19) The effects of ageing on the reproductive system

Question 1

Define ageing

Answer 1

the accumulation of physical and psychological changes that occur within a person over a period of time

Question 2

What is the effect of changes in hormone levels on the female reproductive system?

Answer 2

many follicles don’t mature and rupture to release a secondary oocyte but instead, disappear over time until no follicles or oocytes are left

Question 3

State the changes in oestrogen, FSH and LH levels in the female reproductive system due to ageing

Answer 3

secretion of oestrogen decreases

secretion of FSH and LH increase to peak 1-3 years after the last menstrual cycle then gradually decrease over time to 0

Question 4

What do ovarian follicles capable of further development secrete?

Answer 4

anti-Mullerian hormone

Question 5

What can the concentration of anti-Mullerian hormone in the blood indicate?

Answer 5

ovarian reserve

Question 6

What can anti-Mullerian hormone be used as a measure of?

Answer 6

potential for IVF treatment to succeed

Question 7

Female fertility has a _ correlation with age.

Answer 7

inverse

Question 8

Describe changes in female fertility from puberty to 35 years

Answer 8

after puberty fertility increases to peak at 20-25 years and then slowly decreases to sudden drop at 35 years

Question 9

Why does female fertility slowly decrease after around 25 years?

Answer 9

number of oocytes that can be successfully fertilised decrease

Question 10

Define ovarian reserve

Answer 10

the ability for an ovary to produce oocytes that can be fertilised

Question 11

Define menopause

Answer 11

the time the last menstrual cycle occurs caused by a lack of ovarian follicles

Question 12

When does menopause usually occur?

Answer 12

50 - 54 years; after perimenopause

Question 13

When is menopause completed?

Answer 13

when a woman has not experienced a menstrual period for one year

Question 14

Name 7 commons symptoms of menopause

Answer 14

change in regularity of periods
insomnia
hot flushes
high heart rate
flushed skin
night sweats
heart racing / pounding

Question 15

Name 6 additional possible symptoms of menopause

Answer 15

fall in libido
depression
headaches
heart palpitations
vaginal dryness (painful sexual intercourse)
irritability and anxiety

Question 16

Define hormone replacement therapy (HRT)

Answer 16

replacement of female hormones (oestrogen and progesterone) to relieve the symptoms of menopause

Question 17

State and explain two types of hormone replacement therapy

Answer 17

unopposed oestrogen - oestrogen only
combined HRT - oestrogen with progestin (synthetic molecule with similar effects to progesterone, reduces the risk of uterine cancer from oestrogen)

Question 18

State and explain two different ways hormone replacement can be administered

Answer 18

continuous schedule - same hormones continually through month as an oral tablet, skin patch or under-skin implant; no withdrawal bleeds
cyclical regime
- 3 weeks then withdrawal bleeds
- oestrogen continuously, progestin days 10-14 then withdrawal bleeds after day 14

Question 19

Give 5 possible advantages of hormone replacement therapy

Answer 19

prevent hot flushes
reduce risk of developing osteoporosis
protective effect against loss of connective tissue
possible improvement in sleep and reduce in muscle ache
reduced mood swings and depressive symptoms

Question 20

Give 2 potential side effects / disadvantages of hormone replacement therapy

Answer 20

fluid retention

breast tenderness

Question 21

State 4 serious, rare health risks associated with hormone replacement therapy

Answer 21

venous thromboembolism (VTE)
stroke
breast cancer
endometrial (uterine) cancer

Question 22

Suggest 6 reasons why HRT may not be suitable

Answer 22

history of breast, ovarian or endometrial cancer
history of blood clots
history of heart disease / stroke
untreated high blood pressure
liver disease
irregular periods

Question 23

Define and explain phytoestrogens, an alternative to hormone replacement therapy

Answer 23

phytoestrogens = chemicals found in plants that have a similar molecular structure to oestrogen / are converted to oestrogen-like compounds by gut bacteria

• antibacterial and antifungal properties
• taken as supplements / increase dietary intake

Question 24

Name 3 different relaxation therapies as an alternative to hormone replacement therapy

Answer 24

yoga, aromatherapy, reflexology

Question 25

Name 5 different lifestyle changes that can be made as an alternative to hormone replacement therapy

Answer 25

``` regular exercise reducing caffeine, alcohol and spicy food intake reduce stress levels give up smoking staying cool ```

Question 26

State of a change in hormone levels in the male urinogenital system due to ageing, and a possible effect of this

Answer 26

decrease in testosterone production | reduced libido

Question 27

How is male fertility affected by ageing? Why?

Answer 27

varies between individuals - decreased rate of sperm production - decrease in testicular tissue mass - prostate gland, epididymis and seminal vesicles lose surface cells - sclerosis can occur in the epididymis causing tissue to be less elastic

Question 28

Define erectile dysfunction (impotence)

Answer 28

continued problem of a man being unable to get/maintain an erection firm enough to have intercourse

Question 29

Why may erectile dysfunction not always be a direct result of physiological ageing?

Answer 29

may be caused by some medications or disorders e.g. hypertension, diabetes

Question 30

Define benign prostate hyperplasia (BPH)

Answer 30

enlargement of the prostate gland due to prostate tissue being replaced with scar tissue

Question 31

Give two possible consequences of benign prostate hyperplasia

Answer 31

problems with ejaculation formation of large nodules that can compress the urethra, restricting the flow of urine from the bladder or slowing urination

Question 32

Name 3 factors which contribute to enable successful conception

Answer 32

sufficient hormone levels sufficient pH levels healthy uterus lining

Question 33

Name 4 factors which contribute to a decrease in fertility as women age

Answer 33

increase in FSH + LH (increasing risk of miscarriage) decrease in oestrogen thinner uterus lining until periods stop reduced sexual activity (reduced sex drive)

Question 34

Suggest some factors which cause male fertility to decrease with age

Answer 34

erections decline in duration, rigidity and frequency penis is less sensitive, reduced blood flow, testosterone levels and sex drive lower sperm concentration, mobility changes in urinary function

Question 35

Couples who have difficulty conceiving a child may try artificial insemination using donor sperm. Semen is collected from the donor and injected, using a small plastic tube: near the cervix (intra-cervical insemination, ICI) or into the uterus (intra-uterine insemination, IUI). Suggest why ICI is less successful than IUI.

Answer 35

sperm are injected further away | vagina / cervix is a hostile environment

Question 36

Name the method used to store embryos for IVF

Answer 36

cryogenics / frozen embryo replacement

Question 37

Suggest why embryos for IVF can only be stored for a limited period of time

Answer 37

limited by law | lack of viability

Question 38

Describe how sperm are stored in sperm banks

Answer 38

mixed with chemicals to prevent damage frozen labelled insulated metal container

Question 39

Suggest what donor sperm and semen may be screened for before storing in a sperm bank

Answer 39

``` infectious diseases genetic disease sperm volume proportion of abnormalities in sperm sperm mobility ```

Question 40

Suggest a situation where a man may be offered the option of having his sperm harvested and stored for future use

Answer 40

before radiotherapy / chemotherapy / surgery if unable to have intercourse terminal illness in armed forces

Question 41

Explain the trend that there is a decrease in the percentage of live births per treatment cycle of IVF with increasing age

Answer 41

``` implantation less likely in older women miscarriage rate increases fewer / unbalanced hormones or menopause genetic defects increase in oocyte placental function less efficient ```