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Dr.Niraj Mahajan
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Male Infertility

By AdminPosted On 05-Oct-2016

1. Semen Analysis

A young male, underwent semen analysis for infertility. His sperm count is 8 mill/ml with motility 60% and no clot formation and 50% normal cells. The interpretation of this would be

a) Oligospermia
b) Azoospermia
c) Motility disorder
d) Antisperm antibodies
e) Normal

Correct Answer: a) Oligospermia.Please check new WHO guidelines below:

Semen Parameters  WHO 1999   WHO 2010
1) Volume  2 ml  1.5 ml
2) Concentration20 million/ml 15 million/ml
3) Progressive motility  50% 32%
4) Normal forms   14.00%4.00%

2. Spermatogonia matures into Spermatozoa

a) 14 days b) 40 days c) 72 days d) 96 days e) 120 daysCorrect Answer: c) 72 days. For humans, entire process of spermatogenesis takes 72 days. Including the transport on ductal system, it takes 3 months.

3. Aspermia is the term used to describe:

a) Absence of semen
b) Absence of sperm in ejaculate
c) Absence of sperm motility
d) Occurrence of abnormal sperm

Correct answer : a) Absence of semenAspermia is the complete lack of semen (not to be confused with azoospermia, the lack of sperm cells in the semen). In this condition, males usually reach orgasm and experience the sensation of ejaculation, but do not actually ejaculate semen, meaning there is no semen released from the body. There are two noted causes of aspermia: retrograde ejaculation and ejaculatory duct obstruction.

4. Impaired Semen Quality

Which chromosomal abnormality has a known association with severely impaired semen quality?a) Formation of isochromosomes of the X chromosome b) Formation of ring chromosomes c) Microdeletions of the X chromosome d) Microdeletions of the Y chromosome e) Paracentric inversion of the Y chromosomeCorrect Answer: d) Microdeltions of the Y chromosomes. There is a known association of microdeletions and men with impaired semen quality undergoing intracytoplasmic sperm injection.
It is suggested that these lesions may result in oligospermia or azoo
spermia. This is confirmed on testicular biopdy. These can be transferred to the male offsprings. Y microdeletion screening may be beneficial not only to define the aetiology of spermatogenic failure, but also because it may provide information that can lead to a more appropriate clinical plan for both the infertile male and his future male child.

5. Male infertility - Cystic Fibrosis

Male infertility in a patient with cystic fibrosis is likely to be due to which condition?

a) Congenital absence of testes
b) Congenital absence of vas deference
c) Hypothalamic failure
d) Oligospermia
e) Testicular failure

Correct Answer: b) Congenital absence of vas deference. Male infertility in patients with cystic fibrosis is due to obstructive azoospermia. Other causes of azoospermia are idiopathic epididymal obstruction, infections, vasectomy, or other iatrogenic injuries to the male reproductive tract. In these cases, couples should undergo karyotyping of the woman to determine if she is a carrier of the gene. Patients have the option of assisted reproduction treatment, retrieving the sperm from the epididymis or testes, followed by intracytoplasmic sperm injection.

6. Male Infertility - Azoospermia

Couple has presented for infertility workup. Man has azoospermia, testicular atrophy and gynaecomastia. Which karyotype result would be most likely in this case?

a) 46 XX
b) 46 XY
c) 47 XXY
d) 47 XYY
e) 47 XY+21

Correct Answer: c) 47 XXY. This is a likely description of Klinefelter’s syndrome. The karyotype in this case is normally 47 XXY. The other variants that present are XXYY or XXXY. The affected individual is generally tall and has feminine fat distribution. Other features include small testes, external genitalia and low gonadotrophin levels.

7. Klinefelter’s syndrome - Primary Male Infertility

A 22-year-old presents with primary infertility (azoospermia). He is relatively tall for his family with mild gynaecomastia and soft, small testicles. What it is the potential genetic cause? a) 45 XO
b) 47 XXX
c) 47 XXY
d) 47 XYY
e) Trisomy 15

Correct Answer: c) 47 XXY. The clinical history is compatible with Klinefelter’s syndrome. It has an incidence of 1 in 650 males. It occurs due to non-disjunction occurring during meiosis.

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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