550 Obstetrics and Gynecology Board Review •••
❍ How does aging affect male fertility?
- As a man ages, there is a decrease in semen volume, sperm motility, and proportion of morphologically normal
sperm. - Pregnancy rates decrease and time to conception increases as men age.
- IVF data, however, is inconclusive in couples using donor eggs where male partner age is the dependent
variable: some studies show no impact of male age where others demonstrate an age impact. - Male germ cells, (spermatogonia), undergo more mitotic replications than female germ cells; however, it is not
clear whether there is any increased risk of miscarriage with age; - Sperm overproduction thought to buffer affects of aging as there is no measurable decrease in male fertility
before age 45 to 50.
❍ A male with low testosterone and serum gonadotropin values <5 IU/L or lower would have what diagnosis?
Hypogonadotropic hypogonadism.
❍ What should be done when hypogonadotropic hypogonadism is diagnosed?
Check a prolactin level and obtain an MRI of the brain to look for an adenoma.
❍ How is congenital versus adult onset hypogonadotropic hypogonadism treated differently?
If spermatogenesis was never initiated as in prepubertal/congenital hypogonadotropic hypogonadism, the patient
must be treated with LH (hCG) and FSH.
If azoospermia occurs after puberty, spermatogenesis can be resumed and maintained with hCG alone.
❍ What is the treatment of adult hypogonadotropic hypogonadism?
hCG 2000 IU IM three times per week for 6 months followed by 37.5 IU of FSH IM three times per week, or
pulsatile administrations of gonadotropin-releasing hormone (GnRH) 4 mg q 3 hours by an infusion pump.
❍ What is the most common cause of retrograde ejaculation and how is it diagnosed?
The most common cause is prostatectomy. The second most common cause is testicular carcinoma. Diagnosis is
made by finding ejaculate of low volume with azoospermia or severe oligospermia and multiple sperm in urine
specimen postejaculation.
❍ How do you treat retrograde ejaculation?
Phenylpropanamide 75 mg bid or ephedrine sulfate 25 mg qid or urine can be collected and sperm can be
harvested from the urine for insemination.
❍ Exposure to which drug toxins is hypothesized to produce disorders of sperm production?
Chemotherapeutic agents.
Sulfasalazine.
Alcohol.
Cimetidine.
Lead, cadmium, mercury.
Carbon disulfide industrial solvent.
Nematocide (DBCP).
Beta-blockers.