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Flashcards in Male Infertility Deck (24):
1

GnRH is produced by _______; GnRH then stimulates production of LH and FSH by _______; LH acts upon ______ resulting in ______, whereas FSH stimulates ______ within the ______ via ______

the hypothalamus; the anterior lobe of the pituitary gland; Leydig cells; production of testosterone; spermatogenesis; seminiferous tubules; Sertoli cells

2

spermatogenesis: mitosis is responsible for ______, whereas meiosis is involved in ______

replenishing immature germ cells; the maturation of germ cells

3

spermatogenesis begins at ______ with _______, occurs in _______

puberty; spermatogonia; seminiferous tubules

4

spermatogenesis produces ______ that undergo ______ (______, ______) to form mature ______

spermatids; spermiogenesis; loss of cytoplasmic contents; gain of acrosomal cap; spermatozoon

5

ploidy: spermatogonium, primary spermatocyte, secondary spermatocyte, spermatid, mature spermatozoon

spermatogonium: diploid
primary spermatocyte: diploid
secondary spermatocyte: haploid
spermatid: haploid
mature spermatozoon: haploid

6

spermatogenesis: ____ months
entire time course from immature germ cell to mature sperm ready for ejaculation: ____ months

2; 3

7

difference between emission and ejaculation

emission: release of seminal fluid from prostate and ejaculatory ducts in posterior urethra (sympathetic nervous system; hypogastric nerve)
ejaculation: transport of seminal fluid from the prostatic urethra into the anterior urethra and meatus (visceral and somatic nerves; pudendal nerve)

8

what is the classic pretesticular cause of infertility?

hypogonadotrophic hypogonadism (failure of GnRH and/or gonadotropin production, leading to lack of testosterone production and germ cell stimulation)

9

most common cause of testicular cause of infertility

varicocele (abnormal dilation of the pampiniform plexus of the internal spermatic veins, which typically occurs on the left side, although they may be bilateral)

10

male infertility: endocrine studies should include ______ to evaluate Leydig cell function, and ______ to evaluate Sertoli cell/germ cell function

total testosterone; FSH

11

how does varicocele lead to infertility?

it increases intratesticular temperature due to the loss of venous valvular function --> pooling of warm blood in testis --> altered spermatogenesis, Leydig cell dysfunction, and subsequent infertility

12

what is the criteria for male patients who should be offered karyotypic and genetic testing?

men with azoospermia or severe oligospermia (<2 million/mL)

13

2 major genetic alterations that have been associated with male infertility

Klinefelter's syndrome, Y chromosome deletions

14

Klinefelter's syndrome: clinical presentation, pathogenesis

classic triad: small firm testes, azoospermia, and gynecomastia
pathogenesis: 47 XXY

15

Y chromosome is responsible for ______ and ______

testis formation; spermatogenesis

16

dx: male with infertility, small firm testes, azoospermia, and gynecomastia

Klinefelter's syndrome

17

congenital bilateral absence of the vas deferens (CBAVD): genetic cause

mutation of the cystic fibrosis transmembrane receptor (CFTR) gene; combination of a cystic fibrosis mutation on one chromosome with a CF mutation or 5T variant on the other chromosome

18

if a patient has congenital bilateral absence of the vas deferens (CBAVD) without genetic deletion, what is the most likely etiology? what test is indicated?

insult to mesonephric (Wolffian duct); renal ultrasound

19

compare symptoms of obstructive vs. irritative lower urinary tract problems for males

obstructive: decreased force of stream, hesitancy, incomplete emptying, nocturia, straining
irritative: urgency, frequency, dysuria

20

BPH is characterized by ________. _____ is the major hormonal stimulus for this process.

proliferation of benign stromal and glandular elements; DHT

21

what is the most appropriate next step when you suspect prostate cancer in a patient?

trans-rectal ultrasound of the prostate with 12 core biopsies

22

dx: testicular tumor with Schiller-Duval bodies (resemvling primitive glomeruli), elevated AFP

yolk sac tumor

23

what testicular tumors can you rule out if there is elevated AFP?

pure seminomas or choriocarcinomas

24

ddx: testicular tumor, elevated hCG

choriocarcinoma, teratoma, embryonal carcinoma