••• Chapter 54^ Infertility^549
❍ What is asthenospermia?
- Poor sperm motility.
- Associated with sperm autoantibodies, genital tract infection, varicocele, partial obstruction, and prolonged
abstinence. - Kartagener syndrome—primary ciliary dyskinesia resulting in poor sperm motility, also affects cilia of the
respiratory tract. - Nonmoving sperm can be viable—tests for viability include a dye test and the hypoosmotic sperm swelling test.
❍ What is teratospermia?
- High percentage of morphologically abnormal sperm.
- Considered severe if there is only 4% morphologically normal sperm by traditional WHO standards.
- Associated with varicocele and primary or secondary testicular failure.
- Most labs do not complete a “strict” morphology evaluation, this is done at specialized andrology labs using
specific criteria; most labs do a basic morphology assessment.
❍ Semen morphology may be graded using what “strict” criteria?
Kruger strict morphology. This assessment results in a more rigorous systematic evaluation of sperm morphology.
❍ What test is available to assess sperm function—attachment, penetration, and fertilization of ova?
There is no reliable test of sperm function!
❍ What should happen when abnormal semen parameters are found?
(1) Physical examination by urologist.
(2) Endocrine evaluation—particularly low sperm concentration or sexual dysfunction.
(3) Genetic evaluation—particularly for azoospermia or severe oligospermia.
❍ What are the four categories of male infertility?
- Hypothalamic-pituitary problems (1–2%).
- Primary gonadal disorder (30–40%).
- Disorder of sperm transport (10–20%).
- Idiopathic.
❍ What is cryptorchidism and what is it a possible sign of^?
Cryptorchidism—failure of testicular descent.
Testicular descent is an androgen-dependent process; therefore, it is more common in men with abnormal
testosterone production such as Klinefelter syndrome
❍ What are varicoceles?
A varicocele is a dilated pampiniform plexus, more common on the left than on the right.
❍ What is the treatment of clinically evident varicoceles?
Surgical repair may improve semen parameters and fertility rates in up to 40% of cases.