Questions
1) Which hormones play a central role in regulation of
Sertoli cell function?
a LH, FSH
b FSH, estradiol
c Prolactin, LH
d FSH, testosterone
e ABP, testosterone
1) Which hormones play a central role in regulation of
Sertoli cell function?
a LH, FSH
b FSH, estradiol
c Prolactin, LH
d FSH, testosterone
e ABP, testosterone
• FSH and testosterone play the most important role in
the regulation of Sertoli cell function, including
androgen binding protein (ABP) production
2) How do elevated levels of prolactin influence
testosterone production?
a Inhibit gonadotrophin-releasing hormone (GnRH)
and LH
b Indirectly inhibit Sertoli cells
c Directly inhibit Leydig cells
d Upregulate inhibin
e Downregulate activin
2) How do elevated levels of prolactin influence
testosterone production?
a Inhibit gonadotrophin-releasing hormone
(GnRH) and LH
b Indirectly inhibit Sertoli cells
c Directly inhibit Leydig cells
d Upregulate inhibin
e Downregulate activin
3) All the following are true statements regarding semen
analysis EXCEPT:
a Abstinence of 2 to 7 days before a semen analysis
is optimal
b Two separate samples at least 7 days apart should
be analyzed
c Coitus interruptus is an accurate and reliable
method of obtaining semen
d Only 50% of men will have a recognizable cause
of infertility on the basis of the standard semen analysis
e The most common cause of low-volume ejaculate
is incomplete collection
3) All the following are true statements regarding semen
analysis EXCEPT:
a Abstinence of 2 to 7 days before a semen analysis is
optimal
b Two separate samples at least 7 days apart should be
analyzed
c Coitus interruptus is an accurate and
reliable method of obtaining semen
d Only 50% of men will have a recognizable cause of
infertility on the basis of the standard semen analysis
e The most common cause of low-volume ejaculate is
incomplete collection
Coitus interruptus is an accurate and reliable method of
obtaining semen
Often the initial drops of ejaculate that are lost contain
the largest concentration of spermatozoa
4) Initial hormone evaluation in an infertile man with
severe oligospermia includes:
a testosterone and FSH
b FSH and LH
c FSH, LH, and prolactin
d FSH and inhibin B
e LH, prolactin, and free testosterone
4) Initial hormone evaluation in an infertile man with
severe oligospermia includes:
a testosterone and FSH
b FSH and LH
c FSH, LH, and prolactin
d FSH and inhibin B
e LH, prolactin, and free testosterone
Although not universally agreed on, a reasonable
progression of hormone analysis would be a
morning testosterone and FSH, and if these
were abnormal, one should repeat morning
testosterone, LH, and prolactin (especially in
low testosterone).
5) Which of the following is TRUE regarding genetic
testing in male infertility patients?
a 25% of all infertile males will have structural and
numerical chromosomal abnormalities
b Genetic testing with karyotype and Ychromosome microdeletion is indicated for all patients
with azoospermia or severe oligospermia
c Y-chromosome microdeletion exists in 50% of
patients with azoospermia
d CFTR mutations are identified in only 10% of
patients with congenital bilateral absence of vas
deferens (CBAVD)
e None are true
5) Which of the following is TRUE regarding genetic
testing in male infertility patients?
a 25% of all infertile males will have structural and
numerical chromosomal abnormalities
b Genetic testing with karyotype and Ychromosome microdeletion is indicated for all
patients with azoospermia or severe
oligospermia
c Y-chromosome microdeletion exists in 50% of
patients with azoospermia
d CFTR mutations are identified in only 10% of
patients with congenital bilateral absence of vas deferens
(CBAVD)
e None are true
Genetic testing with karyotype and Y-chromosome
microdeletion is indicated for all patients with
azoospermia or severe oligospermia
Genetic abnormalities are rare in men with infertility;
however, 10% to 15% of azoospermic men will
have a karyotype abnormality
In addition, 10% to 15% of men with azoospermia or
severe oligospermia may have microdeletions of
the Y-chromosome in addition
CFTR mutations are found in 80% of men with
CBAVD.
6) Which of the following is TRUE regarding ejaculatory
duct obstruction (EJDO)?
a Normal volume azoospermia is a common
presentation for EJDO
b EJDO will often present with low-volume
azoospermia
c Seminal vesicle width greater than 12 to 15 mm is
suggestive of obstruction
d In a patient with suspected EJDO, seminal pH will
usually be around 8
e If any sperm is found in seminal vesicle aspiration
at the time of transrectal ultrasonography (TRUS), the
diagnosis of EJDO is confirmed
6) Which of the following is TRUE regarding ejaculatory
duct obstruction (EJDO)?
a Normal volume azoospermia is a common
presentation for EJDO
b EJDO will often present with lowvolume azoospermia
c Seminal vesicle width greater than 12 to 15 mm is
suggestive of obstruction
d In a patient with suspected EJDO, seminal pH will
usually be around 8
e If any sperm is found in seminal vesicle aspiration
at the time of transrectal ultrasonography (TRUS), the
diagnosis of EJDO is confirmed
EJDO will often present with low-volume azoospermia,
with an acidic pH usually reflecting only prostatic
secretions
Occasional sperm may be present in seminal vesicles on
men without EJDO, but findings of 3 or more
sperm/HPF in the seminal vesicle usually indicate
EJDO
7) In the evaluation for vasectomy reversal, which clinical
finding is suggestive of epididymal obstruction?
a Varicocele
b Hydrocele
c Sperm granuloma
d Normal serum follicle-stimulating hormone (FSH)
level
e Vasal gap larger than 2 cm
7) In the evaluation for vasectomy reversal, which clinical
finding is suggestive of epididymal obstruction?
a Varicocele
b Hydrocele
c Sperm granuloma
d Normal serum follicle-stimulating hormone (FSH)
level
e Vasal gap larger than 2 cm
The presence of a hydrocele in the presence of excurrent
ductal system obstruction is often associated with
secondary epididymal obstruction
Surgeons attempting reconstruction should be aware of
the possibility of the need for a vasoepididymostomy
8) In which of the following scenarios is a testis biopsy
least helpful?
a Failure to retrieve motile sperm from the
epididymis
b Sperm retrieval for nonobstructive azoospermia
c Diagnostic evaluation of men with congenital
absence of vas and normal FSH levels
d Diagnostic evaluation in azoospermic men with
normal findings on scrotal examination and normal
serum testosterone and FSH levels
e Sperm retrieval for men diagnosed with Sertoli
cell–only pattern in the testes
8) In which of the following scenarios is a testis biopsy
least helpful?
a Failure to retrieve motile sperm from the
epididymis
b Sperm retrieval for nonobstructive azoospermia
c Diagnostic evaluation of men with
congenital absence of vas and normal FSH levels
d Diagnostic evaluation in azoospermic men with
normal findings on scrotal examination and normal
serum testosterone and FSH levels
e Sperm retrieval for men diagnosed with Sertoli
cell–only pattern in the testes
Diagnostic evaluation of men with congenital absence
of vas and normal FSH levels
Testis biopsy is indicated in azoospermic men with
testes of normal size and consistency, palpable vasa
deferentia, and normal serum FSH levels
Under these circumstances, biopsy will distinguish
obstructive azoospermia from primary seminiferous
tubular failure
In the testes of men with congenital absence of vasa,
biopsy always reveals normal or at least some
spermatogenesis and biopsy is not necessary before
definitive sperm aspiration and in-vitro fertilization
(IVF) with ICSI
9) All of the following situations are appropriate for
assisted reproduction with ICSI as a first line of
treatment EXCEPT:
a obstruction with multiple failures of
reconstruction
b mild oligoasthenospermia with varicoceles and
a female partner of 29 years of age
c Klinefelter syndrome
d only a few viable sperm found in the ejaculate
e postchemotherapy azoospermia
9) All of the following situations are appropriate for
assisted reproduction with ICSI as a first line of
treatment EXCEPT:
a obstruction with multiple failures of
reconstruction
b mild oligoasthenospermia with varicoceles
and a female partner of 29 years of age
c Klinefelter syndrome
d only a few viable sperm found in the ejaculate
e postchemotherapy azoospermia
Mild oligoasthenospermia with varicoceles and a female
partner of 29 years of age
Assisted reproduction can be offered to men with
surgically unreconstructable obstruction such as
congenital absence of the vas deferens; men with few
viable sperm in the ejaculate; azoospermic men with
varicoceles (half of these men will respond to
varicocelectomy with return of enough sperm to
ejaculate to achieve pregnancy using IVF with ICSI);
and men with nonobstructive azoospermia.
10) In which of the following scenarios would a diagnostic
testicular biopsy provide valuable clinical information?
a Men with azoospermia, atrophic testes, and an FSH
level of 25 IU/L
b Men with a 47 XXY karyotype
c Men with a fecundity history who seek vasectomy
reversal
d Men with primary infertility, azoospermia, normal
physical examination findings, and a normal serum FSH
level
e Men with anejaculation caused by high spinal cord
injury
10) In which of the following scenarios would a diagnostic
testicular biopsy provide valuable clinical information?
a Men with azoospermia, atrophic testes, and an FSH
level of 25 IU/L
b Men with a 47 XXY karyotype
c Men with a fecundity history who seek vasectomy
reversal
d Men with primary infertility,
azoospermia, normal physical examination
findings, and a normal serum FSH level
e Men with anejaculation caused by high spinal cord
injury
Testis biopsy is indicated in azoospermic men with
testis of normal size and consistency, palpable vasa
deferentia, and normal serum FSH levels