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Male Infertility Flashcards

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1
Q

what chromosomes are in a sperm

A

22 + x or Y

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2
Q

what chromosomes are in an oocyte

A

22 + x

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3
Q

how many chromosomes should you have

A

23 pairs = 46 in total

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4
Q

which chromosome has the sex determining region and what does it cause

A

Y

development of testis from the bipotential gonad

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5
Q

what do fetal testes secrete

A

testosterone and AMH (cause the development of the male internal genital tract)

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6
Q

what are the two primitive genital tracts

A

wolffian (male)

mullerian (female)

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7
Q

what happens the primitive genital ducts in males

A

wolffian ducts form epididymis, vas deferens, seminal vesicles
mullerian degenerates

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8
Q

what happens the primitive genital ducts in females

A

wolffian degenerates

mullerian forms uterus, fallopian tubes, cervix and upper 1/3rd of vagina

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9
Q

what happens to primordial germ cells during week 5-6

A

migrate to gonadal ridge

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10
Q

when do testis start to develop

A

week 7 onwards

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11
Q

what do leydig cells secrete

A

testosterone (converted to DHT)

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12
Q

what hormones do sertoli cells secrete

A

mullerian inhibiting factor

inhibin and activin (regulate FSH secretion)

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13
Q

what stimulates the formation of male external genitalia

A

dihydrotestosterone

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14
Q

when do external genitalia start to differentiate

A

week 9, able to recognise on scan at 16 weeks

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15
Q

what stimulates the formation of male external genitalia

A

absence of testosterone

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16
Q

what is androgen insensitivity syndrome

A 
(a.k.a testicular feminisation) 
Congenital insensitivity to androgens
X-linked recessive disorder
Male karyotype (46XY)
Testis develop (but do not descend)
No androgen (T) 
Androgen induction of Wolffian duct does not occur, Mullerian inhibition does occur: born phenotypically external genitalia female, absence uterus and ovaries, with short vagina
Commonly present at puberty with primary amenorrhoea, lack of pubic hair
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17
Q

where does spermatogenesis occur

A

seminiferous tubules

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18
Q

where do sperm mature

A

epididymis

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19
Q

what is the path of sperm

A 
seminiferous tubules 
epididymis 
vas deferens 
ejaculatory duct 
(seminal vesicles and prostate)
urethra 
meatus of penis
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20
Q

what cells are responsible for spermatogenesis

A

sertoli

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21
Q

what is the path of the testes

A

develop in abdominal canal - lower pole of kidney in retro peritoneum
internal ring
inguinal canal
scrotal sac

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22
Q

what is the descent of the testes dependent on

A

androgens

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23
Q

why do the testes need to descend

A

lower temp outside body to facilitate spermatogenesis

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24
Q

what does the dartos muscle do

A

lowers/ raises testes according to external termperature

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25
what does the origin of testes mean for its anatomy
artery branch of aorta (gonadal) veins: L testicular joins to L renal, R joins to IVC lymphatic drainage to para aortic nodes
26
what does the cremaster muscle do
works in conjunction with the dartos muscle
27
what type of muscles are the dartos and cremaster
cremaster skeletal | dartos smooth
28
when do testes usually descend
6-9 months of age
29
what is cryptorchidism
undescended testes
30
what are the implications of cryptorchisism
reduces sperm count, if unilateral usually fertile | if undescended from 12 years onwards increased risk of ger cell cancer
31
what treatment for cryptorchidism
orchidopexy below to minimise risks | if adult consider orchidectomy
32
why does the corpus spongiosum not engorge with blood during erection
to maintain patency of urethra
33
what drives sertoli cell function
FSH
34
what is the steps of sperm production
``` germinal cell (diploid totipotent) primary spermatocyte (diploid) (meiosis 1) 2x secondary spermatocytes (haploid) (meiosis 2) 4x spermatids (haploid) spermatozoa ```
35
where is the genetic information in a sperm
nucleus in its head (has no cytoplasm)
36
what is in the neck of a sperm
mitochondria
37
what is acrosome
enzyme covering head of sperm, used in penetrating ovum
38
what are the roles of sertoli cells
form a blood testes barrier (protect the sperm from antibody attack, provides suitable fluid for sperm development) provide nutrients phagocytosis (removes surplus cytoplasm and destroys defective cells) secrete seminiferous tubule fluid (carries cells to epididymis) secretes androgen binding globulin (binds to testosterone) secretes inhibin, AMH and activin hormones (regulates FSH secretion and controls spermatogenesis)
39
describe the hormonal control of spermatogenesis
GnRH-> FSH and LH LH stimulates testosterone secretion testosterone then decreases GnRH and LH DHT causes: enlargement of male sex organs, secondary sexual characteristics and anabolism FSH stimulates spermatogenesis together with testosterone inhibin decreases FSH secretion
40
what type of hormone is GnRH and what releases it
decapeptide | released from hypothalamus in bursts every 2-3 hours from age 8-12 onwards
41
what does GnRH do
stimulates ant pituitary to produce LH and FSH
42
what is GnRH under negative feedback control from in males
testosterone
43
what type of hormones are LH and FSH
gonadotrophins- glycoproteins secreted by anterior pituitary
44
what is the role of LH
acts on leydig cells, regulates testosterone secretion
45
what is the role of FSH
acts on sertoli cells to enhance spermatogenesis
46
is production of gonadotrophins in males cyclical
no
47
what produces testosterone
leydig cells
48
what type of hormone is testosterone
steroid hormone- derived from cholesterol
49
what structures does testosterone have negative feedback on
hypothalamus and pituitary gland
50
what are the affects of testosterone from before birth to adult hood
before birth: masculinises repro tract, promotes descent of testes puberty: promotes puberty and male characteristics adult: controls spermatogenesis, secondary sexual characteristics (body shape, voice, thick skin), libido, penile erection
51
what type of hormone are inhibin and activin and what secretes them
petides secreted by sertoli cells
52
what liquifies sperm
enzymes from prostate gland
53
what is capacitation
series of changes that allow sperm to be able to fertilise egg
54
what are the steps of fertilisation
``` Penetration of cumulus complex bind to zona pellucida of oocyte Acrosome reaction Hyperactivated motility Zonal reaction Fusion with oocyte membrane and fertilisation ```
55
what do the seminal vesicles do
Produce semen into ejaculatory duct, supply fructose (energy supply), secrete prostaglandins (stimulates motility), secrete fibrinogen (clot precursor)
56
what is the role of the prostate
Produces alkaline fluid (neutralizes vaginal acidity), produces clotting enzymes to clot semen within female
57
what is the role of the bulbourethral glands
secretes lubricating mucous
58
what are the accessory glands
seminal vesicles, prostate gland, bulbourethral
59
what is responsible for erections
blood filling corpora cavernosa, under parasympathetic control
60
what is responsible for ejaculation
contraction of smooth muscles of urethra and erectile muscles, sympathetic control
61
how much of infertility is male factor
30% | same for female factor
62
what is happening to the prevalence of male infertility
increasing (possibly due to environmental oestrogens)
63
what is the most common cause of male infertility
idiopathic
64
what are the causes of obstructive male infertility
: cystic fibrosis (one faulty gene causes congenital bilateral malformation of vas deferens), vasectomy, infection
65
what are the non obstructive causes of male infertility
``` Congenital: Cryoptorchadism Infection: mumps orchitis Iatrogenic: chemotherapy/radiotherapy Pathological: testicular tumour Genetic: chromosomal (Klinefelter’s syndrome 47 xxy, microdeletions of Y chromosome, Robertsonian translocation) Specific semen abnormality e.g. globozoospermia Systemic disorder Endocrine ```
66
which form of male infertility has normal spermatogenesis
obstructive
67
what are the endocrine causes of male infertility
pituitary tumours: acromegaly, cushings, hyperprolactinaemia (all these decrease LH, FSH and testostrone) hypothalamic: idiopathic, tumours, kallmanns (hypogonadotrophic hypogonadism, GnRH deficiency), anorexia (decrease LH, FSH and test) thyroid: hyper or hypo (decreases libido increases prolactin) diabetes (decreases sexual function and test) CAH (increased testosterone) androgen insufficiency (normal/ raised LH and test) steroid abuse (decrease LH, FSH and test)
68
what does prolactin have negative feedback on
GnRH
69
what are you lacking if you dont get early morning erections
testosterone
70
what should you include in male infertility Hx
infertility- duration, primary or secondary, any Tx so far, libid, sexual function and activity general health: diabetes, resp, recent illnesses any GU infections (proven or suspected) surgery to repro tract exposure to meds (hormonal, steroids, antibiotics (sulphasalazine), alpha blockers, 5 alpha reductase inhibitors, chemo or radiotherapy, finasteride, narcotics enviroment: heat and pesticides recreational drugs: alcohol, marjuana genetic abnormalities in patient or family
71
what are you looking for on exam
General examination: - secondary sexual characteristics/ - presence of gynaecomastia Genital Examination: - testicular volume - presence of vas deferens and epididymis - penis (urethral orifice) - presence of any varicocele/other scrotal - swelling- testicular cancer
72
what is normal testicular volume
pre pubertal 1-3mls | adult 12-25 mls
73
what are you looking for on semen analysis
``` volume density (number of sperm) motility (how many are moving) preogression (how well they move) morphology ```
74
what might cause low ejaculatory volume
problems with accessory glands
75
what factors can affect result of semen analysis
completeness of sample period of abstinence (less than 3 days or longer than a week) condition during sample (cold) time between production and assessment (deteriorates after an hour) natural variations between samples health 2-3 months before
76
what further Ix are done into infertility
repeat semen analysis 6 weeks later if abnormal endocrine profile (LH, FSH, testosterone, PRL, TSH) chromosome analysis (including karyoptype, Y chromosome microdeletions), cystic fibrosis screening Depending on results: testicular biopsy, scrotal scan
77
what are the clinical features of obstructive infertility
normal testicular volume normal secondary sexual characteristics vas deferens may be absent
78
what are the endocrine features of obstructive infertilitt
normal LF, FSH and testosterone
79
how much of male infertility is obstructive
20%
80
what are the clinical features of non obstructive infertility
low testicular volume reduced secondary sexual characteristics vas deferens present
81
what are the endocrine features of non obstructive infertility
high LH/ FSH +/- low testosterone
82
what are the treatments for male infertility
General advice Treat any specific cause e.g. reversal of vasectomy if vasectomy, carbegoline if hyperprolactinamia, psychosexual Tx, medication review Intracytoplasmic sperm injection (ICSI: may require surgical sperm aspiration) Donor Insemination (DI)
83
what is the general advice for male infertility
Frequency sexual intercourse: 2-3 X per week and avoid lubricants that are toxic to sperm Alcohol: < 5 units per day Smoking: associated decrease semen quality and decreased health Caffeine: nil evidence (<3/4 cups a day) BMI: < 30 likely to improve fertility and health Avoid tight fitting underwear and prolonged hot baths/sauna may improve Certain occupations: overheating/exposure to chemicals Complementary therapies and non-prescription drugs Possible benefits of anti-oxidants (vitamin C or zinc)
84
who would benefit most from a vasectomy reversal
person with young female partner, takes a while so sperm retrieval quicker if female older
85
what is the process of ICSI
Sperm prepared from semen (or tissue from surgical sperm aspiration Each egg is stripped Sperm immobilised Single sperm injected
86
what is the indication for surgical sperm aspiration
azoospermia
87
what are the indications for donor sperm insemination
azoospermia or very low count, failed ICSI treatment, genetic conditions, infective conditions
88
what are the steps in donor sperm insemination
``` Sperm donors (altruistic and not anonymous) matched for recipient characteristics and screened for genetic conditions and STIs Sperm quarantined by cryopreservation and rescreened Prepared thawed semen sample inserted intrauterine at time of ovulation ```

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