WEEK 4:MALE FERTILITY AND SPERM VIABILITY

Question 1

What is oligozoospermia or oligospermia?

Answer 1

Low sperm count
fewer than 20 million/ml

Question 2

What is azoospermia?

Answer 2

Absence of measurable sperm cells
No spermatozoa in the ejaculate

Question 3

What is characterized by low sperm count,high slow moving sperms and high sperms with abnormal morphology?

Answer 3

Oligoasthenoteratozoospermia

Question 4

What is low sperm motility?

Answer 4

Asthenozoospermia
At least 50% should have progressive motility

Question 5

What is teratozoospermia?

Answer 5

Abnormal morphology of sperms
Normal morphology should be equal to or greater than 14%

Question 6

What is leukospermia or leukocytospermia?

Answer 6

Excessive amount of leukocytes in seminal fluid
Should be less than 1milion /ml

Question 7

What is infertility?

Answer 7

The inability of a sexually active couple who are not on contraceptives to achieve a pregnancy in one year

Question 8

State the two types of infertility and define them

Answer 8

Primary inferility: one has never got pregnant or made a woman pregnant
Secondary infertility: At least once got pregnant or got a woman pregnant

Question 9

Describe the hypothalamus -pituitary-testicular axis

Answer 9

It describes the 3 hierarchy of regulating sperm production
Hormones involved: Gonadotropin Releasing Hormone (hypothalamus), FSH and LH (anterior pituitary gland), inhibin ( Sertoli cells) and testosterone (Leylig cells)

Question 10

State the 3 main classification of the etiology of male infertility

Answer 10

• Pre-testicular: hormonal problem, hypothalamic disease, pituitary disease, pituitary insufficiency(tumors, radiation,surgery)

*Testicular:
CONGENITAL: Undescended testis ( ryptorchidism),Genetic , Y chromosome, microdeletions, Noonan Syndrome

AQUIRED:chemotherapy,varicocele, radiation to the testicles, testicular tumors, systemic failure, idiopathic:a disease of unknown cause.

• Post testicular: mainly obstruction
  ACQUIRED: Vasectomy, infection (chlamydia, gonorrhoea) , latrogenic vas injury
  CONGENITAL: Cystic fibrosis, young’s syndrome, Congenital absence of vas deferens (CAVD)

Question 11

What is varicocele?
What type of etiology of male infertility is it?

Answer 11

Enlarged veins in the scrotum
Testicular

Question 12

State other causes of infertility

Answer 12

Infection in the genital tract
Increased scrotal temperature
Oligoasthenoteratozoospermia (leading cause)
Endocrine disturbances
Genetic abnormalities
Immunological factors
Urogenital abnormalities (acquired and con
Celiac disease.Celiac disease is a digestive disorder caused by sensitivity to a protein found in wheat called gluten. The condition may contribute to male infertility. Fertility may improve after adopting a gluten-free diet.

Question 13

List the prognostic factors of male infertility

Answer 13

Duration of infertility
Fertility of the female partner
Age
Results from semen analysis

Question 14

When is the peak fertility age in both sexes?

Answer 14

24

Question 15

State how history taking issued to evaluate male infertility.

Answer 15

MEDICAL HISTORY: Diabetes mellitus, cancer, infection, cystic fibrosis,
SURGICAL HISTORY:cryptochidism, hermia repair, testicular trauma,
FERTILITY HISTORY: Previous pregnancies, duration of infertility, previous infertility treatments

SEXUAL HISTORY: erection or ejaculation problems, frequency of intercourse, use of lubricants

MEDICATION HISTORY: Chemotherapy, cimetidine, A-blockers, spironolactone, antidepressants, amiodarone, sulfasalazine, colchicine, nitrofurantoin, phenothiazines, methotrexate

SOCIAL HISTORY: Alcohol, smoking, anabolic steroids, recreational drugs, exposure to ionising radiation, chronic heat exposure, aniline dyes, pesticides, lead exposure

Question 16

State how physical examination is used to evaluate male infertility

Answer 16

– habitus, gynecomastia: increase in breast gland in men and boys caused by imbalances of the of testosterone and estrogen hormone
– sexual development
– testicular volume (5x3 cm)
– epididymis, vas, prostate by palpation
– check for varicocele
– hypospadias: a birth defect in boys where the opening of the urethra (the tube that carries urine from the bladder to the outside of the body) is not located at the tip of the penis.
-Inguinal area
-penile anatomy
-scrotum
-testes
-

GENERAL EXAMINATION
*BMI
*Weight
*blood pressure
*gynaecomastia
*distribution and chickness of body hair
*Examination of varicocele in standing position
*Palpation of vas id mandary
*DRE
*Signs andof androgen defeciency

EXAMINATION OF EXTERNAL GENITALIA
STAGE II:Penile length: above 3.5
STAGE III:Scrotal skin: pigment with rugosity
STAGE V:Testicular volume- normal above 15ml
STAGE I:Tanner stage -pubic hair tanner 5

Question 17

Describe the seminal fluid analysis used in evaluating male infertility

Answer 17

*At least two samples preferably taken at
least two or three weeks apart.

*Collection method: After a defined period of abstinence of 2-3 days.

*Semen may be collected in a clean container by masturbation or via intercourse using silastic condom that does not contain spermicidal agents.

*Sample should be examined within an hour of collection.
If abnormal, repeat it after 4 weeks.

Question 18

State the normal range for the following aspects of seminal fluid analysis
Volume
pH
Sperm concentration :
Total number of sperms
Motility : movement speed
Morphology : sructure
Viability: the percentage of live sperm found in a semen sample.
Leukocytes
Immunobead test : is a test for antisperm antibodies bound to sperms
MAR test (mixed antiglobulin Reaction): also tests for antibodies

Answer 18

Volume: ≥ 2mL
pH: 7-8
Sperm concentration ≥20million per mL
Total number of sperms ≥40million/ ejaculate
Motility :≥50%with progressive motility,25% rapid motility
Morphology ≥14% normal
Viability :&raquo_space;50% spermatozoa
Leukocytes ≤1million per mL
Immunobead test: <50% spermatozoa with adherent particles
MAR test :<50% spermatozoa with adherent particles

Question 19

What is the difference between sperm concentration and sperm count?

Answer 19

Sperm concentration is the number of sperm in one milliliter of semen. Sperm count is the total number of sperm in a sample (one ejaculate), which can be calculated by multiplying sperm concentration by semen volume.

Question 20

What is the purpose of hormone testing in evaluating male infertility?

Answer 20

*To test if the man has enough testosterone and FSH
Usually do if sperm concentration is less than 10 million per mL
* Tests if the pituitary- testis axis is functioning

Question 21

What could be the reason for low volume?

Answer 21

*Retrograde ejaculation: occurs when semen enters the bladder instead of emerging through the penis during orgasm.

*Ejaculatory duct obstruction

*Seminal vesicle agenesis: Congenital absence of one or both seminal vesicles

Question 22

Outline the components of semen evaluation

Answer 22

Sperm count
Sperm motility
Sperm morphology
Sperm Vialibility
Sperm DNA fragmentation

Question 23

Describe how genetic testing and counseling is used to evaluate male infertility

Answer 23

*usually used in patients with azoospermia and severe oligozoospermia
*Check for karyotype abnormalities
*including Klinefelter syndrome (47,XXY), Turner syndrome (45X or mosaic), and fragile X syndrome

Question 24

Scrotal ultrasound and transrectal ultrasound use in evaluating male infertility

Answer 24

Scrotal ultrasound:screen for varicocele
Transrectal ultrasound: screen for ejaculatory duct obstruction

Question 25

What is sterility?

Answer 25

Total inability to produce a pregnancy
Inability to conceive

Question 26

State the risk factors of infertility

Answer 26

*obesity
* Alcohol abuse
*Type 2 diabetes mellitus
*Injury on the testicles
Medical history: STI, prostatitis, medication use (i.e., β-blockers, calcium channel blocker, antiulcer medication), endocrinopathy, cancer

Surgical history: orchiopexy, hernia repair, vasectomy with/without reversal

Social: smoking, alcohol/substance abuse, anabolic steroids, environmental exposures, occupations leading to increased scrotal temperature (frequent use of saunas, hot tubs, or tight underwear), prescription drugs that impair male potency

Question 27

Define the following terms
Hypospadias
Cryptorchidism
Gynecomastia

Answer 27

*where the urethra does not open at its normal area in the tip of the penis
* Undescended testis
* Abnormal enlargement of breast gland in men and boys

Question 28

What are male sex hormone called?

Answer 28

Androgens

Question 29

How long does spermatogenesis take?

Answer 29

74 days from spermatocyte stage

Question 30

Why do sperms 12-21 days to travel through length of the epididymis?

Answer 30

To give them time to mature and be able to gain the ability to propel themselves

Question 31

What is the purpose of prostatic secretion?

Answer 31

*it provides a medium for sperm transport
*contains nutrients that nourish the sperm

Question 32

What is the difference between congenital and acquired causes?

Answer 32

A congenital disorder is a medical condition that is present at the time of birth. The acquired diseases are acquired during the lifetime of an individual and also are not present from birth.

Question 33

What is orichidometer?

Answer 33

a device used to measure testicle size and track sexual development in boys