Infertility - Men Flashcards
What are the major causes of infertility in men?
Epididymitis due to STDs CF CBAVD Testicular Maldescent Varicocele Hypospadias Tumours Azoospermia
How does CF cause infertility?
Leads to mutations in the Vas Deferens
What is CBAVD?
Congenital Bilateral Absence of Vas Deferens
What is varicocele?
Dilatation of pampiniform venous plexus
Surgically repairing it doesn’t actually help pregnancy rate so we often don’t (For fertility anyway)
What are the types of Azoospermia?
Testicular:
- Normogonadotrophic
- Hypogonadism
- Hypergonadotrophic
Post-testicular (Obstructive)
Give an example of hypogonadism causing Azoospermia?
Klinefelter syndrome
- Very small testes
- Caused by a chromosomal aneuploidy XXY
What could cause obstructive azoospermia?
- Iatrogenic
- Congenital e.g. CF
- Infection
What would we want to ask a man about fertility?
- Change in body hair
- Testicular Descent
- PMH relating testicles, chemo or radiotherapy.
- Occupational history
- Sexual history
- Drugs & Environmental
What do we look for on exam for man’s fertility?
BMI
Fait/Hair distribution (hair loss due to hypoandrogenism)
Abdo & inguinal Exam
Genital Exam
What sources of infertility could we spot on a genital exam?
- Undescended or too small testes
- Epididymitis
- Lack of Vas Deferens
- Varicocele
- Hypospadias
What investigations can we do for male infertility?
History & exam FSH, LH, Testosterone & PRL Karyotyping CF screen Computerised Semen Analysis
Give some rough reference values for sperm concentration?
Lower reference value is 15million/ml
<15 is oligospermia
<5 is severe
0 (or close) is termed Azoospermia
How do we manage a male whos infertile?
If they are in fact producing sperm we can do Surgical Sperm Retrieval for IVF by either:
- Micro-epididymal Sperm Aspiration
- Testicular Sperm Extraction
How do we measure testicular size?
Orchidometer
Anything smaller than 15ml is small
