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Repro and Sexual Health > Spermatogenesis and Male Infertility > Flashcards

Spermatogenesis and Male Infertility Flashcards

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1
Q

What determines the development of the internal reproductive tract in the embryo?

A

SRY on Y chromosome result in the development of testes, and the degeneration of the mullerian ducts

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2
Q

What will the foetal testes secrete?

A

Testosterone

AMH

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3
Q

What are the 2 primitive genital tracts?

A

Wolffian

Mullerian

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4
Q

What duct is present in males?

A

Wolffian

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5
Q

What duct is present in females?

A

Mullerian

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6
Q

When can you distinguish sex on a USS?

A

Week 16

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7
Q

What is androgen insensitivity syndrome (testicular feminisation)?

A

Congenital insensitivity to androgens
Testis develop but do not descend
Androgen induction of wolffian duct does not occur, but mullerian inhibition occurs

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8
Q

What internal sex organs will those with testicular feminisation have?

A

Externally female genitalia
Absence of uterus and ovaries
Short vagina

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9
Q

How will those with androgen sensitivity present?

A

Puberty with primary amenorrhoea and a lack of pubic hair

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10
Q

What is the function of the testis?

A

Spermatogenesis (seminiferous tubules)

Production of testosterone (leydig cells)

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11
Q

What covers the testis?

A

Double layer of tunical vaginalis

White fibrous tunica albingia

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12
Q

Why is the descent of the testis important?

A

Lower temp outside body to facilitate spermatogenesis

Nervous reflex triggers dartos muscle contraction in scrotal sac to lower/ raise testes according to the external temp

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13
Q

How common is cryptorchidism?

A

1:25

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14
Q

When should an orchiopexy be performed in cryptorchidism?

A

By 12 months due to strong assoc with azoospermia
12 years to minimize risk of testicular germ cell ca
If undescended as adult - consider orchidectomy

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15
Q

What are the venous drainage of the testes?

A

Left testicular joins left renal

Right drains directly to IVC

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16
Q

What gonadotropin drives sertoli cell function?

A

FSH

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17
Q

What gonadotropin drives testosterone production?

A

LH - leydig cells

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18
Q

What is present in the head of a sperm?

A

Acrosome - enzymes required for penetration of ovum

Nucleus

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19
Q

What is present in the midpiece of the sperm?

A

Mitochondria

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20
Q

What is present in the tail of the sperm?

A

Microtubules

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21
Q

What is the function of the sertoli cells?

A 
Blood-testes barrier 
Nutrientes
Phagocytosis 
Secrete seminiferous tubule fluid
Secrete ABG 
Secretes inhibin and activin
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22
Q

Describe the GnRH release in men?

A

Every 2-3 hours

Begins age 8-12

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23
Q

What is testosterone?

A

Steroid hormone derived from cholesterol

Secreted into blood and seminiferous tubules for sperm production

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24
Q

Effect of testosterone before birth?

A

Masculinises reproductive tract and promotes descent of testes and generation of external genitalia

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25
Role of testosterone in puberty?
Puberty and male characteristics (growth and maturation male reproductive system)
26
Role of testosterone in the adult?
Spermatogenesis Secondary sexual characteristics (male body shape, deep voice, thickening of skin), libido, penile erection, aggressive behaviour
27
What is capacitation?
A series of biochemical and electrical events before fertilisation (hyperactive motility, ability to bind ZP and AR)
28
How are spermatozoa attracted to oocytes?
Chemoattraction; binds to zona pellucida
29
What liquefies the spermatozoa?
Enzymes in prostate
30
Function of the epididymis and vas deferens?
Exit route from testes to urethra Concentrate and store sperm Site for sperm maturation
31
Function of the seminal vesicles?
Produce semen into ejaculatory duct, supply fructose, secrete prostaglandins (motility), secretes fibrinogen (clot precursor)
32
Function of the prostate gland?
Alkaline fluid (neutralizes vaginal acidity), produces clotting enzymes to clot semen within female
33
Function of the bulbourethral gland?
Mucus to act as lubricant
34
What is erection under control from?
Parasymp system
35
What % of infertility is due to male factor?
30% - biggest portion
36
What causes obstructive male infertility?
CF - mutation in one gene can result in bilateral absence of vas Vasectomy Infection
37
What causes non-obstructive male infertility?
``` Cryptorchidism Mumps orchitis Chemo/radiotherapy Testicular tumour Klinefelter's syndrome Globozoospermia Systemic disorder Endocrine ```
38
What pituitary tumours can cause male infertility?
ACromegaly Cushing's disease Hyperprolacinaemia
39
What hypothalamic causes can result in male infertility?
Idiopathic Tumours Kallmann syndrome Anorexia
40
What are the endocrine causes of male infertility?
``` Pituitary tumours Hypothalamic Thyroid Diabetes CAH Androgen insensitivity Steroid abuse ```
41
How is male infertility assessed?
``` See as couple Infertility history Andrology history Examination; general and genital Ix; semen analysis ```
42
What are the best questions to ask about testosterone?
Facial hair; will be reduced in low testosterone | Early morning erection
43
What are you examining in a genital male examination?
Testicular volume Presence of vas and epididymis Penis; urethral orifice (hypospadia) Presence of any varicocele or other scrotal swellings
44
What are the normal testicular volumes?
Pre-pubertal; 1-3mls | Adults; 12-25 mls
45
How do you measure testicular volume?
Orchidometer
46
What testicular volume is likely to be infertile?
Less than 5ml
47
What do you assess in semen analysis?
``` Volume Density Motility Progression Morphology ```
48
What is a normal semen volume?
1.5ml
49
What is the normal sperm concentration?
15 million sperm per ml
50
What is normal motility of sperm?
40
51
What is normal morphology of sperm?
4% morphologically normal
52
What are factors that can affect semen analysis?
Completeness of sample Period of abstinence; less than 3 days or over 7 day Cold condition whilst travelling Time between production and assessment over 1 hour Natural variations between samples Health of man 3 months prior
53
What are the clinical and endocrine features of obstructive infertility?
Normal testicular volume Normal secondary sexual characteristics Vas deferens may be absent Normal LH, FSH and testosterone
54
What are the clinical and endocrine features of non-obstructive infertility?
Low testicular vol Reduced secondary sexual characteristics Vas deferens present High LH, FSH +/- low testosterone
55
What is the treatment of male infertility?
Treat any specific cause e.g. reversal of vasectomy, cabergoline if hyperprolactinemia ICSI +/- surgical sperm aspiration Donor insemination
56
General advice for male infertility?
``` Frequent sexual inercourse; 2-3x a week Less than 4 units of alcohol per day Stop smoking BMI <30 Avoid tight fitting underwear and prolonged hot baths Certain occupations Complementary therapies Possible benefits of anti-oxidants ```
57
Treatment for anejaculation conditions?
Psychosexual treatment
58
What is ICSI?
``` Sperm prepared from semen Egg stripped Sperm immobilised Single sperm injected Success rate 35% ```
59
What is the indication for surgical sperm aspiration?
Azoospermia
60
What is surgical sperm aspiration?
Sperm aspirated surgically then injected into oocyte (ICSI_
61
What are the indications for donor sperm insemination?
Azoospermia or v low count, failed ICSI, genetic conditions, infective conditions
62
What is the pregnancy rate of donor sperm insemination?
15% per cycle

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