Male Infertility Causes and Patient History
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Questions and Answers

What is the normal pH of semen?

  • 8.5
  • 6.5
  • 7.0
  • 7.8 (correct)
  • Which syndrome can present with subvirilization and gynecomastia?

  • Sertoli cells-only syndrome
  • Cryptorchidism
  • Klinefelter syndrome (correct)
  • Orchitis
  • What causes primary infertility?

  • The inability to achieve conception despite less than 6 mo of unprotected intercourse
  • The failure to conceive after one year of frequent unprotected intercourse with any partner (correct)
  • The inability to maintain an adequate erection for vaginal entry in half or more attempts
  • The inability to conceive despite prior successful conception with current or previous partners
  • What is the first choice of treatment for prolactinoma?

    <p>Cabergoline</p> Signup and view all the answers

    Which condition can cause congenital bilaterally aplasia of the vas deferens?

    <p>Cystic Fibrosis</p> Signup and view all the answers

    What does the parasympathetic system cause during penile erection?

    <p>Vasodilation of the helicine arteries</p> Signup and view all the answers

    What neurotransmitter helps relax the smooth muscle helicine arteries during penile erection?

    <p>[Nitric oxide]</p> Signup and view all the answers

    Which enzyme degrades nitric oxide to end the penile erection process?

    <p>[PDE-5 enzyme]</p> Signup and view all the answers

    When should semen be collected for analysis?

    <p>[2-7 days after sexual abstinence]</p> Signup and view all the answers

    'Secondary infertility' occurs when:

    <p>[There was a previous conception with current or past partners but no current conception]</p> Signup and view all the answers

    What is the purpose of a vacuum erection device?

    <p>To engorge the penis with blood by creating negative pressure</p> Signup and view all the answers

    Which factor can lead to artherosclerotic or traumatic occlusive disease causing erectile dysfunction?

    <p>Smoking</p> Signup and view all the answers

    What is the purpose of a tourniquet-like ring used with a vacuum erection device?

    <p>To restrict blood from flowing out of the penis</p> Signup and view all the answers

    Which function does Alprostadil injections serve in the management of erectile dysfunction?

    <p>To lead to muscle relaxation and erections</p> Signup and view all the answers

    What is the nocturnal penile tumescence test primarily used for?

    <p>To assess penile response during sleep</p> Signup and view all the answers

    Why is a vacuum erection device not to be used for longer than 30 minutes?

    <p>It can cause tissue necrosis</p> Signup and view all the answers

    What is the primary basis for diagnosing erectile dysfunction?

    <p>Physical exam findings and patient history</p> Signup and view all the answers

    What is the first-line treatment for premature ejaculation according to the text?

    <p>SSRI (paroxetine)</p> Signup and view all the answers

    What is the recommended duration for using a vacuum erection device?

    <p>30 minutes</p> Signup and view all the answers

    What is the main cause of gynecomastia in male patients that could lead to infertility?

    <p>Hyperprolactinemia</p> Signup and view all the answers

    Which condition could a patient have if they display small, soft testicles?

    <p>Sertoli cells-only syndrome</p> Signup and view all the answers

    Which genetic condition is associated with reduce to no sperm in the sperm count?

    <p>Klinefelter syndrome</p> Signup and view all the answers

    What is the first choice of treatment for abnormally high prolactin levels in male patients?

    <p>Cabergoline</p> Signup and view all the answers

    Which artery supplies the penis with blood during penile erection?

    <p>Internal iliac artery</p> Signup and view all the answers

    What is the main type of erectile dysfunction characterized by life-long inability to initiate an erection?

    <p>Primary erectile dysfunction</p> Signup and view all the answers

    What is the primary function of nitric oxide during penile erection?

    <p>Relaxing smooth muscle helicine arteries</p> Signup and view all the answers

    What do PDE-5 inhibitors primarily work by preventing?

    <p>Degradation of a key agent for erection</p> Signup and view all the answers

    What neurotransmitter helps in inhibiting the ejaculation center and postponing premature ejaculation when pain signals are detected?

    <p>Serotonin</p> Signup and view all the answers

    Study Notes

    Male Infertility

    • Infertility is defined as the inability to achieve conception despite one year of frequent unprotected intercourse.

    Causes of Male Infertility

    • Patient history is crucial in diagnosing infertility, including timing and frequency of intercourse.
    • Avoiding vaginal lubricants is recommended due to the potential of spermicide.
    • Pediatric history, including orchitis, testicular torsion, and cryptorchidism, can contribute to infertility.

    Physical Exam of the Male Patient for Infertility Causes

    • Gynecomastia in male patients may be caused by hyperprolactinemia.
    • Klinefelter syndrome can present with subvirilization and gynecomastia.
    • Small, soft testicles may indicate Sertoli cells-only syndrome due to hypogonadism.
    • Small, hard testicles are a finding linked to Klinefelter syndrome.

    Semen Analysis Results

    • Semen should be collected 2-7 days after sexual abstinence with 2 separate collections at least 7 days apart.
    • Normal semen pH is 7.8, and more acidic semen fluid may indicate ejaculatory duct obstruction.
    • A red colored semen could indicate prostate inflammation.
    • At least 32% of sperm should be mobile in a semen sample under a microscope.

    Genetic Evaluation

    • Y chromosome microdeletions assessment can be used to determine non-obstructive azoospermia.
    • Cystic Fibrosis can cause congenital bilaterally aplasia of the vas deferens.
    • Klinefelter Syndrome is the most common cause of non-obstructive azoospermia.
    • XYY (called Jacob’s syndrome) can cause reduced to no sperm in sperm count.

    Endocrine Testing

    • Endocrine testing is recommended in male infertility for abnormally low sperm concentrations, impaired sexual function, or physical exam findings of endocrinopathy.
    • Initial tests include morning serum testosterone, serum follicle stimulating hormone, and luteinizing hormone.
    • Cabergoline is the first choice of treatment for prolactinoma.

    Types of Male Infertility

    • Primary infertility is the failure to conceive at any time in the past year with any partner.
    • Secondary infertility occurs when there was prior conception with current or previous partners, but now the inability to conceive despite one year of frequent unprotected intercourse.

    Neurophysiology of Penile Erection

    • The internal iliac artery supplies the penis with blood.
    • In the flaccid state, the helicine arteries are tonically contracted with little blood in the cavernae.
    • During the erect state, the helicine arteries dilate to allow the cavernae to fill with blood and compress the veins against the tunica albuginea.
    • The parasympathetic system causes the vasodilation of the helicine arteries.
    • Pain signals from pinching the glans of the penis will inhibit the ejaculation center and postpone premature ejaculation.
    • The main neurotransmitter to relax the smooth muscle helicine arteries to allow for penile erection is nitric oxide.
    • Nitric oxide does not keep the deep artery dilated permanently, and the active agent is degraded by PDE-5 enzyme to end the erection.
    • PDE-5 inhibitors work by preventing the degradation of the active agent to allow for erection, but they do not work without sexual stimulation.

    Physiology of Sexual Intercourse

    • During the emission stage of ejaculation, the ductus deferens contracts and moves sperm into the urethra.
    • During the expulsion stage of ejaculation, the internal urethral sphincters contract to push sperm out.

    ED Classifications and Diagnostics

    • Erectile dysfunction is the inability to maintain an adequate erection for vaginal entry in half or more of one's attempts.
    • There are neurogenic, vasculogenic, endocrine, and drug-causes types of erectile dysfunction.
    • Primary erectile dysfunction is the life-long inability to initiate erection beginning with the first sexual encounter.
    • The main type of neurogenic erectile dysfunction is diabetes mellitus, with a three-time higher risk of ED in diabetic patients.
    • Smoking, hyperlipidemia, and hypertension can cause artherosclerotic or traumatic occlusive disease leading to erectile dysfunction.
    • Diagnosis of erectile dysfunction tends to be based on physical exam findings and patient history.
    • Nocturnal penile tumescence test is rarely used, recording erections.

    Management of ED

    • A vacuum erection device creates negative pressure surrounding the penis to engorge it with blood, but a tourniquet-like ring must be placed to keep the blood in the penis.
    • Alprostadil injections can lead to muscle relaxation and erections.
    • SSRI (paroxetine) is a first-line treatment for premature ejaculation.

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    Description

    Learn about the causes of male infertility and the importance of patient history in assessing fertility issues. Understand the significance of timing, frequency of intercourse, and avoiding vaginal lubricants when trying to conceive. Explore the connection between past conditions like orchitis and current fertility problems.

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