Specialty fertility clinics have many new techniques to help couples conceive. M

Question

Specialty fertility clinics have many new techniques to help couples conceive. Male infertility is at least half the question that must be considered with any infertile couple. In the U.S., about 15% of couples experience some problems conceiving. More and more couples are seeking help and today at least 1% of all newborns in the U.S. are due to help using IVF, which is an abbreviation for

________________________________________________________________________________.

Or ICSI, Intra-Cytoplasmic Sperm Injection, where sperm are injected into the oocyte. If a

sperm has to be injected, what are they missing that is inside the acrosome? ____________________

A thorough history and physical is done, along with a microscopic sample of an ejaculate sample. If the sample is abnormal, a second sample is scheduled over 2 months in the future. Why wait so long?

__________________________________________________________________________________

Sometimes the sample has azoospermia, what is that? ______________________________________

A medical work up starts with a test of the “pretesticular hormones’, what are they? _______________ If those hormones are low, synthetic anterior pituitary hormones can be given.

Tests of the testicular hormones are also done. What are those (2)? __________________________________________________________________________________

A testicular biopsy can be done and sometimes finds that the ONLY cells in the testes are Sertoli cells.

What do Sertoli cells do? ___________________________________________________________

We also want Interstitial cells that release _______________________________ and spermatogonia that produce the sperm. Because testicular tissue would be harmed by biopsy, they may hold off doing that procedure. If the hormones are normal but the sample was not, then a trans-rectal ultra sound can be done to examine the seminal vesicle and the ductus deferens. In some patients, that may show an obstruction of the ductus and in others it may show a lack of a ductus deferens. Absence of the ductus deferens is associated with Cystic Fibrosis, what is that?

There are many different mutations of CF. Some variants may cause more digestive than respiratory problems and not all people have the same severity of symptoms. So, it is possible for a person to have a milder form of CF and not know it. If a person does not have a ductus, genetic testing is offered.

Another reason for low volume ejaculate and no sperm would be retrograde ejaculate, what is that?

________________________________________________________________________________

Sometimes using an alpha agonist such as pseudoephedrine helps reverse this issue. What does it do to the bladder sphincter?

______________________________________________________________________________

Obviously if a patient is on an alpha blocker drug, they may have retrograde ejaculation. What are 2 common reasons for prescribing alpha blockers?

Explanation / Answer

IVF: In-vitro fertilization

ICSI has to be done if the sperm lacks digestive enzymes in the acrosome (such as hyaluronidase and acrosiin)

The second sample is taken late so that in case the abnormality is caused by a temporary factor, such as drugs, the abnormal sperm will be replaced by healthy sperm in about that time.

Azoospermia: lack of sperm in the ejaculate

Follicle stimulating hormone (FSH) and Interstitial cell stimulating hormone (ICSH)

Testosterone and estrogen

Sertoli Cells: production of sprematozoa from germ cells

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