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Spermatogenesis and Male Infertility Flashcards

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1
Q

What do the fetal testes secrete?

A

Testosterone

Mullerian inhibiting factors

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2
Q

What are the two primitive genital tracts?

A

Wolffian and Mullerian ducts

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3
Q

Where do the testes develop from?

A

Y chromosome has sex determining region: testes develop from bipotential gonad

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4
Q

What do testosterone and mullerian inhibiting factors cause the development of?

A

Male internal genital tract

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5
Q

What do the Wolffian and Mullerian ducts become?

A

Reproductive tract in males, Mullerian degenerates in males

Vice versa in females

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6
Q

What is the main hormone that causes the differentiation of external genitalia?

A

Dihydrotestosterone (present in males, absent in females)

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7
Q

What happens in androgen insensitivity syndrome (testicular feminisation)?

A

Congenital insensitivity to androgens
Testis develop but do not descend
Androgen induction of Wolffian does not occur, Mullerian inhibition does: phenotypically external female genitalia with absence of uterus and ovaries with short vagina

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8
Q

What are the genetics of androgen insensitivity syndrome?

A

X-linked recessive

Male karyotype: 46XY

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9
Q

Nervous reflex trigger what in scrotal sac to lower/raise testes according to external temperature?

A

Dartos muscle contraction

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10
Q

What is cryptorchidism?

A

Undescended testes

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11
Q

What are the clinical features of cryptorchidism?

A

Adulthood with undescended testes

Reduced sperm count, usually fertile if unilateral

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12
Q

What should be done to males <14yo with cryptorchidism to minimise the risk of testicular germ cell cancer?

A

Orchidopexy

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13
Q

What should be done in adults with undescended testes?

A

Orchidectomy

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14
Q

What is the function of the testes?

A 
Spermatogenesis (seminiferous tubules)
Testosterone production (Leydig cells)
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15
Q

What is a spermatozoon?

A

Single sperm

Acrosome contains enzymes for penetrating ovum

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16
Q

What are the roles of the Sertoli cells?

A

Form a blood testes barrier: protects from antibodies, provides suitable fluid composition
Provide nutrients
Phagocytosis: remove surplus cytoplasm and destroy defective cells
Secrete seminiferous tubule fluid: used to carry cells to epididymis
Secrete androgen binding globulin: binds testosterone to keep concentration high in lumen, essential for sperm production
Secrete inhibin/activing hormones: regulates FSH secretion and controls spermatogenesis

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17
Q

What does FSH stimulate in males?

A

Spermatogenesis together with testosterone

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18
Q

What does LH stimulate in males?

A

Testosterone secretion

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19
Q

What does testosterone decrease in males?

A

Release of GnRH and LH

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20
Q

What does dihydrotestosterone cause in males?

A

Enlargement of male sex organs
Secondary sexual characteristics
Anabolism

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21
Q

What is GnRH?

A

A decapeptide

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22
Q

When is GnRH released?

A

From hypothalamus in bursts every 2-3hours (begins 8-12yo)

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23
Q

What does GnRH do?

A

Stimulates anterior pituitary to produce LH and FSH

Under -ve feedback control from testosterone

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24
Q

What are LH and FSH?

A

Glycoproteins released from anterior pituitary

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25
What does LH act on?
Leydig cells-regulate testosterone secretion
26
What does FSH act on?
Sertoli cells to enhance spermatogenesis | Regulates by -ve feedback from inhibin
27
Is LH/FSH production cyclical?
Not in males
28
What is testosterone?
Steroid hormone derived from cholesterol
29
Where is testosterone secreted?
Into blood and seminiferous tubules
30
What does testosterone produce -ve feedback on?
Hypothalamus and pituitary gland
31
What are testosterones effects before birth?
Masculinises reproductive tract and promotes descent of testes
32
What are testosterones effects at puberty?
Promotes puberty and male characteristics (grown and maturation male reproductive systems)
33
What are testosterones effects as an adult?
``` Controls spermatogenesis Secondary sexual characteristics (male body shape deep voice, thickens skin) Libido Erection Aggressive behaviour ```
34
What are inhibin and activin?
Peptides
35
What are inhibin and activin secreted by?
Sertoli cells
36
What do inhibin and activin provide feedback on?
FSH: inhibin inhibits and activin stimulates
37
What happens to spermatozoa after ejaculation?
Liquified Capacitation: biochem and electrical events before fertilisation (hyperactived mobility, ability to bind) Chemoattraction to oocyte and bind to zona pellucida Acrosome reaction Hyperactivated mobility Penetration and fusion with membrane Zonal reaction
38
What is the function of the epididymis and vas deferens?
Exit route from testes to urethra, concentrate & store sperm, site for sperm maturation
39
What is the function of the seminal vesicles?
``` Produce sperm into ejaculatory duct Supply fructose Secrete prostaglandins (stimulate motility) Secrete fibrinogen (clot precursor) ```
40
What is the function of the prostate gland?
Produces alkaline fluid (neutralises vaginal acidity) | Produces clotting enzymes to clot semen within female
41
What is the function of the bulbourethral glands?
Secretes mucus to act as lubricant
42
What is filled with blood during an erection?
Corpora cavernosa
43
What is emission?
Contraction of accessory sex glands and vas deferens so semen expelled to urethra
44
What occurs in ejaculation?
Contraction of smooth muscles of urethra and erectile muscles (Sympa control)
45
What is male infertility?
Infertility resulting from failure of the sperm to normally fertilise egg Usually associated with abnormalities in semen analysis
46
What is the most common cause of male infertility?
Idiopathic
47
What are some obstructive causes of male infertility?
CF Vasectomy Infection
48
What are some non-obstructive causes of male infertility?
``` Congenital: Cryoptorchadism Infection: mumps orchitis Iatrogenic: chemotherapy/radiotherapy Pathological: testicular tumour Genetic: chromosomal (Klinefelter’s syndrome, microdeletions of Y chromosome, Robertsonian translocation) Specific semen abnormality e.g. globozoospermia Systemic disorder Endocrine ```
49
What pituitary causes exist for male infertility?
Acromegaly Cushings disease Hyperprolactinaemia (decrease LH/FSH/test.)
50
What are some hypothalamic causes of male infertility?
Idiopathic Tumours Kallman's syndrome Anorexia (decrease LH/FSH/test.)
51
What are some thyroid causes of male infertility?
Hyper/hypothyroidism (decrease sexual function and increase PRL)
52
How does diabetes cause male infertility?
Decrease sexual function and decrease test.
53
How does CAH cause male infertility?
Increase test.
54
How does androgen insensitivity cause male infertility?
Normal or raised LH and test.
55
How does steroid abuse cause male infertility?
Decrease LH/FSH/test.
56
What is particular about examination of male infertility?
Genital exam: testicular volume, presence of vas deferens and epididymis, penis (urethral orifice), presense of any varicocele/other scrotal swelling
57
What is the normal testicular volume?
Pre puberty: 1-3mls Adult: 12-25mls If below 5ml likely infertile
58
What is assessed in semen analysis?
``` Volume Density Motility (proportion moving) Progression (how well they move) Morphology ```
59
Beyond normal consultation and semen analysis, what further assessments can be carried out in male infertility?
``` Repeat semen analysis 6wks later Endocrine profile Chromosome analysis CF screening Biopsy, scrotal scan ```
60
In an obstructive diagnosis of male infertility, what are the clinical and endocrine features?
Normal volume, secondary sexual characteristics Vas deferens may be absent Normal LH/FSH/test.
61
In a non-obstructive diagnosis of male infertility, what are the clinical and endocrine features?
Low volume, reduced secondary sexual characteristics Vas deferens present High LH/FSH and low testosterone
62
How can male infertility be treated through lifestyle changes?
Sex 2-3x/week, avoid toxic lubricants Alcohol: <4 units/day Smoking: stop/decrease BMI: <30 Avoid tight underwear/prolonged baths and saunas Occupation: overheating, chemical exposure Complementary therapies and non-prescription drugs Benefits of anti-oxidants
63
What is IUI indicated?
Mildly reduced sperm count
64
What is the procedure in IUI and pregnancy rate?
Semen sample prepared to produce concentrated sample Inseminated into uterine cavity around ovulation 15%
65
What is intracytoplasmic sperm injection indicated?
Very low sperm count
66
What is the procedure and pregnancy rate in ICSI?
Sperm injected into stripped oocyte obtained during IVF | 30%
67
When is surgical sperm aspiration indicated?
Azoospermia
68
What is the procedure of surgical sperm aspiration, and the success rate at obtaining sperm?
Sperm aspirated surgically (diagnostic produce or at time of oocyte recovery) 95% in obstructed, 50% in non-obstructed
69
When is donor sperm insemination indicated?
Azoospermia or very low sperm count | Genetic or infective conditions
70
What is the procedure for donor sperm insemination?
Sperm donors (altruistic and not anonymous) matched for recipient characteristics and screened for conditions Sperm quarantined by cryopreservation and rescreened Prepared thawed sample inserted IU at ovulation
71
What is the pregnancy rate in donor sperm insemination?
15%

Reproduction (40 decks)

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