2022 - Lesson 33 Male Infertility Flashcards

1
Q

When is sperm DNA fragmentation analysis recommended in male infertility workup?

A

Sperm DNA fragmentation analysis is used for specific indications such as recurrent pregnancy loss.

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2
Q

What are Selective Estrogen Receptor Modulators (SERMs), and how are they used in male infertility?

A

SERMs like Clomiphene are recommended for idiopathic oligozoospermia.

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3
Q

What is the stance on antioxidant therapy in the management of male factor infertility?

A

Evidence supports the use of antioxidant supplements in specific cases, with caution against overuse due to a lack of robust evidence.

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4
Q

What are the considerations for testosterone therapy in male infertility with low testosterone?

A

Testosterone therapy is considered for patients with low testosterone, weighing the risks and benefits.

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5
Q

What is the guideline’s stance on genetic testing in male infertility workup?

A

Genetic testing, including sperm DNA fragmentation analysis, chromosomal abnormalities, and Y-chromosome microdeletions, is recommended for specific indications.

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6
Q

What hormonal treatments are suggested for abnormal semen parameters in male infertility?

A

The guideline recommends testosterone therapy for patients with low testosterone and Selective Estrogen Receptor Modulators (SERMs) like Clomiphene for idiopathic oligozoospermia.

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7
Q

What does the document define as the timing for the initial evaluation of infertility?

A

: Infertility is defined as the failure to conceive after 1 year of unprotected sexual intercourse, and couples should be evaluated by a fertility specialist at that point.

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8
Q

What does the document recommend for men in couples experiencing recurrent pregnancy loss (RPL)?

A

The document recommends that men in couples with RPL be evaluated with a karyotype and SDF analysis.

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9
Q

What does the 2020 guideline recommend regarding the initial evaluation of infertility in couples?

A

The 2020 guideline recommends concurrent assessment of both male and female partners as part of the initial infertility evaluation.

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10
Q

What are the potential consequences of advanced paternal age in relation to fertility and offspring health?

A

Advanced paternal age can contribute to genetic mutations, chromosomal abnormalities, worsened semen parameters, an increased rate of miscarriage, and greater morbidity in offspring, including associations with certain malignancies and neuropsychiatric conditions.

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11
Q

What is the recommended evaluation timing for couples where the female partner is 35 or older?

A

The recommendation is for couples to be evaluated after 6 months of failure to conceive if the female partner is 35 or older.

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12
Q

Age-related decline in ovarian reserve and oocyte quality leads to the recommendation for earlier evaluation.

A

Earlier evaluation is recommended due to age-related decline in ovarian reserve and oocyte quality.

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13
Q

What challenges are associated with women aged 35 or older in terms of fertility?

A

There is a decline in fertility potential and an increased time to conception in women of this age.

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14
Q

What is new about the 6-month time interval for evaluation in the AUA/ASRM guideline?

A

The specific time interval of 6 months for evaluation had not been previously explicitly stated in the AUA/ASRM guideline.

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15
Q

What does the 2020 guideline recommend regarding the concurrent assessment of male and female partners?

A

The 2020 guideline recommends that male and female partners undergo concurrent assessment as part of the initial infertility evaluation, focusing on abnormal semen parameters or concerns for male factor infertility.

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16
Q

When is male evaluation specifically recommended in infertility cases?

A

Male evaluation is recommended for couples with failed assisted reproductive technology (ART) cycles or recurrent pregnancy losses (RPLs), defined as 2 or more losses.

17
Q

Why is emphasizing male partner evaluation in infertility cases important?

A

Emphasizing male partner evaluation is important because it is often delayed or altogether overlooked.

18
Q

What did a 2019 study by Samplaski et al reveal about male infertility evaluation?

A

The study revealed that only 4.8% of men seen at centers specializing in male infertility had previously undergone an evaluation by a reproductive urologist.

19
Q

What disparity does the text highlight between couples treated with ART and men evaluated by a reproductive urologist?

A

Despite 17% of couples being treated with ART, only 4.8% of men were evaluated by a reproductive urologist.

20
Q

Who are the main referring parties for men in male infertility evaluations?

A

Approximately 60% of men were referred by reproductive endocrinologists, and 20% by primary care providers.

21
Q

Why is a definitive recommendation for the timely evaluation of the male partner necessary?

A

It is necessary to effect improvements in clinical practice.

22
Q

What specific changes are highlighted in the 2020 guideline regarding male infertility?

A

The 2020 guideline emphasizes the association of medical comorbidities with male infertility and specifically discusses advanced paternal age.

23
Q

How is advanced paternal age defined in the context of male infertility?

A

Advanced paternal age is defined as a male partner aged 40 years or older.

24
Q

What genetic factors are associated with advanced paternal age?

A

Advanced paternal age contributes to more de novo genetic mutations and chromosomal abnormalities.

25
Q

How does advanced paternal age affect semen parameters?

A

Advanced paternal age leads to worsened semen parameters.

26
Q

What are the broader health implications of advanced paternal age on offspring?

A

It is associated with an increased rate of miscarriage, greater offspring morbidity, and likely associations with some childhood malignancies, rare musculoskeletal syndromes, and neuropsychiatric conditions such as schizophrenia and autism spectrum disorders.

27
Q

What are the primary considerations in the evaluation of male infertility, leading to the discussion of genetic testing?

A

Physical examination and semen analysis are paramount, and based on these, hormonal evaluation may be warranted as part of the fertility evaluation.

28
Q

For which conditions is genetic testing advised?

A

For which conditions is genetic testing advised?

29
Q

When is testing for Y chromosome microdeletions recommended?

A

In specific clinical scenarios, including nonobstructive azoospermia and severe oligospermia.

30
Q

When is CFTR mutation analysis recommended?

A

For men with congenital bilateral absence of the vas deferens (CBAVD).