Male infertility

Question 1

Reasons for male infertility

Answer 1

Problems with male reproductive system (30%)
Varicoceles
Infection 
Obstruction 
Endocrine problems

Question 2

Testicular varicocele

Answer 2

Abnormally dilated pampiniform plexus

Which is the venous network that drains blood from the testicles

Question 3

Varicocele responsible for what percentage of infertility?

Answer 3

40%

Question 4

How are varicoceles diagnosed?

Answer 4

Dubin system

Intraobserver variation in diagnosis of grade

Question 5

Cause of varicocele

Answer 5

Multi-factorial mechanisms by which dilated scrotal veins impair spermatogenesis

Question 6

Anatomical differences in venous drainage between the left and right internal spermatic vein

Answer 6

Account for predominance of left sided varicocele

Question 7

Progressive toxic effects of varicoceles

Answer 7

Elevated temperature and oxidative stress

Question 8

Increase temperature in the testicles

Answer 8

Decreases sperm count and sperm quality

Question 9

Mechanism of damage in varicocele

Answer 9

Unknown, presumed to be due to damage to DNA and proteins in the nucleus of spermatic tubule cells and Leydig cells

Question 10

Radiation causing infertility by Radiofrequency electromagnetic fields (RF-EMF)

Answer 10

Have negative effects on semen parameters

Question 11

RF-EMF affects..

Answer 11

Kinase role in cellular metabolism and produces genotoxicity, genomic instability and oxidative stress

Question 12

RF-EMF is omitted from..

Answer 12

Mobile phones, laptops and microwave ovens

Question 13

Specific absorption rate (SAR) absorbed by human tissue depends on..

Answer 13

Frequency, intensity, polarisation, duration of exposure and position of the device

Question 14

Radiation responsible for causing infertility due to..

Answer 14

Over production of ROS in exposed cells

Question 15

Desai et al., 2009

Answer 15

Concluded that RF-EMF exposure might induce DNA damage due to increase oxidative stess

Question 16

Desai et al., 2009

DNA damaged due to increase oxidative stress

Answer 16

May accelerate spermatoxoal cell death and promote testicular carcinogenesis

Question 17

Pandey et al 2017

Answer 17

Reported sig increase in abnormal cells- spermatogonia and decrease spermatids
Sig increase in DNA damage at 4hrs and 8 hrs exposure in male Swiss albino mice

Question 18

Post-testicular obstructive azoospermia

Answer 18

Sperm is produced normally inside the testicle but there is a blockage or obstruction in the reproductive tubing that is preventing sperm from flowing out

Question 19

Example of post-testicular obstructive azoospermia

Answer 19

Retrograde ejaculation

Question 20

Retrograde ejaculation

Answer 20

Is the abnormal backward flow of semen into the bladder with ejaculation

Question 21

What percentage of infertility is caused by RE?

Answer 21

0.3-2%

Jefferys et al 2012

Question 22

RE is associated with

Answer 22

Dysfunction of the internal urethral sphincter mechanism

Question 23

RE dysfunction caused by

Answer 23

Autonomic neuropathy or iatrogenic damage to sympathetic nerves or the bladder neck

Question 24

RE diagnosis

Answer 24

Examine post-orgasm or post-coital urine samples

Question 25

RE urine analysis

Answer 25

Sperm in urine | Vroege et al found fructose may also be found in urine analysis

Question 26

Treatment of varicocele

Answer 26

Varicocelectomy | Can restore normal scrotal temperature

Question 27

Limitation of varicoceletomy studies

Answer 27

Do not address factors that can affect scrotal temperature other than varicoceles e.g. external exposure to heat and daily postural changes

Question 28

Abdel-Meguid et al 2011 showed..

Answer 28

Using 145 participants that inguinal varicocele repair sig improved semen parameters

Question 29

Spontaneous pregnancy achieved by inguinal varicocele repair | Abdel-Meguid et al 2011

Answer 29

9%

Question 30

Varicocele repair is preferred method of treatment before..

Answer 30

TESE/ICSI in all azoospermic men who have clinically palpable varicoceles

Question 31

Treatment of radiation | Meena et al 2014

Answer 31

Proposed melatonin treatment to reverse effects of RF-EMF for sperm count, testosterone levels and DNA fragmentation

Question 32

Roychonduhury et al 2017 suggested for RF-EMF damage

Answer 32

Consume green tea | Decreases oxidative stress

Question 33

Treatment of RE

Answer 33

Sperm retrieved from epididymis or testis by TESE or PESA | Followed by IVF or intracytoplasmic sperm injection (ICIS)

Question 34

Abrahams 1975 suggested what treatment for RE

Answer 34

Bladder neck reconstruction | 2 patients went on to father children