male infertility+varicocele

Question 1

How is couple infertility defined?

Answer 1

Absence of pregnancy after at least 1 year of unprotected targeted sexual intercourse.

Question 2

What percentage of infertility is attributable to male factors?

Answer 2

30–40% of cases.

Question 3

What are dysgenetic causes of male infertility?

Answer 3

Klinefelter syndrome, XX male syndrome, Kartagener’s syndrome, chromosomal abnormalities.

Question 4

What are neuroendocrine causes of infertility?

Answer 4

Hypogonadotropic hypogonadism, Prader-Willi, Rud syndrome, hyperprolactinemia, Cushing’s.

Question 5

Name testicular causes of infertility.

Answer 5

Cryptorchidism, trauma, tumors, orchitis, Sertoli-cell-only syndrome.

Question 6

What are post-testicular causes?

Answer 6

Varicocele, seminal obstructions, infections, ejaculation disorders.

Question 7

What are some environmental causes?

Answer 7

Pollution, heat, smoking, cannabis, pesticides.

Question 8

What are level 1 diagnostic steps?

Answer 8

Medical history, physical examination, spermiogram.

Question 9

What information is gathered from sexual history?

Answer 9

Smoking, drugs, work exposure to heat, chemo/radiotherapy history.

Question 10

What does physical exam assess?

Answer 10

Testicle volume and consistency, vas deferens, epididymis, prostate.

Question 11

What is required before a spermiogram?

Answer 11

3–6 days of sexual abstinence.

Question 12

When should semen sample be analyzed?

Answer 12

Within 30 minutes of ejaculation.

Question 13

How many spermiograms are needed for evaluation?

Answer 13

At least two tests.

Question 14

Define azoospermia.

Answer 14

Absence of spermatozoa even after centrifugation.

Question 15

Define cryptozoospermia.

Answer 15

Sperm absent initially but found after centrifugation.

Question 16

What is oligozoospermia?

Answer 16

Low sperm concentration (<20 million/mL).

Question 17

What is OTA?

Answer 17

Oligoteratoasthenospermia: reduced count, morphology, and motility.

Question 18

What is the aim of sperm culture?

Answer 18

To detect infections in the seminal/prostatic tract.

Question 19

What does scrotal ultrasound assess?

Answer 19

Testicle volume, epididymis, vas deferens, varicocele.

Question 20

What hormones are tested in screening?

Answer 20

FSH, LH, prolactin, testosterone, TSH.

Question 21

What does high FSH suggest in azoospermia?

Answer 21

Secretive cause of infertility.

Question 22

What is varicocele?

Answer 22

Venous ectasias in pampiniform plexus causing venous stasis.

Question 23

What percent of adult Italian males have varicocele?

Answer 23

0.11

Question 24

At what age is varicocele most common?

Answer 24

Between 15 and 20 years old.

Question 25

On which side is varicocele most frequent?

Answer 25

Left side (95%).

Question 26

What is a type I Coolsaet varicocele?

Answer 26

Intra-funicular due to reno-spermatic reflux.

Question 27

What causes venous reflux?

Answer 27

Valve insufficiency, right-angle confluence, aorto-mesenteric clamp.

Question 28

What are consequences of varicocele?

Answer 28

Testicular damage, hypotrophy, dyspermia, infertility.

Question 29

What is a key physical sign of varicocele?

Answer 29

‘Bag of worms’ palpable during Valsalva maneuver.

Question 30

What is used to measure testicle volume?

Answer 30

Prader orchidometer.

Question 31

What is subclinical varicocele?

Answer 31

Not visible or palpable; detectable only with imaging.

Question 32

Describe stage 3 clinical varicocele.

Answer 32

Visible and palpable at rest.

Question 33

What is Sarteschi stage 1?

Answer 33

Reflux after Valsalva to scrotal level only.

Question 34

What is Sarteschi stage 5?

Answer 34

Basal reflux not incrementable; hypotrophic testicle and visible varicocele.

Question 35

What is the goal of varicocele surgery?

Answer 35

Improve sperm quality and fertility.

Question 36

What are two main treatments for varicocele?

Answer 36

Ligation/section of veins and scleroembolization.

Question 37

What are approaches for vein ligation?

Answer 37

Scrotal, inguinal, suprainguinal, and laparoscopic.

Question 38

What is sclerotization?

Answer 38

Venous exclusion via sclerosing agents damaging vein intima.

Question 39

What is embolization?

Answer 39

Blocking the vein using emboli to stop reflux.

Question 40

Describe retrograde scleroembolization.

Answer 40

Catheter from femoral vein to spermatic vein guided by fluoroscopy.

Question 41

What is Tauber technique?

Answer 41

Antegrade sclerotization via scrotal incision and venous cannulation.