Subfertility, spermatogenesis Flashcards by M Y

Requirements for conception

Progressively motile normal sperm able to reach and fertilise oocytes
Timely release of a competent oocyte
Free passage through vagina, cervix, uterus and fallopian tube for sperm to reach oocyte
Mature endometrium for implantation

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Infertility

Inability to conceive after a period of time of frequent, unprotected intercourse requiring investigation and possible treatment
Affects 1 in 6

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General causes of infertility

Unexplained
Ovulatory
Male factor
Tubal abnormality
Endometriosis

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Indications for referral or investigation in women

Aged over 35
Amenorrhoea/oligomenorrhoea
Previous PID/STD
Abnormal abdo/pelvic examination

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Indications for referral or investigation in men

Previous genital pathology
Previous STD
Significant systemic illness
Abnormal genital examination

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Semen analysis

Sperm count>15 x 10^6/ml
Motility >40%
Morphology >4%
Vitality >58%
Volume 1.5-6.0ml

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Abnormal semen analysis

Testicular failure
Obstructive or non-obstructive azoospermia
Y chromosome microdeletion
Cystic fibrosis - congenital bilateral absence of vas deferens

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Female assessment

Screen for chlamydia and rubella
Ovarian reserve - LH, FSH, oestradiol, AMH, AFC
Ovulation tests - day 21 progesterone, LH surge testing kits
Tubal test

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AMH in males

Produced by sertoli cells until reproductive maturity due to testosterone and FSH production

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AMH in females

Produced by granulosa cells until early antral stage
Measures of ovarian reserve and response to ARTs
Increased AMH = Increased AFC = Increased OR

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Causes for anovulation

PCOS - normal FSH, LH and E2
POF - high FSH and low E2
Hypogonadotrophic hypogonadism - low FSH, LH & E2

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Monitoring ovulation

Basal body temperature
Ovulation(LH) testing kits
Day 21 Progesterone/follicular tracking (USSS)

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Hypogonadotrophic hypogonadism

complete shut down of ovaries as pituitary is not producing gonadotrophins

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Causes of abnormal tubal patency

PID due to chlamydia
Septic abortion
Ruptured appendix
Previous pelvic surgery
Ectopic pregnancy

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Imaging for tubal patency

Hysterosalpingogram HSG
Hysterosalpingo contrast sonography (HyCoSy)
Laprascopic dye

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HSG

Hysterosalpingogram
X-ray imaging of the uterine cavity and fallopian tubes using a dye
Performed 2-5 days after menstruation
Advantages: relatively safe, easy to use, clear delineation of uterine cavity and fallopian tubes
Disadvantages: unable to assess pelvic peritoneum
Ideal imaging for most women

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HyCoSy

Hysterosalpingo contrast sonography
Speculum inserted into vagina with catheter, water then dye injected to check fallopian tube patency and check uterus during ultrasound scan
Disadvantages: time consuming and requires training
Used in fertility clinics rather than NHS

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Laprascopic dye

GOLD STANDARD
Need to screen for chlamydia
Advantages: live imaging of uterus and fallopian tube with greater sensitivity and specificity, used to diagnoses adhesions and endometriosis
Disadvantages: Invasive procedure

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Induction of ovulation

Clomifene/clomiphene (oestrogen receptor blocker to increase FSH)
FSH and LH injections (FSH for a few days to develop follicle then LH for ovulation)

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Use of FSH and LH injections for ovulation induction

If resistant to clomifene

Hypogonadotrophic hypogonadism - no or low FSH production

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ARTs

Intrauterine insemination treatment
In-vitro fertilisation
Controlled ovarian hyperstimulation

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Controlled ovarian hyperstimulation

The use of fertility medications to induce ovulation by multiple ovarian follicles

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IVF

Study These Flashcards

Egg collection - may be frozen
Intra-cytoplasmic sperm injection - helpful for men with low sperm count
Embryo development - implanted into endometrium after day 5

IVF live birth rate

Study These Flashcards

national average 30-35% in under 35s

IVF live birth rate

national average 30-35% in under 35s

Function of testes

Spermatozoa and hormones

Structure of seminiferous tubules

Surrounded by myoid cells and basement membrane | Within - sertoli cells and spermatogenic cells

Pituitary control

LH stimulates Leydig to produce androgens | FSH stimulates Sertoli cells for spermatogenesis and conversion of testosterone to DHT by 5-alpha reductase

Testosterone synthesis

From acetate and cholesterol in Leydig cells | 4-10mg per day

Hypophysectomy

Removal of pituitary gland causing shrinking of testes and spermatogenesis to arrest

Areas of seminiferous tubules

Basal compartment for mitosis | Adluminal compartment meiosis

Mitosis

Prospermatogonia reactivated at puberty A1 and B spermatogonia Primary spermatocyte

A1 spermatogonia vs B spermatogonia

A1 spermatogonia replenish spermatogonia | B spermatogonia form mature sperm

Meiosis

Meiosis I: secondary spermatocytes formed (2 cells with 2 pairs of chromosomes) Meiosis II: haploid spermatids (4 cells with 1 chromosome in each new cell)

Spermiation

Release of spermatozoa into lumen of seminiferous tubules

Packaging

``` Tail for propulsion Mid-piece for mitochondrial energy Nucleus to package chromosomes Cap to aid sperm-oocyte fusion Acrosome to penetrate oocyte ```

Spermatogenesis

Mitosis Meiosis Packaging Completed in 64 days

Residual body

Dustbin for unwanted cytoplasm during packaging | Eaten by sertoli cells

Final maturation of spermatozoa

Enter rete testis, pass through vasa efferentia and into epididymis Physiological maturation of sperm between rete testis and epididymis to improve sperm motility - dependent on androgen stimulation

Spermatogenic wave

Multiple spermatogenic processes are occurring simultaneously in the same seminiferous tubule

Spermatogenic cycle

Time taken for appearance of the same stage within a given stage of the seminiferous tubule (16 days)

Semen formed by...

Seminal vesicle Prostate Bulbourethral gland

Cellular component of semen

Spermatogenic cells, spermatozoa, epithelial cells, leucocytes

Fluid component of semen

Fructose Buffer for vaginal acidity Sorbitol Antioxidant e.g. VitC

Capacitation

Glycoproteins stripped from sperm surface as sperm travel through female reproductive tract to prepare the sperm for the acrosome reaction and fertilisation of egg Causes hyperactive motility of sperm (from circular to whiplash movements)

What does the endocervix offer the sperm?

Thin, watery mucus to allow easy passage Protection from vagina Reservoir within endocervical crypts Supplementation of energy requirements

Morphological variations of sperm

Head defects Tail defects Neck and midpiece defects

Normozoospermia

normal sperm values

Oligozoospermia

Low concentration

Asthenozoospermia

Too little motility

Teratozoospermia

Too many abnormals

Oligoasthenoteratozoospermia

Mixture of low concentration, too little motility and abnormal sperm

Azoospermia

No spermatozoa

Aspermia

no ejaculate

Biopsy of ST

Need to take 30 seminiferous tubules to fully understand the spermatogenesis

Subfertility, spermatogenesis Flashcards

(55 cards)