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Urology > Infertility > Flashcards

Infertility Flashcards

(73 cards)

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1
Q

Infertility def

A

Couples inability to conceive after 1yr of intercourse w/out contraceptives

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2
Q

Infertility def

A

Couples inability to conceive after 1yr of intercourse w/out contraceptives

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3
Q

Male infertility causes

A

MC-idiopathic
Hypothalamic-pituitary DZ
Testicular Dz (primary teste issues)
Post-testicular defects D/O of sperm transport

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4
Q

Oligozoospermia def

A

<15mil/mL sperm

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5
Q

Azoospermia def

A

Complete abscence of sperm

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6
Q

Spermatogenesis takes

A

74d

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7
Q

Infertility Spermatogenesis consideration during W/U

A

Review past 3 months for gonadotoxic exposure/insults

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8
Q

Infertility testicular insult hx

A

Torsions
Cryptochidism
Trauma

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9
Q

Infertility infectious insult hx?

A

Mumps orchitis
Epididymitis
STIs

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10
Q

Infertility Environmental insult hx?

A

Excess heat
Chemo/rad
Pesticides

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11
Q

Infertility insults spermatogenesis due Rx

A 
Testosterone
Finasteride
Cimetidine
SSRI’s
Spironolactone
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12
Q

Infertility insults motility due Rx

A

Sulfasalazine

Nitrofurantoin

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13
Q

Infertility retrograde ejaculation due Rx

A

Tamsulosin

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14
Q

Infertility lowered FSH due Rx

A

Phenytoin

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15
Q

Other common Rx affecting fertility

A

ETOH
tobacco
Bud

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16
Q

Infertility due to varicocele affects?

A

Motility/morphology

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17
Q

Infertility due to obesity, CV, thyroid, liver disease affects?

A

Decreased spermatogenesis

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18
Q

Infertility due to DM affects?

A

Decreased spermatogenesis
Retrograde ejaculation
Anejaculation

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19
Q

Infertility due to pituitary tumor affects?

A

Loss of libido
+
HA, visual disrupted, galactorrhea

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20
Q

Infertility Hx basic thoughts

A 
Sexual fx
Freq/timing intercourse
Lubricant use
Previous fertility success
Previous infertility w/u
Age >35 partner age
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21
Q

Infertility PE

A

hypogonadism features
Penis/scrotum inspection
Prostate examination

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22
Q

hypogonadism features

A

Underdeveloped sexual characteristics
DEC male hair patterns
Body habitus/obesity
Gynecomastia

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23
Q

Scrotal inspection includes

A

Testicular size
Check varicocele
Palpate vas deferens/epididymis

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24
Q

How to check varicocele

A

Standing and w/ valsalva

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25
Infertility labs
``` Semen analysis +- (endocrine) Testosterone FSH/LH PRL Estradiol Genetic testing (10mil) -CH-y microdeletions ```
26
Analyze semen timeframe
2-3d after ejaculatory abstinence | W/in 1hr of collection
27
Semen analysis criteria
Volume Conc Motility Morphology
28
Nl semen volume
1.5-5.0mL
29
Low semen volume causes?
Retrograde ejaculation Duct obstruction Congenital bilateral vasa deferentia abscence Androgen insufficiency
30
Nl sperm motility?
>45% motile
31
Nl sperm motility?
>45% motile
32
Male infertility causes
MC-idiopathic Hypothalamic-pituitary DZ Testicular Dz (primary teste issues) Post-testicular defects D/O of sperm transport
33
Oligozoospermia def
<15mil/mL sperm
34
Azoospermia def
Complete abscence of sperm
35
Low sperm concentration reflex
<15mil Repeat semen analysis >ABNL -LH, FSH, PRL testosterone
36
Infertility Spermatogenesis consideration during W/U
Review past 3 months for gonadotoxic exposure/insults
37
Infertility testicular insult hx
Torsions Cryptochidism Trauma
38
Infertility infectious insult hx?
Mumps orchitis Epididymitis STIs
39
Infertility Environmental insult hx?
Excess heat Chemo/rad Pesticides
40
Infertility insults spermatogenesis due Rx
``` Testosterone Finasteride Cimetidine SSRI’s Spironolactone ```
41
Infertility insults motility due Rx
Sulfasalazine | Nitrofurantoin
42
Infertility retrograde ejaculation due Rx
Tamsulosin
43
Infertility lowered FSH due Rx
Phenytoin
44
Other common Rx affecting fertility
ETOH tobacco Bud
45
Infertility due to varicocele affects?
Motility/morphology
46
Infertility due to obesity, CV, thyroid, liver disease affects?
Decreased spermatogenesis
47
Infertility due to DM affects?
Decreased spermatogenesis Retrograde ejaculation Anejaculation
48
Infertility due to pituitary tumor affects?
Loss of libido + HA, visual disrupted, galactorrhea
49
Infertility Hx basic thoughts
``` Sexual fx Freq/timing intercourse Lubricant use Previous fertility success Previous infertility w/u Age >35 partner age ```
50
Infertility PE
hypogonadism features Penis/scrotum inspection Prostate examination
51
hypogonadism features
Underdeveloped sexual characteristics DEC male hair patterns Body habitus/obesity Gynecomastia
52
Scrotal inspection includes
Testicular size Check varicocele Palpate vas deferens/epididymis
53
How to check varicocele
Standing and w/ valsalva
54
Infertility labs
``` Semen analysis +- (endocrine) Testosterone FSH/LH PRL Estradiol Genetic testing (10mil) -CH-y microdeletions ```
55
Analyze semen timeframe
2-3d after ejaculatory abstinence | W/in 1hr of collection
56
Semen analysis criteria
Volume Conc Motility Morphology
57
Nl semen volume
1.5-5.0mL
58
Low semen volume causes?
Retrograde ejaculation Duct obstruction Congenital bilateral vasa deferentia abscence Androgen insufficiency
59
Nl sperm conc?
>15mil
60
Nl sperm motility?
>45% motile
61
Reasons for ABNL motility
``` Varicocele Antisperm antibodies Infection Flagella ABNLs Partial duct obstruct ```
62
Reasons for ABNL Sperm morphology
varicocele Infection Gonadotoxins Tob smoke
63
For dx ensure semen analysis is conducted how many times?
2 samples on 2 seperate visits At least 60d apart
64
Low ejaculate volume reflex
<1.5mL Obtain post-ejaculation urine samples -centrifuge, R/O retrograde ejaculation
65
Low sperm concentration reflex
<15mil Repeat semen analysis >ABNL -LH, FSH, PRL testosterone
66
Semen analysis W/U bottom line
1st test > confirm w/ 2nd =same result > done 2nd test different > 3rd Req 2 like results for confirmation
67
Special infertility test labs
-Low motility > test sperm viability and autoantibodies -Round cells >1mil > stain for leukocyte esterase/peroxidase staining Testicular Bx
68
Infertility imaging
Scrotal U/S TRUS (transrectal U/S) MRI
69
Purpose of Scrotal U/S for infertility
Chacterize testes | Detects subclinical varicocele
70
Purpose of Transrectal U/S for infertility
Eval prostate/seminal vesicles | Low volume w/out retrograde evidence
71
Purpose of MRI for infertility
Eval pituitary if Increased PRL or hypogonadotropic hypogonadism - Eval pelvis/scrotum for cryptorchidism
72
Infertility TXT
``` ID and TXT UC -refer endocrinology/urology PRN Pt education - timing/habits Stop offending Rx Avoid gonado toxin exposure Ref for fertility specialist (ARTs) Adoption education ```
73
Clinical infertility Pearl
25% of cases unresolved/unexplained after W/U

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