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Reproductive - Reproductive Gynaecology > Male Infertility - Clinical > Flashcards

Male Infertility - Clinical Flashcards

(61 cards)

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1
Q

Male infertility is responsible for what percentage of cases of infertility?

A

1/3rd

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2
Q

Male infertility is usually associated with abnormalities in what?

A

Semen analysis

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3
Q

What is the most common reason for male infertility?

A

Unknown (idiopathic)

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4
Q

If there is a known cause for male infertility, what are the two categories these causes can be split into?

A

Obstructive and non-obstructive

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5
Q

What are some obstructive causes of male infertility?

A

CF (absence of vas deferens), infections e.g. chlamydia, vasectomy

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6
Q

What is a congenital, non-obstructive cause of male infertility?

A

Cryptorchidism

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7
Q

What is an infective cause of non-obstructive male infertility?

A

Mumps orchitis

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8
Q

What are the two main iatrogenic causes of non-obstructive male infertility?

A

Chemo and radiotherapy

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9
Q

What is the major pathological cause of non-obstructive male infertility?

A

Testicular tumour

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10
Q

What is a genetic cause of non-obstructive male infertility?

A

Kleinfelter’s (XXY)

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11
Q

What are some more general causes of non-obstructive male infertility?

A

Specific semen abnormality, systemic illness, endocrine conditions

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12
Q

What are the 7 main things to ask about in a history of male infertility?

A

Infertility history/sexual function, general health, genitourinary infections, surgery to the genital tract, medications and therapies, environmental exposures, recreational drugs

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13
Q

What are some medications which may adversely affect spermatogenesis?

A

Hormone therapy, steroids, sulphasalazine, alpha blockers, 5 alpha reductase inhibitors

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14
Q

What are some environmental exposures that may contribute to male infertility?

A

Pesticides, excessive heat on the testicles

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15
Q

What recreational drugs are particularly bad for causing male infertility?

A

Marijuana and excessive alcohol

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16
Q

What are some endocrine causes of male infertility?

A

Pituitary tumours, hypothalamic problems, thyroid disorders, diabetes, CAH, androgen insensitivity, steroid abuse

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17
Q

What will happen to the levels of LH, FSH and testosterone if there is a pituitary tumour?

A

They will all decrease

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18
Q

What are some more specific features that a pituitary tumour may cause depending on its type?

A

Acromegaly, Cushing’s, hyperprolactinaemia

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19
Q

What will happen to the levels of LH, FSH and testosterone if there is a hypothalamic cause for male infertility?

A

They will all decrease

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20
Q

What are some examples of hypothalamic causes for male infertility?

A

Idiopathic, Kallmann’s, tumours, anorexia

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21
Q

What may be some changes associated with a thyroid disorder (either hyper or hypo) causing male infertility?

A

Decreased sexual function and increased prolactin

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22
Q

What may be some changes associated with diabetes being the cause for male infertility?

A

Decreased sexual function and decreased testosterone

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23
Q

What happens to testosterone levels in congenital adrenal hyperplasia?

A

Increased

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24
Q

What will happen to the levels of LH and testosterone in androgen insensitivity syndrome?

A

Normal or increased

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25
What will happen to the levels of LH, FSH and testosterone if steroid abuse is the cause of male infertility?
They will all be decreased
26
What forms the first part of assessment of a couple with infertility?
See as a couple and take a history
27
What two examinations should you do on a male with suspected infertility?
General and genital
28
What are you looking for on general examination of a man with suspected infertility?
The presence of secondary sexual characteristics, any gynaecomastia
29
What do you look for on genital examination of a man with suspected infertility?
Testicular volume, presence of vas deferens and epididymis, urethral oriface, any swellings
30
How do you measure testicular volume? What is norma;?
Orchidometer - normal is 12-25ml
31
A testicular volume of < 5ml suggests what?
The male is unlikely to be fertile
32
What things are you looking for with semen analysis?
Volume, density, motility, progression, morphology
33
When should semen analysis be taken?
After 3-4 days abstinence from ejaculation
34
What are some factors the may affect the quality of semen analysis?
< 3 days abstinence, not kept cool during transport, > 1 hour between production and assessment, not a complete sample, ill health in the last 3 months
35
If semen analysis is abnormal, what should be done? Why?
Repeat in 6 weeks as it may only be abnormal as a result of current illness
36
The presence of what in a semen sample indicated prompt investigation into the cause?
Azoospermia
37
What are some investigations (other than semen analysis) that can be used for male infertility?
Endocrine profile, chromosomal analysis, testicular biopsy, scrotal scan
38
What hormones are tested in an endocrine profile for male infertility?
LH, FSH, testosterone, PRL, TSH
39
What could you test for as part of chromosomal analysis for male infertility?
Karyotype, Y chromosome microdeletions, CF screening
40
What are the clinical features of obstructive male infertility?
Normal testicular volume and secondary sexual characteristics
41
What structure may be absent in obstructive male infertility? What condition is this especially associated with?
Vas deferens - CF
42
What are the endocrine features of obstructive male infertility?
Normal LH, FSH and testosterone
43
What are the clinical features of non-obstructive male infertility?
Low testicular volume and reduced secondary sexual characteristics
44
Will the vas deferens be present in non-obstructive male infertility?
Yes
45
What are the endocrine features of non-obstructive male infertility?
High LH/FSH +/- low testosterone
46
What is the first line treatment for male infertility if possible?
Treat the underlying cause
47
If there is no underlying cause for male infertility that can be treated, what are the options?
ICSI or donor insemination
48
Reversal of a vasectomy has a poor outcome after how long?
10 years
49
What is the treatment for hyperprolactinaemia?
Cabergoline
50
What is the treatment for anejaculatory conditions?
Psychosexual treatment
51
What are some general ways you can treat an underlying cause of male infertility?
Treat chronic illness, change any medications
52
When is ICSI used as a treatment for male infertility?
If sperm are available
53
Where are sperm taken for to be used in ICSI?
Either from the semen or from surgical aspiration
54
When is surgical sperm aspiration indicated for ICSI?
If there is azoospermia
55
Surgical sperm aspiration for ICSI has better outcomes in which type of male infertility?
Obstructive (95% chance of obtaining sperm)
56
How does ICSI work?
Each egg is stripped, sperm are immobilised and a single sperm is injected
57
What is the success rate of ICSI?
35%
58
When is donor insemination used as a treatment for male infertility?
If there is azoospermia or a very low count, ICSI has failed, genetic or infective conditions
59
How are sperm donors chosen?
They are matched for recipient characteristics and screened for genetic disease and STIs
60
When is a donor sperm sample inserted into the uterus?
At ovulation
61
What is the success rate of donor insemination?
15% each cycle

Reproductive - Reproductive Gynaecology (12 decks)

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