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Male infertility Flashcards

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1
Q

What determines gender?

A

Socially constructed roles and behaviours that a society typically associated with males and females

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2
Q

Genotype and phenotype are determined by

A

Sex

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3
Q

What is the phenotype of androgen insensitivity syndrome

A
  • female external genitalia

- lack of pubic hair

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4
Q

What is the common presentation of androgen insensitivity syndrome

A

Present with amenorrhoea

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5
Q

Androgen sensitivity is an _-______ ______ disorder

A

Androgen sensitivity is an x-linked recessive disorder

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6
Q

What is the karyotype of androgen insensitivity disorder?

A

46 XY

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7
Q

Describe the pathogenesis of androgen insensitivity disorder?

A

Testis develop but don’t descend, no androgen and so induction of wolffian duct does not occur. Absent uterus and ovaries with short vagina and female external genitalia

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8
Q

What is the function of the testis?

A
  • Spermatogenesis (seminiferous tubules)

- Production of testosterone (leydig cells)

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9
Q

Testicular artery is a branch of what artery?

A

The aorta

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10
Q

The left testicular vein joins the _____ _____ ____ and right testicular vein drains into _________ ____ ____

A

The left testicular vein joins the left renal vein and right testicular vein drains into inferior vena cava

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11
Q

Where is the lymphatic drainage of the testis?

A

Into the abdomen

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12
Q

Why is it important that the testes descend?

A

Lower temperature outside the body for spermatogenesis

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13
Q

______/______ muscle contraction in scrotal sac _____/______ testes according to external ______

A

dartos/cremaster muscle contraction in scrotal sac lowers/raises testes according to external temperature

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14
Q

The dartos muscle is ______ ______

A

The dartos muscle is smooth muscle

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15
Q

The cremaster muscle is _____ _______ and a continuation of the _______ _______

A

The cremaster muscle is skeletal muscle and a continuation of the internal oblique

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16
Q

What is contained in the spermatic cord?

A

Arteries, veins, nerves, lymphatics, vas deferens

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17
Q

What covers the testis

A

Tunica vaginalis- peritoneal remnant and then tunica albuingea (firm fibrous covering)

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18
Q

What is cryptorchidism?

A

Individual has reached adolescence/adulthood and testes have not descended

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19
Q

When do testes normally descend?

A

Between 6-9 months of age

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20
Q

When should orchidopexy be performed?

A

By 12 months because of strong association with infertility (azoospermia) and by 12 years to minimise risk of testicular germ cell cancer

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21
Q

What should be done if undescended testis are discovered as an adult?

A

Consider orchidectomy as risk of cancer is 6x baseline

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22
Q

What is corpus cavernosum?

A

Two columns of tissue running along the sides of the penis- blood fills to cause an erection

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23
Q

What is corpus spongiosum?

A

A column of sponge like tissue running along the front of the penis ending at the glans penis; it fills with blood during an erection keeping the urethra open

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24
Q

Spermatozoa contain ______ genetic material

A

Spermatozoa contain haploid genetic material

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25
What are the roles of Sertoli cells?
- form blood-testes barrier - provide nutrients - phagocytosis - secrete seminiferous tubule fluid - secrete androgen binding globulin - secrete inhibin and activin hormones
26
What is the function of the blood-testes barrier?
- Protects the sperm from antibody attack | - Provides a suitable fluid composition which allows later stages of development of sperm- v different from blood.
27
What is the role of phagocytosis by Sertoli cells?
Remove surplus cytoplasm from packaging process & destroys defective cells
28
What is the role of seminiferous tubule fluid?
Carries cells to epididymis
29
What is the role of androgen binding globulin?
Binds testosterone so concentration remains high in lumen Essential for sperm production
30
What is the role of inhibin and activin hormones?
regulates FSH secretion and controls spermatogenesis
31
GnRH is a ____peptide released from the ________ in ______ every ___ hours (beginning at age ____ years)
GnRH is a decapeptide released from the hypothalamus in bursts every 2-3 hours (beginning at age 8-12 years)
32
GnRH stimulates the anterior pituitary to produce __ and ____ and is under _______ ______ ____ from testosterone
GnRH stimulates the anterior pituitary to produce LH and FSH and is under negative feedback control from testosterone
33
Gonadotrophins are _______ secreted by the anterior pituitary
Gonadotrophins are glycoproteins secreted by the anterior pituitary
34
What is the role of LH in men?
Acts on leydig cells- regulates testosterone secretion
35
What is the role of FSH in men?
Acts on Sertoli cells to enhance spermatogenesis | Regulates by negative feedback from inhibin
36
Production of gonadotrophins is ______ in females and __________ in males.
Production of gonadotrophins is cyclical in females and non-cyclical in males.
37
Testosterone is a _____ hormone derived from cholesterol
Testosterone is a steroid hormone derived from cholesterol
38
Testosterone has negative feedback on which glands?
Hypothalamus and pituitary
39
What are the effects of testosterone before birth?
Masculinises reproductive tract and promotes descent of testes
40
What are the effects of testosterone during puberty?
Promotes puberty and male characteristics and maturation of male reproductive system
41
What are the effects of testosterone in adulthood ?
Controls spermatogenesis, secondary sexual characteristics (male body shape, deep voice, thickens skin), libido, penile erection, aggressive behaviour
42
Inhibin and activin are what type of hormones
Peptides
43
What secretes inhibin and activin?
Sertoli cells
44
What do inhibin and activin do?
Feedback on FSH
45
What liquefies the ejaculate?
Enzymes from the prostate gland
46
What is capacitation?
Series of biochemical cellular events before fertilisation (hyper activated motility, ability to bind to ZP and AR)
47
How does the spermatozoa find the oocyte?
By chemoattraction
48
Describe the process of fertilisation?
- Penetration of cumulus complex - acrosome reaction/zona binding - Fusion with oocyte membrane and fertilisation
49
What are the functions of the epididymis and vas deferens?
Exit route from testes to urethra, concentrate and store sperm, site for sperm maturation
50
What is the function of the seminal vesicles?
Produce semen into ejaculatory duct, supply fructose, secrete prostaglandins (stimulates motility), secrete fibrinogen (clot precursor)
51
What is the function of the prostate gland?
Produces alkaline fluid (neutralises vaginal acidity), produces clotting enzymes to clot semen within female
52
What is the function of the bulbourethral glands
Secrete mucus to act as lubricant
53
Describe the route of sperm
testes --> epididymis --> vas deferens --> ejaculatory duct -->urethra
54
What controls erection?
Parasympathetic control
55
What is emission
Contraction of accessory sex glands and vas deferens so semen is expelled to urethra
56
What is ejaculation
Contraction of smooth muscles of urethra and erectile muscles
57
What are the three aetiologies of MF infertility?
Idiopathic Obstructive Non-obstructive
58
What causes obstructive MF infertility
Vasectomy Cystic fibrosis- absence of vas Infection
59
What causes congenital non-obstructive MF infertility
cryptoorchidism
60
What causes infectious non-obstructive MF infertility
Mumps orchitis
61
What causes iatrogenic non-obstructive MF infertility
Chemotherapy/radiotherapy
62
What causes pathological non-obstructive MF infertility
testicular tumour
63
What causes genetic non-obstructive MF infertility
chromosomal (kleinfelter's syndrome, micro deletions of Y chromosome, robertsonian translocation)
64
What specific semen abnormality causes non-obstructive MF infertility
Globozoospermia
65
What are the hypothalamic endocrine causes of male factor infertility?
Idiopathic, tumours, Kallman's syndrome, anorexia
66
What are the pituitary endocrine causes of male factor infertility?
Acromegaly, cushings disease, hyperprolactinaemia
67
What are the thyroid endocrine causes of male factor infertility?
Hyper or hypothyroidism (decreases sexual function and increases prolactin)
68
How does diabetes cause MF infertility?
Decrease sexual function and testosterone
69
How does CAH cause MF infertility?
Increased testosterone
70
How does steroid abuse cause MF infertility?
Decrease testosterone, LH and FSH
71
How should an assessment of infertility be carried out?
See as couple History (Andrology) Examination (general and genital) Investigations (semen analysis, others depending on results)
72
Describe the examination of MF infertility
General - 2ry sexual characteristics - gynaecomastia? ``` Genital -testicular volume -presence of vas deferens and epididymis -penis (urethral orifice) presence of any varicocoele/other scrotal swelling ```
73
What is normal testicular volume?
Pre-pubertal 1-3mls Adults 12-25 mls If <5mls unlikely to be fertile
74
What is looked at when analysing semen?
- Volume - Density (number of sperm) - Motility - Progressive motility - Morphology
75
What needs to be taken into account for a valid semen analysis
- Completeness of sample - Period of abstinence - Condition during transport - Time between production and assessment (deteriorates after 1 hr - Natural variation - Current health and health of man in 2-3 months before production
76
What further tests should be done after initial semen analysis and examination
Repeat semen analysis if abnormal in 2-3months Endocrine profile (LH, FSH, PRL, TSH, testosterone) Chromosome analysis (including karyotpie, Y chromosome micro deletions) CF screening Testicular biopsy or scrotal scan
77
What are the clinical features of obstructive azoospermia?
Normal testicular volume Normal 2ry characteristics Absent vas deferens
78
What are the endocrine features of obstructive azoospermia?
Normal LH, FSH and testosterone
79
What are the clinical features of non-obstructive azoospermia?
Low testicular volume Reduced 2ry characteristics Vas deferens present
80
What are the endocrine features of obstructive azoospermia?
High LH, FSH +/- low testosterone
81
What is given for high PRL in MF infertility
Cabergoline
82
What general advice should men be given if infertile?
-Frequency sexual intercourse: 2-3 X per week -Avoid lubricants that are toxic to sperm -Alcohol: < 5 units per week -Smoking: associated decrease semen quality and decreased health -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)
83
What is the success rate of vasectomy reversal?
75% if vasectomy within 3 years 55% after 3-8 years 30-40% after 9-19 years
84
What is the treatment for anejactulation?
Psychosexual treatment
85
How can sperm be retrieved?
- PESA (Percutaneous Epididymal Sperm Aspiration) - TESA (Testicular Sperm Aspiration) - testicular biopsy
86
What is micro TESE?
Specialise urological surgery under high power magnification to dissect and direct examination of seminiferous tubules to identify regions with spermatogenesis
87
What is the pregnancy rate of donor insemination?
15% per treatment cycle

Reproductive & Sexual Health (54 decks)

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