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42 Cards in this Set
- Front
- Back
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FSH and LH act on which cells in the testicle?
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FSH acts on sertoli cells and inhibin is the mediator of feedback inhibition, LH acts on Leydig cells and testosterone is the mediator to pituitary
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How many meiotic divisions occur to produce mature sperm?
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germ cells undergo many mitotic divisions to produce primary spermatocytes which then under 2 meiotic divisions to first produce secondary spermatocytes and then spermatids
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where does sperm maturation occur?
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epididymis
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what does PSA do?
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secreted by prostate epithelium serves as a protease enzyme for semen liquefaction
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what is the acrosome?
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a cap on the sperm head that contains enzymes necessary for drilling into the zona pellucida of the egg
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Pt develops retrograde ejaculation after RPLND, which nerves are injured?
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TL sympathetic nerves control closure of BN during seminal emission via norepinephrine; alpha agonists can sometimes helpe
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men with non-obs azospermia can have DNA microdeletions in which genes?
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AZF (azospermia factor) on the Y chromosome
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what chromosome is CFTR gene located?
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7
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Pt with primary infertility with normal sperm count, but zero motility. Viability staining shows that sperm are alive. Semen culture and antisperm antibody testing is negative. Which syndrome is suspected?
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immotile cilia syndrome. If he has chronic sinusitis, bronchiectasis, and situs inversus then he has Kartagener's syndrome
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Pt with Klinefelter's and small number of sperm in ejaculate. What is his karyotype?
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46, XY/47, XXY mosaic
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what is normal adult testicular size?
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20cc or greater volume and at least 4cm length
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Pt with infertility c/o new onset R varicocele, what must you do next?
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CT to r/o R retroperitoneal mass
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what is the morphologic semen stress pattern from varicocele?
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inc number with tapered heads, immature germ cells, and amorphous sperm cells
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what % of pts will see improvement in semen analysis after varicocelectomy?
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70%; motility is most often improved followed by count and then morphology
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Pt with primary infertility and oligoasthenoteratospermia has low-normal levels of FSH, LH, and T; what medication can be used to improve semen parameters?
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clomiphene citrate: while most pts will have an inc in FSH, LH, and T, only a small subset of pts will obtain an improvement in semen parameters
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what are the signs of Kallman's syndrome?
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low FSH, LH, T, and anosmia; defect in the hypothalamus (tertiary hypogonadism)
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Is having mumps at the age of 6 important in infertility?
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No, only postpubertal mumps can result in testicular damage and atrophy
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what are normal values for sperm count, motility, and morphology?
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count greater than 50 million, motility greater than or equal to 50%, and 50% or more normal forms by WHO criteria
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what is most commonly the cause of secondary infertility?
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varicocele in 80%
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what % of couples are infertile and how often is a male factor present?
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15% of couples are infertile; 50% of cases have a male factor present
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tall, thin patient with gynecomastia and infertility:
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Klinefelter's; small, firm testes, azoospermia, 47 XXY
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Marijuana smoker with infertility:
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dec sperm concentration, motility, abnl morphology, dec serum T nnd gynecomastia; drug alters HPG axis
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Pt who receives 4 courses of cisplatin-based chemo for testis cancer; now azoospermic; will he regain spermatogenesis?
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Yes; 80% chance of complete return
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How long does spermatogenesis take?
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74 days; including ductal transit time, the time from spermatogenesis to ejaculation is about 3 mos
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when is post radiation return of spermatogenesis?
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up to 5 yrs; conception should be avoided for 2 yrs b/c direct effects of DNA can result in numerical and structural chromosomal abnormalities
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what's the underlying cause of infertility in Prader-Willi and Laurence-Moon--Biedl syndrome?
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hypogonadotropic hypogonadism
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What % of infertile men have chromosomal abnormalities?
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6%
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what percentage of infertile men have varicoceles?
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30-45%
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what % of infertile men have no known cause?
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about 25%
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An isolated bundle of dec sperm motility suggest what?
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antisperm antibodies or a varicocele
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how often do varicocelectomy improve semen parameters?
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2/3; usually see improvement by 3 mos
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what is overall success rates of assisted reproduction?
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about 15-20% per cycle or 50% overall
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what semen parameters suggest eventual need for ICSI?
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500,000 sperm or less than 5% motile sperms, less than 4% normal morphology, and less than 2 million sperm/mL
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what is optimal timing for intercourse mid-cycle?
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every 48jrs
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how often are testicular cancer pts oligospermic?
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60%
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How do clomiphene and tamoxifen work in male inferitlity?
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mild anti-estrogens; work best in men with low-normal testosterone and FSH levels
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what is the estimated inc in malformation rates from IVF and ICSI?
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overall, about 29% higher risk
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what % of men develop significant antisperm antibodies after vasectomy?
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60%
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what is the fertilization and pregnancy rates for ICSI?
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about 60% fertilization and 35% pregnancy rates overall
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define oligospermia:
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less than 20 million sperm
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define teratospermia:
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less than 30% normal morphology
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T/F:a semen fructose level less than 120mg/dL suggests ejaculatory duct obstruction?
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True
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