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Repro and Sexual Health > Spermatogenesis and Male Infertility > Flashcards

Spermatogenesis and Male Infertility Flashcards

(60 cards)

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1
Q

when do primordial germ cells migrate to gonadal ridge?

A

week 5-6

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2
Q

what does Y chromosome cause?

A

development of testis at week 7
leydig cells secrete testosterone (will become DHT)
sertoli cells secrete mullerian inhibiting factor

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3
Q

ducts in males?

A

wolffian = becomes reproductive tract (epididymis, vas defrens, seminal vesicles)
mullerian duct = degenerates

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4
Q

ducts in females?

A

opposite

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5
Q

what does DHT stimulate?

A

development of male external genitalia

female genitalia develops in its absence

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6
Q

when can gender be differentiated on a scan?

A

week 16

starts to differentiate at wek 9

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7
Q

what is androgen insensitivity syndrome?

A

X linked congenital insensitivity to androgens

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8
Q

features of androgen insensitivity syndrome?

A

testes develop but dont descend
androgen induction of wolffian duct does not occur and mullerian inhibition does occur
causes phenotypically female external genitalia but without uterus or ovaries and a short vagina
often presents are puberty with primary amenorrhoea and lack of pubic hair

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9
Q

cells of the smeiniferous tubules?

A

sertoli cells

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10
Q

which cells produce sperm?

A

seroli sperm

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11
Q

descent of testes in utero?

A

testes develop in abdomen on foetus
descend into scrotal sac before birth (androgen dependent)
- etsticukar artery is branch of aorta
- veins in similar path (L testicular vein joins L renal vein, R drains straight into IVC)
- lymphatic drainage to abdomen

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12
Q

why must the testes descend?

A

need lower temp for spermatogenesis

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13
Q

what muscle controls lifting/descent of testes?

A

dartos muscle

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14
Q

what is cryptorchidism?

A

undescended testes
individual has reached adolescence/adulthood and testes have not descended
(usually descend by 6-9 months)

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15
Q

implications of chryptorchidism?

A

affects spermatogenesis (low sperm output)
germ cell cancer risk
- orchidopexy before age 14 can reduce risk
- or orchidectomy if adult

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16
Q

what does the urethra pass through in the penis?

A

corpus spongiosum

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17
Q

what causes an erection?

A

blood engorging in corpus cavernosum and corpus spongiosum

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18
Q

what hormone drives sertoli function and therefore sperm production?

A

FSH

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19
Q

where is genetic info held in sperm?

A

head

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20
Q

what else is contained within the sperm cell?

A

acrosome covers head (contains enzymes for penetrating ovum)

mitochondria in midpiece

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21
Q

6 functions of sertoli cells?

A

form blood-testes barrier (protects sperm from antibody attack)
provide nutrients for developing cells
phagocytosis (surplus cytoplasm and defective cells)
secrete seminiferous tubule fluid (carries cells to epididymis)
secrete androgen binding globulin (binds to testosterone to maintain high levels)
secrete inhibin and activin hormones (regulates FSH and controls spermatogenesis)

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22
Q

what does LH affect?

A

leydig cells

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23
Q

function of inhibin?

A

decreases secretion of FSH

FSH stimulates spermatogenesis so therefore causes low sperm

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24
Q

describe gonadotrophin releasing hormone?

A

decapeptide released from hypothalamus in bursts every 2-3 hours
stimulates anterior pituitary to produce LH and FSH
under negative feedback control from testosterone

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25
what are gonadotrophins?
glycoproteins secreted by anterior pituitary LH - acts on leydig cells to regulate testosterone FSH - acts on sertoli cells to enhance spermatogenesis, regulates by negative feedback from inhibin
26
what produces testosterone?
leydig cells
27
what type of hormone is testosterone?
steroid derived from choelsterol
28
effects of testosterone?
negative feedback on anterior pituitary before birth: - masculine reproductive tract and promotes descent of testes puberty: - promotes puberty and male characteristics (growth and maturation male reproductive system) adult: - controls spermatogenesis, secondary sexual characteristics, libido, penile erection, aggressive behaviour
29
what are inhibin and activin?
peptides secreted by sertoli cells feedback on FSH - inhibin inhibits and activin stimulates
30
what happens to spermatozoa after ejaculation?
liquefied by enzymes from prostate gland capacitation: - series of biochemical cellular events before fertilization (hyperactivated motility, ability to bind to ZP and AR of egg) chemoattraction to oocyte penetration of cumulus complex acrosome reaction/zona binding fusion with oocyte membrane and fertilization
31
where does fertilization occur?
ampulla of fallopian tube
32
function of epididymis and vas deferens?
exit route from testes to urethra, concentrate and store sperm, site for sperm maturation
33
function of seminal veisicles?
produce semen into ejaculatory duct, supply fructose, secrete prostaglandins (stimulate motility) and secrete fibrinogen (clos precursor)
34
function of prostate?
produces alkaline fluid which neutralizes vaginal acidity | produces clotting enzymes to clot semen within female
35
function of bulbourethral glands?
secrete mucous to act as lubricant
36
general function of accessory glands?
secrete semen to suspend and sustain sperm
37
route of sperm?
testes > epididymis > vas deferens > ejaculatory duct > urethra
38
what causes erection?
blood fills corpora cavernosa (under parasympathetic control)
39
what causes emission?
contraction accessory sex glands and was deferens so semen expelled to urethra
40
what causes ejaculation?
contraction of smooth muscles of urethra and erectile muscles (sympathetic control)
41
definition of male infertility?
infertility resulting from failure of the sperm to normally fertilise the egg usually associated with abnormalities in semen analysis
42
most common cause of male infertility?
idiopathic
43
obstructive causes of male infertility?
CF vasectomy infection
44
non-obstructive causes of male infertility?
``` congenital (e.g cryptorchadism) infection (e.g mumps) iatrogenic (chemo) pathology (testicular tumour) genetic (chromosomal e.g kleinfelter's) specific semen abnormality (e.g globozoospermia) systemic disorder endocrine ```
45
endocrine causes of male nfertility?
hypothalamus (idiopathic, tumour, kallman's, anorexia) pituitary tumours (acromegaly, cushings, hyperprolactinaemia) thyroid (hyper/hypo) diabetes CAH (increases testosterone) androgen insensitivity steroid abuse (decerases testosterone and LH/FSH)
46
questions to determine testosterone levels?
feeling tired needing to shave less loss of libido loss of early morning erection
47
examination in male infertility?
general (look for 2ndary sexual characteristics and gynaecomastia etc) genital - testicle volume - presence of vas deferens and epididymis - penis and urethral orifice - presence of any variocele/other scrotal swelling
48
normal testicular volume?
pre-puberty = 1-3 mls adult = 12-25 mls unlikely to be fertile if under 5ml
49
how is testicular volume measured?
orchidometer
50
what is measured in semen analysis?
``` volume density (numbers of sperm) motility (how many moving) progression (how they move) morphology ```
51
what factors can influence result of semen analysis?
completeness of sample period of abstinence (must be at least 2 days but no more than 7) condition during transport (e.g too cold) time between production and assessment (must be <1 hr) natural variants between samples health of man 3 months before production
52
further assessment in male infertility?
repeat semen analysis after 6 weeks endocrine profile (LH, FSH, testosterone, PRL, TSH) chromosome analysis CF screen depending on results - testicular biopsy, scrotal scan
53
clinical features of obstructive male infertility?
normal testicular volume normal 2ndary sexual characteristics vas deferens may be absent normal LH, FSH and testosterone
54
clinical features of non-obstructive male infertility?
low testicular volume reduced 2ndary sexual characteristics vsa deferens present high LH, FSH +/- low testosterone
55
general advice in male infertility?
frequent intercourse (2-3 times per week and avoid toxic lubricants) <4 units alcohol per week stop smoking BMI <30 avoid tight fitting underwear and prolonged heat/hot water exposure certain occupations (exposure to heat/chemicals etc) complementary therapies and possible benefits of anti-oxidants etc
56
treatment of specific disorders in male infertility?
``` reversal of vasectomy (works best if done within 3 years and more worth it if female is young) endocrine (e.g cabergoline for hyperprolactinaemia) anejaculation conditions (e.g psychosexual treatment) chronic disorders (e.g renal failure) medications (steroids, immunotherapy etc) ```
57
IVF vs ICSI?
``` IVF = normal sperm used ICSI = sperm is abnormal so injected manually into the egg ```
58
methods of sperm retrieval?
PESA TESA testicular biopsy
59
normal testicular volume?
12-25mls
60
indications for donor sperm insemination?
``` azzospermia very low count failed ISCI genetic conditions infective conditions ```

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