554 Obstetrics and Gynecology Board Review •••
❍ What are oligospermia, asthenospermia, and teratospermia?
Oligozoospermia—Low concentration of sperm.
Asthenozoospermia—Decreased motility.
Teratozoospermia—Abnormal sperm morphology.
❍ What is the most severe case of male infertility?
Azoospermia—No sperm in ejaculate (prevalence 1%).
❍ What are the two types of azoospermia?
Obstructive azoospermia—Due to obstruction of outflow; occurs with absence of vas deferens or surgical ligation
of vas deferens as well as severe infection.
Nonobstructive azoospermia—No obstruction identified; testicular failure.
❍ What are the four types of procedures used to obtain sperm from patients with obstructive azoospermia?
TESA: Testicular sperm aspiration
PESA: Percutaneous epididymal sperm aspiration
MESA: Microepididymal sperm aspiration
TESE: Testicular biopsy
❍ What is a varicocele? How does it affect fertility?
Dilation of the pampiniform plexus of the spermatic vein is known as a varicocele (ie, a varicosity of the spermatic
vein). Approximately 40% of men have a varicocele commonly occurring on the left side because the right
spermatic vein drains into the inferior vena cava (a shorter distance); however, a severe varicocele can cause a
decrease in sperm production by increasing the temperature of the left testes, which then heats up the right testes.
❍ What is ovarian reserve? How is it assessed?
Ovarian reserve is essentially the quantity and quality of the remaining egg supply that a woman has. Women are
born with approximately 2 million oocytes and do not generate any new eggs. Men constantly produce new
sperm. By the age of 37, approximately 200,000 or 10% of the original egg supply remains.
The three most commonly used tests of ovarian reserve are the “Day 3 FSH level,” the “Clomiphene Challenge
Test,” and the “Basal Antral Follicle Count.” Essentially, if the pituitary is secreting comparatively high levels
of FSH in order to achieve normal follicular development, this indicates a poor egg supply. The Basal Antral
Follicle Count is an estimate of the number of small follicles seen without any stimulation.
❍ How is an IVF cycle performed?
(1) Supraphysiologic doses of gonadotropins (follicle-stimulating hormone, FSH and luteinizing hormone, LH)
are given to stimulate the ovaries to produce multiple eggs.
(2) Ultrasounds are performed to monitor the growth of the follicles containing the oocytes as well as the rising
serum estradiol levels resulting from multifollicular development.
(3) Human chorionic gonadotropin (hCG) is given to simulate an “LH surge.”
(4) Just prior to the time that ovulation would have occurred, the eggs are aspirated from the ovary under
transvaginal ultrasound guidance and sedation anesthesia.
(5) In the IVF laboratory, the oocytes are incubated or injected with sperm.