B8.010 Prework 1: Evaluation of Male Infertility

Question 1

definition and incidence of infertility

Answer 1

inability to achieve pregnancy with times intercourse for at least 1 year
10-15% of married couples are affected

Question 2

sperm head

Answer 2

nucleus: takes DNA to egg
acrosome: contains enzymes that allow the sperm to enter the egg

Question 3

sperm tail

Answer 3

propels sperm

Question 4

steps of spermatogenesis

Answer 4

1. spermatogonial cell multiplication and proliferation at the base of the seminiferous tubules produce primary spermatocytes
2. primary spermatocytes undergo meiotic division to form secondary spermatocytes
3. a second meiotic division produces haploid round spermatids

Question 5

spermiogenesis

Answer 5

4th step of spermatogenesis where remodeling of nuclear and cytoplasmic components render spermatozoa

Question 6

steps required for male normal fertility

Answer 6

healthy sperm production
normal ejaculation
adequate sperm number and sperm morphology
normal sperm function: motility

Question 7

general alterations involved in male infertility

Answer 7

1. defective sperm production
2. reproductive tract obstruction
3. sexual disorders, erectile, and ejaculatory dysfunctions (delayed, premature, and retrograde ejaculations)
   * *great amount is idiopathic**

Question 8

relevant components of medical history to infertility diagnosis

Answer 8

sexual history, coital frequency and timing
duration of infertility and prior fertility
childhood illnesses and developmental history
systemic medical illnesses
prior surgeries
toxin/lifestyle exposures/habits
medications

Question 9

diagnostic testing for male infertility

Answer 9

sperm analysis, blood tests, imaging

Question 10

low volume of semen

Answer 10

test for obstructions or retrograde ejaculation

Question 11

no sperm

Answer 11

testicular biopsy

Question 12

sperm number, morphology, and function defects

Answer 12

hormonal tests

check for varicocele, hormones

Question 13

steps of semen analysis

Answer 13

1. confirm length of abstinence (2-5 days)
2. produce semen sample (on site preferred)
3. perform basic semen analysis, minimum of 2 samples should be analyzed

Question 14

normal volume of ejaculate

Answer 14

> 1.5 mL

Question 15

color of ejaculate

Answer 15

whitish, opalescent

Question 16

ejaculate liquefaction

Answer 16

complete within 30 min

Question 17

ejaculate pH

Answer 17

7.2-8.0
infection = basic pH
obstructive azoospermia = acidic pH

Question 18

normal total sperm #

Answer 18

> 39 million

Question 19

normal sperm concentration

Answer 19

> 15 mil per mL

Question 20

normal sperm vitality

Answer 20

> 75%

distinguish live/dead with cell dyes

Question 21

normal sperm morphology

Answer 21

> 4% normal

Question 22

normal total motile sperm

Answer 22

> 40 million

Question 23

normal total sperm motility

Answer 23

> 40%

Question 24

normal total progressive sperm motility

Answer 24

> 32%

Question 25

normal WBCs in sperm

Answer 25

<1 mil | more = chronic inflammation

Question 26

aspermia

Answer 26

no ejaculate

Question 27

hypospermia

Answer 27

low ejaculate volume

Question 28

azoospermia

Answer 28

no spermatozoa in ejaculate

Question 29

oligospermia

Answer 29

< 15 mil sperm/ ejaculate

Question 30

asthenozoospermia

Answer 30

low sperm motility

Question 31

teratospermia

Answer 31

low sperm motility

Question 32

CASA

Answer 32

computer sperm analysis for sperm motility | can measure total and different patterns of sperm motility in multiple spermatozoa simultaneously

Question 33

when to do an endocrine evaluation

Answer 33

if an abnormal semen analysis if impaired sexual function if other clinical findings of endocrinopathy if patient is taking testosterone or anabolics

Question 34

tests for male endocrine evaluation

Answer 34

FSH, LH, T, prolactin

Question 35

genetic testing for male infertility

Answer 35

karyotype Y chromosome microdeletion (AZF) cystic fibrosis testing klinefelter (XXY, hypogonadism)

Question 36

transrectal US

Answer 36

images prostate, seminal vesicles and vas deferens | rule out obstructive infertility

Question 37

scrotal US

Answer 37

for varicocele, epididymal abnormalities, undescended testis

Question 38

anti-sperm antibodies

Answer 38

presence indicates autoimmune infertility

Question 39

absent seminal fructose

Answer 39

indicates seminal vesicle issues, or duct obstruction

Question 40

sperm-zona binding test

Answer 40

hemizona assay | measures binding to isolated ZP and this is compared to normal donor sperm

Question 41

sperm penetration test

Answer 41

measured with hamster oocytes freed of ZP

Question 42

medications which can cause male infertility

Answer 42

``` T replacement therapy anabolic steroid use chemotherapy certain antifungal meds some ulcer drugs recreational drugs ```

Question 43

idiopathic male infertility

Answer 43

65+% of infertile males

Question 44

environmental causes of male infertility

Answer 44

industrial chemicals heavy metal exposures radiation or xrays overheating the testicles

Question 45

ejaculation issues

Answer 45

retrograde ejaculation caused by diabetes, spinal cord injuries, medications, and surgery of the bladder, prostate, or urethra

Question 46

genetic causes of male infertility

Answer 46

``` chromosomal defect/genetics klinefelters syndrome CF kallmanns kartageners ```

Question 47

other pathological causes of male infertility

Answer 47

``` infection: orchitis, epididymitis, STIs hormone imbalances DM hypothyroidism undescended testicles varicocele testis tumors antisperm antibodies ```

Question 48

what is a varicocele

Answer 48

dilation and tortuosity of the internal spermatic veins (pampiniform plexus) that drain the testis and are within the spermatic cord

Question 49

testicular venous drainage

Answer 49

veins of pampiniform plexus ascend and pass along the inguinal canal merge to form the testicular vein, which opens on the R into the IVC (at an acute angle) and on the L side into the L renal vein (at a right angle)

Question 50

development of varicocele

Answer 50

commonly develops during puberty affects 15% of males most are L sides, 1% right sides and 1% bilateral 40% of men with primary infertility

Question 51

presentation of varicocele

Answer 51

most asymptomatic, sometimes scrotal pain most common symptom is infertility "bag of worms"

Question 52

labs associated with varicocele

Answer 52

volume is at normal levels sperm count is reduced <15 mil sperm/ejaculate normal morphology is below 4% sperm motility is reduced no infection of the male reproductive tract

Question 53

pathophys of infertility in varicocele

Answer 53

associated infertility appears to be due to alteration of spermatogenesis and the function of Leydig cells, secondary to the increase in testis temperature, venous pressure, and hypoxia

Question 54

varicocele treatment

Answer 54

surgical hydrocelectomy offers the most definitive treatment

Question 55

indications for varicocele surgery

Answer 55

female partner has normal fertility or a reversible cause of infertility varicocele is palpated or corroborated by ultrasound male partner has one or more abnormal semen parameters

Question 56

varicocele surgery goals and outcomes

Answer 56

ligation of the internal spermatic veins with preservation of the lymphatics 70% of cases have improvement of the semen quality and 30-35% natural pregnancy rates

Question 57

complications of varicocele surgery

Answer 57

testicular hydrocele occlusion of internal spermatic lymphatic channel during vein ligation during varicocele surgery lack of drainage and fluid accumulation in scrotum

Question 58

treatment for obstructive, undescended testis, or varicocele causes of infertility

Answer 58

surgery

Question 59

treatment for absence of ductal system

Answer 59

sperm retrieval from testis or epididymis - IVF - ICSI

Question 60

low sperm quality but good numbers

Answer 60

intrauterine insemination