Prolonged abstinence could increase sperm concentration
  4. Prolonged abstinence could increase sperm motility
  5. Prolonged abstinence could increase the number of degenerating and dying sperm in the epididymis
  6. The recommended period of abstinence is 2-7 days
  7. A preferred duration is 3-4 days
  8. Ejaculation and sexual abstinence mean the same thing
  9. It’s OK to ask the partner when the last sexual activity occurred
  10. Samples that have a normal profile but exceed the abstinence period must be rejected
A

2, 3, 5, 6, 7

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30
Q

It is impossible to characterize a man’s semen quality from evaluation of a single semen sample.

  1. Yes
  2. No
A

1.

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31
Q

It is helpful to examine two or three samples to obtain baseline data

  1. Yes
  2. No
A

1

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32
Q

The Minimum Period of Abstinence Is?

A

2 days

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33
Q

The Maximum Period Of Abstinence Is?

A

7 days

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34
Q

The time between collection and the start of the investigation should not exceed..?

A

1 hour

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35
Q

Ordinary Latex Condom May affect…..?

A

Sperm Motility

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36
Q

Coitus Interruptus is Not a Reliable Means Of Semen Collection.

A

true

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37
Q

A Postcoital Test May Provide Some Information About Spermatozoa.

A

true

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38
Q

A High Percentage of Immotile and Non-Viable Sperm May Indicate..?

A

Epididymal Pathology

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39
Q

Eosin Y is a vital Dye

  1. Yes
  2. No
A

1

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40
Q

Nigrosine is a vital Dye Used to assess morphology

A

Nigrosin is not a vital Dye but Used Only To Improve Background

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41
Q

Using Eosin-Nigrosin, Red Or Pink Head Indicate the Sperm is Healthy

A

false

  • Using Eosin-Nigrosin, Clear Or Unstained Heads Indicate The Sperm is Healthy
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42
Q

WHO 2010 Recommends 2 Counts Of ……………. Sperm each

A

WHO 2010 Recommends 2 Counts Of 200 Sperm each

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43
Q

The total number of membrane intact sperm in the ejaculate is of biological significance

  1. Yes
  2. No
A

1

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44
Q

Some Commercial Dyes are hypotonic and when used may increase the number of….?

A

Some Commercial Dyes are hypotonic and when used may increase the number of non-viable sperm

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45
Q

After sperm staining, Clear sperm heads and a pink midpiece are considered healthy

  1. Yes
  2. No
A

1

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46
Q

The Lower Reference Limit for the percentage of membrane-intact sperm is …?

A

The Lower Reference Limit for the percentage of membrane-intact sperm is 58%

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47
Q

The HOS Test is an alternative to ………….Studies

A

The HOS Test is an alternative to Dye Exclusion Studies

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48
Q

HOS test Can be used for sperm selection for ICSI

A

true

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49
Q

the lower reference for the HOS test is different from the Eosin Dye test

A

false

the lower reference for the HOS test is similar to the eosin dye test

(58%)_

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50
Q

All sperms with swelling tails are considered………….

A

a live sperm

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51
Q

for therapeutic use, media diluted 1 to 1 with sterile water is ok

52
Q

in HOS sperm with no tail swelling are considered …………

53
Q

which of these conditions may use the HOS test to select sperm for ICSI

  1. Azoospermia
  2. Asthenospermia
  3. Immotile Cilla Syndrome
  4. Kartagener’s syndrome
  5. Primary ciliary dyskinesia (PCD)
  6. Teratozsoospermia
  7. Epididymal spermatozoa
A

3, 4, 5

  • Immotile Cilla Syndrome:
  • Kartagener’s syndrome
  • Primary ciliary dyskinesia (PCD)

Kartagener’s Syndrome , Immotile Cilia Syndrome, or a Primary Ciliary Dyskinesia (PCD), is a rare autosomal recessive genetic disorder caused by defect in the tiny hair like structure, the cilia lining the respiratory tract (upper and lower), sinuses, eustachian tubes, middle ear and fallopian tubes. strongly related with infertility

54
Q

Semen Samples Should be Mixed but a Vortex Mixer should be …….

A

A Vortex Mixer should be avoided

55
Q

Semen Samples Should be Mixed but Incomplete Mixing May Produce………………

A

Incomplete Mixing May Produce Large Variations Between Replicates

56
Q

Bubbles after Mixing the semen sample Indicate ……………..

A

Bubbles after Mixing the semen sample Indicate Excessive Mixing

57
Q

a chamber depth of less than 20um may influence ………

A

a chamber depth of less than 20um may influence motility

58
Q

A Chamber depth of greater than 50um may make ……………..

A

A Chamber depth of greater than 50um may make assessment problematic.

59
Q

Agglutination……………….

Aggregation…………..

A

Adherence of motile sperm to other motile sperm is called Agglutination 0,1,2,3

⇔

Adherence of immotile Sperm to Mucus or non-sperm Cells is Called Aggregation

if motile sperm adhere to immotile sperm ornon-sperm cell ⇒ non-specific Aggregation

60
Q

Agglutination Grades:

zero (0)………..

ONE……………….

TWO……….

THREE……..

A

Agglutination

  • Grade 0 = no adhesion (no)
  • Grade 1 = adhesion Greater Than 10% (Isolation)
  • Grade 2 = adhesion Greater Than 30% (Moderate)
  • Grade 3 = Greater Than 50% (larege)
61
Q

The Initial Microscopic Investigation of a semen analysis should contain an estimate of sperm agglutination and/or aggregation.

62
Q

a chamber depth of less than 20 um constrains the rotational ……. of spermatozoa

A

a chamber depth of less than 20 um constrains the rotational movement of spermatozoa

63
Q

If the chamber is too deep, it will be difficult to assess spermatozoa because …………

A

if the chamber is too deep, it will be difficult to assess spermatozoa

as they move in and out of focus.

64
Q

its OK, If the number of spermatozoa per visual field varies considerably,

A

If the number of spermatozoa per visual field varies considerably, the sample may not be homogeneous. in such cases, the semen sample should be mixed again thoroughly and a new slide prepared.

65
Q

Lack of Homogeneity may also result from……….

A

Abnormal Consistency

Abnormal Liquefaction

Aggregation Of Spermatozoa

Sperm Agglutination

66
Q

The adherence either of immotile spermatozoa to each other or of motile spermatozoa to mucus strands, non-sperm cells or debris is considered to be……….

A

Nonspecific Aggregation:

  • immotile spermatozoa⇔ each other
  • motile spermatozoa ⇔ Mucus strands, non-sperm cells or debris

Remember

Motile Sperm to sperm► Agglutination 0,1,2,3 (0,10,30,50%)

Immotile sperm to cells⇒ Aggregation

immotile sperm to each other⇔ non specific aggregation

motile sperm to cells► non specific aggregation

67
Q

Any motile spermatozoa that stick to each other by their heads, tails or midpieces should be noted. (agglutination)

68
Q

Motile spermatozoa stuck to cells or debris

or

Immotile spermatozoa stuck to each other considered …………

a. Aggregation
b. Agglutination

69
Q

The presence of Agglutination is not sufficient evidence to deduce an immunological cause of infertility, but is suggestive of the…………………………….

A

The presence of agglutination is not sufficient evidence to deduce an immunological cause of infertility but is suggestive of more diagnostics tests may required

the presence of anti-sperm antibodies and further testing is required

70
Q

True or false:

The assessment of sperm motility and concentration is independent of severe Agglutination

71
Q

The basis for assessing sperm morphology in the 5th edition (2010)………………..

A

The basis for assessing sperm morphology in the 5th edition (2010) was strict criteria

72
Q

Zona Pellucida bound sperm are similar to normal strict criteria based spermatozoa

73
Q

Normal sperm are defined largely by those in cervical mucus by ……..

A

Strict Criteria

74
Q

The 5th centile of a fertile morphology in population is ………

A

4%

4% is the 95% cutoff → a range of sperm morphology from a fertile population

75
Q

According to (Early Liberal Methodology) implies most sperm were …… ………while Strict Criteria implies most sperm are ………

A

According to (Early Liberal Methodology) implies most sperm were Normal while Strict Criteria implies most sperm are Abnormal

(The Introduction of Strict Criteria has in itself decreased the normal range.)

76
Q

Globospermia is a ………. condition

A

Globospermia is a genetic condition
-not aquired

77
Q

Non-Genetic Conditions that affect sperm morphology may be reversible with treatment

78
Q

The Prognosis for Short Tailed Syndrome is good with ICSI.

A

false

The Prognosis for Short Tailed Syndrome is Very Poor Even with ICSI

79
Q

Elongated sperm heads are thought to be ……………..

A

Elongated sperm heads are thought to be stress induced

80
Q

Cytoplasmic residues are associated with the production of…………….

A

Cytoplasmic residues are associated with the production of ROS

81
Q

In the 5th edition WHO manual, the Dimensions of a normal sperm head is:

a. 4.1um x 2.8um
b. 1.4um x 2.8um
c. 2.3um x 2.6 um

82
Q

The acrosome index is not predictive of ……..rates

A

The acrosome index is not predictive of IVF rates

83
Q

in this figure
Identify The Cell Type Of Cell # 1, 2, 3

A
  1. Macrophage
  2. Abnormal spermatozoon
  3. (dividing) spermatid
84
Q

in this figure
Identify the cell type of cell # 4,5, 6 and 7.

A
  1. Abnormal spermatozoon
  2. Spermatocyte
  3. Abnormal spermatozoon
  4. Abnormal spermatozoon
85
Q

in this figure
Identify the cell type of cell # 8, 9, 10, and 11

A
  1. Cytoplasm
  2. (dividing) spermatid
  3. Spermatocyte
  4. Degenerating spermatid
86
Q

An assessment of the degree of spermatogenesis found in a testicular biopsy…..

A

Johnson Score

87
Q

Johnson Score

1- ….

2- …..

3- …

4-5 ……

6-7 …..

8-10 …….

A

Johnson Score after testicular biopsy

1- No cells are present in a tubule

2- Only Sertoli Cells can be Identified

3- Only Spermatogonia

4-5: Spermatocytes

6-7: Spermatids

8-10: Spermatozoa

88
Q

There is a correlation between testicular size and the Johnson score.

89
Q

Sertoli cell-only syndrome (del Castillo) also called Germ cell aplasia
has a john score of……….

90
Q

Subnormal spermatogenesis has a Johnson score of:

91
Q

The Johnson Score for normal spermatogenesis is:

92
Q

Klinefelter’s Syndrome (XXY)

  1. Acquired
  2. Congenital
93
Q

Mumps Orchitis

  1. Congenital
  2. Acquired
A

2.

Mumps Orchitis

  • Pain and swelling of the testicle (orchitis) affects up to 1 in 3 males who get mumps after puberty.
  • The swelling is usually sudden and affects only one testicle. The testicle may also feel warm and tender.
94
Q

Cryptorchidism

  1. Congenital
  2. Acquired
A

1
-undescended testis

Cryptorchidism

One or both of the testes fail to descend from the abdomen into the scrotum.

95
Q

Anorchia

  1. Congenital
  2. Acquired
A

1.

Anorchia

Absence of both testes at birth.

96
Q

Epididymo-Orchitis

  1. Congenital
  2. Acquired
A

2.

  • An inflammation of the tube that stores and carries sperm, and/or of the testicle.
  • It is normally caused by infection, most often a sexually transmitted infection or a urinary tract infection.
  • Antibiotics are usually effective in clearing the infection
97
Q

Torsion (Maturation Arrest)

  1. Congenital
  2. Acquired
A

1.

Testicular torsion is a condition where an individual’s testicle rotates around the spermatic cord, blocking blood flow to the area.

It occurs most often in babies during the first year of life or adolescence.

Testicular torsion is an emergency that requires immediate medical attention, ideally within 6 hours. If a person waits longer to get treatment, they risk losing the testicle

98
Q

Sickle Cell Disease

  1. Congenital
  2. Acquired
A

1.

Sickle cell Disease (SCD)is an inherited disorder which causes red blood cells to become “sickled.” Because of this, these sickled red blood cells have a difficult time moving through the blood vessels and cause occlusion of the vasculature.

males with SCD, with rates as high as 91%. Low sperm density, low sperm counts, poor motility, and increased abnormal morphology occur more frequently in males with SCD than in controls

99
Q

Noonan’s Syndrome

  1. Congenital
  2. Acquired
A

1.

Noonan syndrome is a common genetic disorder characterized by facial anomalies, congenital heart defect, short stature, webbed neck, chest deformities

in male : undescended testes. Lead to defective in spermatogenesis​

100
Q

Myotonic Muscular Dystrophy.

  1. Congenital
  2. Acquired
A

1.
-Autosomal Dominant disorder
-Genetic mutation on chr -19
- cause rising of GnRH, LH, FSH and low T
-testicular atrophy
-infertility

Myotonic Muscular Dystrophy.

101
Q

What proportion of infertile men have azoospermia?

  1. 5%
  2. 8%
  3. 11%
  4. 13%
  5. 15%
102
Q

Obstructive Azo-(OA) and NOA are:

  1. Managed by the same medical and/or surgical options
  2. Managed by different medical and/or surgical options
103
Q

Diagnosis of OA or NOA include:…………

A
  • Thorough history taking
  • Physical examination
  • Possibly laboratory testing
  • Possibly genetic testing
104
Q

What Proportion of Azoospermia is Due To OA

  1. 30%
  2. 40%
  3. 50%
  4. 60%
  5. 70%
A

2.

40% of Azoospermia is due to : Obstructive Azoospermia (OA)

While

  • 60% Due to NOA
105
Q

what is true about OA

  1. OA is a consequence of a physical blockage
  2. OA may occur anywhere along the male excurrent ductal system
  3. FSH and LH are usually normal
  4. FSH is low but LH is normal
  5. Testes volume is increased due to the blockage
  6. Blockage can be unilateral or bilateral
A

1, 2, 3, and 6

106
Q

What is true about NOA

  1. may be caused by toxic exposures
  2. may be caused by abnormal testicular development
  3. may be caused by trauma
  4. may be due to primary testicular failure
  5. may be due to secondary testicular failure
  6. may be due to tertiary testicular failure
A

1, 2, 4, 5.

107
Q

Ambiguous (unclear) NOA May Present As:

  1. Increased FSH and normal volume testis
  2. Increased FSH and increased tests volume
  3. Normal FSH and small tests
  4. Normal FSH and normal testis volume
  5. Reduced FSH and small testis volume
  6. Reduced FSH and normal testis volume
108
Q

Acquired Causes of obstruction of the vas deferens may include:

  1. Vasectomy
  2. Iatrogeneic injury following inguinal hernia surgery
  3. Abstinence
  4. Vasography
A

1, 2 and 4

109
Q

Acquired causes of obstruction of the epididymus may include:

  1. vasal obstruction
  2. prolonged vasectomy
  3. epididymal rupture after excessive intratubal pressure
  4. scrotal trauma
  5. pelvic injury
  6. previous PESA or MESA surgery
  7. epididymal biopsy
  8. abstinence
A

1, 2, 3, 4, 5, 6and 7

110
Q

Congenital OA may result in

A

Congenita Unilateral Absence of Vas Difference (CUAVD) or (not and) ⇒ CBAVD

111
Q

OA may result from:

  1. _severe inflammation of the epididymis (epididymitis)
  2. severe inflammation of the prostate
  3. severe inflammation of the seminal vesicles
  4. upper genitourinary tract infection
  5. lower genito-urinary tract infection
A

1, 2, 3, and 5

112
Q

Ejaculatory Duct Obstruction (EDO) can result from

  1. Abstinence
  2. Trauma
  3. Infection
  4. Surgery
  5. Congenital Mullerian duct cysts
A

2, 3, 4 and 5

113
Q

Ejaculatory Duct Obstruction (EDO) is characterized by

  1. low semen volume
  2. clear, watery appearance
  3. low pH
  4. absent fructose
A

all are true

114
Q

Etiology of OA may be include:…….

A
  • Surgery
  • Infection
  • congenital abnormalities
  • possibly prior successful fertility
  • vasectomy
115
Q

Physical Examination may revel:

A
  • vasal gaps
  • site or prior vasectomy
  • the presence of granuloma
  • epididymal gaps or abnormalities
116
Q

The Presence of granuloma at a previous vasectomy site is an indication of………………….

A

successful microsurgical vasectomy reversal

Note:

Vasectomy reversal

is surgery to undo a vasectomy. During the procedure, a surgeon reconnects each tube (vas deferens) that carries sperm from a testicle into the semen.

After a successful vasectomy reversal, sperm are again present in the semen.

117
Q

Elevated FSH after vasectomy may suggest the need for ………………………………….

A

Elevated FSH after vasectomy may suggest the need for IVF/ICSI after reversal

118
Q

A husband may still remain fertile if unilateral obstruction is diagnosed

119
Q

A Partial Obstruction may result in:

  1. Oligospermia
  2. Oligoasthenoteratospermia
  3. polyspermia
  4. asthenozospermia
120
Q

Clients with Unilateral or Bilateral Absence of The Vas Deferens need to make these diagnosis:

A
  1. testing for CFTR
  2. testing and counselling of partner if CFTR is positive
  3. renal ultrasound if CUAVD to test for renal agenesis
121
Q

Positive Antisperm Antibodies and Vasa Obstruction Indicates:

  1. Active spermatogenesis
  2. testicular biopsy unnecessary prior to microsurgical reconstruction
122
Q

Clients with Unclear Etiology of Azoospermia may warrant a testicular biopsy with these parameters.

  1. normal testes volume
  2. Clear ejaculates
  3. normal vasa
  4. negative antisperm antibodies
  5. normal FSH levels
  6. decreased T
A

1, 2, 3, 4 and 5

Testicular Biopsy decision need:

  • normal testes volume
  • Clear ejaculates
  • normal vasa
  • negative antisperm antibodies
  • normal FSH levels
123
Q

Low Semen Volume, Clear Appearance, Low PH, Absent Fructose ⇒indicate……….

A

Ejaculatory duct obstruction

124
Q

Normal Semen Volume, FSH, LH and Testosterone indicate……..

A

Obstructive Azoospermia OA

125
Q

Decreased Semen Volume and Testosterone, Elevated FSH and LH.

A

Non-Obstructive Azoospermia-NOA

primary testicular failure

126
Q

Decreased Semen Volume, Testosterone, FSH and LH.

A

Non-Obstructive Azoospermia-NOA

hypogonadotrophic hypogonadism

127
Q

Sertoli cell hormones……………..

A

during fetal period, Sertoli cells secrete AMH for male development
at puberty Sertoli cells secrete ABP, and inhibin

Clinical Embryologist's exam samples. (22 decks)

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