Credits

• Section Writer: Dr. Om J Lakhani
• Section Editor: Dr. Om J Lakhani

Other Genetic anomalies

Q. What is Macrozoospermia?

• It is a form of Teratospermia
• It is because of the lack of an enzyme called Aurora kinase C
• This enzyme is responsible for the cell division
• Because of the lack of this enzyme- the sperms have extra chromosomes, which gives it a large head
• This abnormal sperm often leads to infertility or miscarriage because of extrachromosomal material

Q. What is globozoospermia?

• This is also a form of Teratospermia
• In this, the head of the sperm is a globe in shape instead of oval because of the lack of the acrosomal cap.
• This is because of a genetic defect in DPY19L2 gene

Sperm Retrieval

Q. What are the various techniques for Sperm retrieval?

• PESA - Percutaneous epididymal sperm aspiration
• MESA - Microsurgical epididymal sperm aspiration
• TESA - Transcutenous epididymal sperm aspiration
• TESE - Transcutenous epididymal sperm extraction
• MicroTESE
• Vasal Aspirate

Q. Which of these techniques is good for obstructive azoospermia?

• Any of the above may be used for obstructive Azoospermia

Q. Which is better for Non-obstructive azoospermia (NOA)?

• MicroTESE

Other points

Q. What are the grades of Varicocele?

• Grade 1- only on cough impulse
• Grade 2- palpable not visible
• Grade 3- visible

Q. When is ICSI preferred over conventional IVF?

• Sperm count - <2 million
• Motility - <5%
• Normal morphology <5%
• Poor sperm – cervical mucous interaction
• Antisperm antibody

Q. What is the secular trend in sperm count?

• There is a secular trend towards falling sperm count

Q. How many semen analyses must be done before drawing any conclusion?

• 2-3 samples over 2-3 months

Q. Does the WHO 2010 data for Semen analysis include Indian patients?

• No

Q. Which is the most important parameter in the WHO semen analysis according to Infertility specialists?

• Most important parameter is morphology
• Morphology > 4% is associated with sperm count
• If overrides other factors

Q. What is leuckocytospermia?

• It is peroxide positive WBC >10 ^ 6 /ml
• This generally gives poor results if there are WBC in the sperms

Q. What is the success rate after ICSI?

• 40%

Q. What is the effect of reactive oxygen species in sperms?

• It causes DNA fragmentation
• It may lead to idiopathic male infertility

Q. What is IMSI?

• Intracytoplasmic morphologically selection sperm injection

Q. What is P-ICSI?

• Petri Dish ICSI
• Use of hyaluronic acid-binding to select sperms for ICSI

Q. What test must be considered for patients with repeated IVF failure?

• Test for DNA fragmentation

Q. What is semen preparation?

• It is washing of semen done to remove debris, WBC, bacteria, etc
• It is ideally done within 30 min of ejaculation

Q. Name some semen preparation techniques?

• Swim-up
• Density gradient centrifugation
• Percoll gradient

Q. What is the sperm cutoff and various ART?

Q. Which is the oldest sperm function test?

• Sperm – cervical mucus interaction
• Not used much these days

Q. What is the investigation of choice for immotile sperm?

• Hypoosmotic sperm swelling

Q. When should genetic testing be considered for male infertility?

• When sperm count <10 million / ml

Q. Which mutation is specifically associated with azoospermia?

• Yq microdeletion = AZF – azoospermia factor deleted

Q. Which is the newest deletion recorded?

• Gr/gr deletion- increase risk of oligospermia and also testicular germ cell tumors

Q. Should varicocele with OAT/Azoospermia be treated?

• Yes
• Evidence suggests there is improvement in sperm parameters and fertility after Surgery of varicocele

Q. How does varicocele impact male fertility?

• It increases reactive oxygen species and causes DNA fragmentation
• it reduces the sperm count
• It leads to smaller size testis and also lowers the testosterone