Male reproductive tract

Question 1

For conception to occur:

Answer 1

spermatogenesis must be normal

seminal accessory glands must produce seminal fluids

Ducts for sperm transport must be unobstructed

Ejaculation must occur

Spermatozoa must be able to travel to the uterine tubes

Spermatozoa must be capable of functional changes allowing them to fuse with the oocyte

Question 2

infertility =

Answer 2

Inability of a male and female to achieve pregnancy despite unprotected intercourse for a period of more than 12 months

~15% of all couples are infertile = it’s estimated to be 50/50

Question 3

Male infertility =

Answer 3

Pretesticular

Testicular

Post-Testicular

Question 4

Pretesticular Male infertility =

Answer 4

Originate in either the hypothalamus (GnRH) or the pituitary (LH and FSH)

Endocrinopathies most often caused by mutations in genes involved in biosynthesis of hormones, growth factors or receptors

Hormones deficiencies result in loss of intratesticular testosterone production = cessation of spermatogenesis

Question 5

Hypogonadotropic hypogonadism =

Answer 5

Uncommon cause, however, efficiently treated with hormone replacement therapy

Reduced GnRH production = deficient androgen secretion = deficient spermatogenesis

Question 6

Pretesticular syndromes:

Answer 6

Prader-Willi Syndrome

Genetic Mutations of X-linked Dax1 or PC1 gene

Biologically inactive LH or FSH due to genetic mutations

Pituitary Mass Lesions

Anabolic steroid abuse

Question 7

Prader-Willi Syndrome =

Answer 7

Mutations or deletion of a specific locus within paternal chromosome 15 or by maternal uniparental disomy of this locus

Symptoms: obesity, mild or moderate mental retardation, infantile hypotonia, and hypogonadotropic hypogonadism

Question 8

Anabolic steroid abuse =

Answer 8

Negative feedback at the level of the hypothalamus and pituitary

Reduction in LH and FSH release

Disables endogenous testosterone production and spermatogenesis

Question 9

Testicular Causes

Answer 9

Varicoceles: abnormally dilated scrotal veins

Klinefelter Syndrome

Cryptorchidism

Epididymitis

Torsion of the spermatic cord

Question 10

Varicoceles =

Answer 10

are considered the most common cause of subfertility in men

Present in about 15% of male normal male population = ~40% of men presenting with infertility

Question 11

Varioceles associated with impaired spermatogenesis by one of several mechanisms:

Answer 11

Increased scrotal temperature

Alterations in testicular blood flow

Reduced testicular size

Over production of adrenal steroid metabolites

Increased oxidative stress

Alterations in the hypothalamic-pituitary-gonadal axis

Question 12

Klinefelter Syndrome =

Answer 12

Most common chromosomal disorde = severely oligospermic (low sperm count)

Increased serum FSH, normal or increased serum estradiol, and normal to low testosterone

Question 13

Cryptorchidism:

Answer 13

testicular descent does not proceed normally during development = testis remains in the abdominal cavity or groin

3% of full-term newborns, 1-2% by age 6 months

85% of all cases are unilateral

Impaired spermatogenesis in 50-575 of unilateral cases

Question 14

Exposure to toxins

Answer 14

numerous substances and occupations have been suspected, inadequate study sample size and confounding factors make a casual relationship difficult to confirm

Question 15

Cigarette Smoking:

Answer 15

associated with a reduction in sperm count and motility and increase in abnormal forms

Lower sperm concentration suspected = spermatogenic outcome uncertain

Question 16

Testicular Temperature:

Answer 16

approximately 2 C below core body temperature = spermatogenesis dependent upon a cooler temperature

Question 17

Chemotherapy and radiation:

Answer 17

potent gonadotoxins due to damage to germinal epithelium = spermatogenesis may not recover

Recommended that patients bank their semen before chemo and radiation

Question 18

Epididymitis:

Answer 18

Can lead to scarring of the tubules and obstruction of sperm flow

Question 19

Torsion of the spermatic cord:

Answer 19

interruption of testicular blood flow 4-6 hours may cause irreparable damage

Question 20

Testicular trauma:

Answer 20

can lead to testicular edema, hematoma, hematocele, hydrocele, torsion, fracture, or rupture

Question 21

Post-Testicular Causes:

Answer 21

Ductal Obstruction

Congenital

Acquired

Disorders of ejaculation

Idiopathic Oligospermia

Question 22

Ductal Obstruction:

Answer 22

Ejaculatory duct = results in low-volume, acidic, fructose-negative ejaculate

Vasa or epididymides = normal-volume, alkaline, fructose-positive ejaculate

Question 23

Congenital Post-testicular Male infertility:

Answer 23

stenosis of the ejaculatory ducts, utriculor or mullerian and wolffian duct

Question 24

Acquired Post-testicular Male infertility:

Answer 24

vasa obstruction due to vasectomy, epididymal obstruction due to epididymitis

Question 25

Disorders of ejaculation:

Answer 25

Premature ejaculation

Anejaculation

Retrograde

Question 26

Premature ejaculation:

Answer 26

inability to control ejaculation for satisfactory length of time during intercourse = seldom leads to infertility

Question 27

Anejaculation:

Answer 27

complete absence of seminal emission into the posterior urethra

Spinal cord injury is the most common neurologic cause of anejaculation

Always connected with central or peripheral nervous system dysfunction

Question 28

Retrograde:

Answer 28

0.3-2% of cases of male infertility = dysfunction in bladder neck closure in a total or partial absence of antegrade ejaculation = ejaculation flows into the bladder

Diagnosed with absent or intermittent emission of ejaculation with cloudy urine

Question 29

Idiopathic Oligospermia:

Answer 29

Pathophysiology of spermatogenic failure in a majority of infertile men is unknown

Question 30

Benign prostatic hyperplasia =

Answer 30

Nonmalignant growth of the prostate stroma and epithelial glands = cause enlargement of the prostate gland

Growth occurs slowly over decades = prostate gland can eventually reach up to 10 times the normal adult prostate size

Common age related disorder = most men are asymptomatic

Signs and symptoms occur in 1/3 of men greater than 65 years of age

Question 31

Clinical Manifestations of benign prostatic hyperplasia:

Answer 31

Prostatic enlargement causes acute or chronic urinary retention

Acute urinary retention

Chronic urinary retention

Question 32

Acute urinary retention =

Answer 32

painful dilation of the bladder and inability to void

Often precipitated by swelling of the prostate

Question 33

Chronic urinary retention =

Answer 33

obstructive and irritative voiding symptoms

Patient presents with marked urinary retention with few other symptoms

Question 34

Irritative Benign prostatic hyperplasia Symptoms:

Answer 34

occur as a consequence of bladder hypertrophy and dysfunction and include urinary frequency, nocturia, and urgency

Question 35

Obstructive Benign prostatic hyperplasia Symptoms:

Answer 35

result from distortion and narrowing of the bladder neck and prostatic urethra, leading to incomplete emptying of the bladder

Difficulty initiating urination, decreased force and caliber of the urinary stream, intermittency of the urinary stream, urinary hesitancy, and dribbling

Question 36

Complications of chronic bladder dilation include:

Answer 36

Hypertrophy of the bladder wall musculature and development of diverticula, urinary tract infection of the stagnant bladder urine, hematuria, chronic kidney disease

Most troublesome symptoms = inability to urinate on command

Treated with intermittent self-catheterization to empty the bladder every 4 hours