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Self-Assessment Questions

Urology

Male Infertility: Review Questions

Jonathan Mobley, MD and Stanley Zaslau, MD

Dr. Mobley is a senior resident, Section of Urology, West Virginia University, Morgantown, WV. Dr. Zaslau is a program director and assistant professor, Section of Urology, West Virginia University, Morgantown, WV.


Choose the single best answer for each question.

1. A 37-year-old man is referred for an infertility work-up. He and his 35-year-old wife have attempted to conceive for the past 9 months. The couple has not used contraceptive methods during this interval. The patient describes normal sexual practices with frequency approximately every other to every third day. He has no significant medical, surgical, family, or social issues. He takes no medications and does not use alcohol, tobacco, or illicit drugs. Physical examination reveals a well developed and nourished man with average build. His genitourinary examination reveals normal virilization, a circumcised phallus, a urethral meatus located at the tip of the glans, bilateral descended testicles with no palpable masses, bilateral palpable vas deferens, and a nontender prostate with normal size and consistency. Semen analysis reveals normal pH, sperm concentration, total number, motility, morphology, and viability. The volume was 1.4 mL. What is the next step in this couple’s management?
  1. Watchful waiting until 1 year of failed fertilization
  2. Repeat semen analysis
  3. Postejaculatory urinalysis
  4. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone
  5. Scrotal ultrasound
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2. A 35-year-old man is referred to a urologist for azoospermia. Physical examination reveals bilateral descended testes with normal testicular volume. The vas deferens are absent bilaterally. What is the next step in this patient’s management?

  1. Karyotyping
  2. Testing for Y chromosome microdeletions
  3. Testing for cystic fibrosis mutations
  4. Scrotal ultrasound
  5. Vasogram
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  3. What is the most common treatable cause of male infertility?
  1. Androgen deficiency
  2. Cigarette smoking
  3. Cryptorchidism
  4. Ejaculatory duct obstruction
  5. Varicocele
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4. Which statement concerning testing for asthenospermia (ie, defects in sperm movement) is correct?

  1. Direct assays detect serum antisperm antibodies
  2. Kallman’s syndrome should be suspected in patients with immotile sperm, situs inversus, and recurrent upper respiratory tract infections
  3. Patients with negative antisperm antibody assays should undergo serum prolactin levels
  4. Round cells can be segregated into leukocytes and immature germ cells through peroxidase staining techniques
  5. Vasography is performed by injecting contrast medium proximal and distal to the needle insertion site in the vas deferens
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