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Repro / GU > SM_205b: Male Fertility > Flashcards

SM_205b: Male Fertility Flashcards

1
Q

Male infertility has ____, ____, and ____ causes

A

Male infertility has pre-testicular, intrinsic testicular, and post-testicular causes

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2
Q

Infertility examination of men involves ____, ____, and ____

A

Infertility examination of men involves history, physical examination, and appropriate lab testing

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3
Q

Normal testis size is ____ and ____

A

Normal testis size is > 4 cm x 2 cm and x 20 cc

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4
Q

Lab testing for male testing involves ____

A

Lab testing for male testing involves serum FSH and testosterone with other testing as indicated

  • If testosterone is low, consider LH and prolactin
  • If FSH is low, consider LH and prolactin
  • If patient is obese, consider estradiol
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5
Q

Describe normal semen analysis

A

Semen analysis

  • Ejaculate volume: > 1.5 mL
  • Sperm concentration: > 15 million sperm / mL
  • Sperm motility: > 40%
  • Sperm normal morphology: > 4% Kruger
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6
Q

Describe additional sperm parameters

A

Additional sperm parameters

  • If no sperm, centrifuge sample: cyrptozospermia
  • Normal pH ≥ 7.2: prostate secretions are acidic, seminal vesicle secretions are alkaline
  • Low ejaculate volume and normal pH: think incomplete collection or retrograde ejaculation
  • Low ejaculate volume and acidic pH: think ejaculatory duct pathology or congenital bilateral absence of the vas deferens
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7
Q

Describe Kruger morphologic criteria

A

Kruger morphologic criteria (normal)

  • Smooth oval head
  • Acrosome is 40-70% of volume of head
  • No abnormalities of neck, midpiece, or tail
  • No cytoplasmic droplets more than half the size of the head
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8
Q

Highest probability of conception occurs is ____ occurring when intercourse occurs on ____

A

Highest probability of conception occurs is 0.3 occurring when intercourse occurs on day of ovulation

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9
Q

Describe medication effects on male reproductive health

A

Medication effects on male reproductive health

  • Endocrine axis: testosterone
  • Libido: spironolactone
  • Errectile function: beta blockers, thiazide diuretics
  • Ejaculatory function: alpha blockers, antidepressants
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10
Q

Fever impacts semen parameters such as ____ and ____

A

Fever impacts semen parameters such as sperm count / motility / morphology and sperm DNA integirty

  • Return to pre-febrile baseline: motility and morphhology at 4 weeks, sperm count at 8 weeks
  • If patient has fever within 3 months prior to semen testing, consider repeating 4-8 weeks later before making final treatment recommendations
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11
Q

Tobacco, marijuana, and cocaine ____ impact male fertility

A

Tobacco, marijuana, and cocaine detrimentally impact male fertility

  • Tobacco: decreased semen parameters, impaired sperm function, increased sperm DNA damage and aneuploidy, hormonal changes
  • Marijuana: suppresses LH and testosterone secretion, impairs semen parameters, impairs sperm function
  • Cocaine: impaired spermatogenesis, vasoconstriction
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12
Q

Treatment of infertile male involves ____, ____, ____, and ____

A

Treatment of infertile male involves

  • Counselling to optimize male reproductive health
  • Identifying medically treatable conditions
  • Identifying surgically treatable conditions
  • Identifying serious associated health problems
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13
Q

Describe medical management of hormone deficiency contributing to male infertility

A

Hormone deficiency contributing to male infertility

  • Hypogonadotropic hypogonadism: congenital (Kallman’s syndrome: anosmia, cleft palate, cryptorchidism), acquired (pituitary trauma)
  • Isolated LH deficiency
  • Isolated FSH deficiency
  • Mechanism: low levels of gonadotropin secretion
  • Treatment: hCG and FSH replacement therapy, treat underlying medical condition
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14
Q

Hyperprolactinemia causes male infertility by ____

A

Hyperprolactinemia causes male infertility by inhibiting hypothalamic secretion of GnRH

  • Pituitary adenoma, hypothyroidism, stress, liver disease, phenothiazines and tricyclic antidepressants
  • Additional testing: pituitary MRI
  • Treatment: bromocriptine, cabergoline, surgery
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15
Q

Estrogen excess causes male infertility by ____

A

Estrogen excess causes male infertility by inhibiting gonadotropin secretion

  • Adrenal or testicular tumors, liver failure, obesity (testosterone / estradiol ratio < 10/1)
  • Treat underlying condition, possible role for aromatase inhibitors (anastrozole, letrozole, exernstane)
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16
Q

Androgen excess causes male infertility by ____

A

Androgen excess causes male infertility by inhibiting gonadotropin secretion

  • Exogenous source (anabolic steroids) most common, endogenous source (adrenal or testicular tumors), congenital adrenal hyperplasia
  • Treatment: stop use of anabolic steroids, treat underlying medical condition, cortisol replacement for CAH
17
Q

Varicocele is particularly common in ___ males

A

Varicocele is particularly common in infertile males

  • Grade I: palpable on exam only with Valsalva
  • Grade II: palpable on exam without Valsalva
  • Grade III: visible on exam
18
Q

Varicocele causes infertility through ____

A

Varicocele causes infertility through testicular hyperthermia

  • Treatment: radiographic embolization, surgical ligation
19
Q

Obstructive azoospermia causes infertility due to ____ or ____

A

Obstructive azoospermia causes infertility due to vasal obstruction or epididymal obstruction

  • Treatment: microsurgical reconstruction, vasovasostomy, epididymovasostomy
20
Q

Describe congenital bilateral abscence of the vas deferens

A

Congenital bilateral abscence of the vas deferens

  • Also typically missing distal 2/3 of epididymis and seminal vesicle
  • Retrieved sperm generally used in setting IVF / ICSI
  • CFTR gene mutation testing
21
Q

Nonobstructive sperm retrieval techniques include ____

A

Nonobstructive sperm retrieval techniques include microdissection testicular sperm extraction

  • Testicular sperm extraction
  • Testicular percbiopsy
  • Testicular sperm aspiration
22
Q

Single biopsy is often ____ for finding sperm

A

Single biopsy is often not enough for finding sperm

  • Heterogeneous histology of seminiferous tubules with scant pockets of complete spermatogenesis amid a majority of abnormal tubules
23
Q

Micro-TESE has ____ sperm retrieval rate and ____ clinical pregnancy rate

A

Micro-TESE has 50-60% sperm retrieval rate and 40-60% clinical pregnancy rate

24
Q

Klinefelter syndrome is ____ genotype and presents with ____, ____, and ____

A

Klinefelter syndrome is 47 XXY genotype and presents with small firm testes, gynecomastia, and azoospermia

  • Most common genetic cause of azoospermia
  • Accounts for 2/3 of chromosomal abnormalities in infertile men
25
Q

___ chromosome may have ___ in infertile men

A

Y chromosome may have microdeletions in infertile men

  • Microdeletions found in 10-15% of azoospermic men and 3-10% oligospermic men
  • Deletions in long arm of Y chromosome
  • No sperm will be found if complete AZFa or AZFb microdeletion
26
Q

Cystic fibrosis (CFYR) involves ____

A

Cystic fibrosis (CFYR) involves congenital bilateral abscence of the vas deferns

  • Typicallty absent vas deferns and absence of seminal vesicles
  • Congenital unilateral or bilateral abscence of vas deferns
  • Partner must be tested even if patient (-) testing
  • CBAVD semen analysis: low ejaculate volume, acid pH semen, azoospermia
27
Q

Describe forms of artificial contraception

A

Artificial contraception

  • Abstinence
  • Pull out methods
  • Barrier methods
  • Contraceptive pill
  • Intrauterine devices
  • Surgical sterilization
28
Q

Vasectomy involves ____, ____, ____, and ____

A

Vasectomy involves vasal division, excision of vasal segment, mucosal cautery, fascial interposition

  • Can recanalize
29
Q

Clearance from contraception given after vasectomy if ____ or ____

A

Clearance from contraception given after vasectomy if

  • Single semen sample shows no sperm

OR

  • Fresh well-mixed noncentrifuged sample shows no sperm of < 100,000 nonmotile sperm/mL at > 4 months post-procedure
30
Q

If any motile sperm persist at > 6 months after vasectomy, ____

A

If any motile sperm persist at > 6 months after vasectomy, procedure should be deemed a failure and a repeat vasectomy should be offered

Repro / GU (46 decks)

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