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Reproductive And Development > 2-23-16-Female Reproductive Physiology (Lopez) > Flashcards

2-23-16-Female Reproductive Physiology (Lopez) Flashcards

1
Q

Trace the stages of ovarian follicle maturation:

A

Primary oocyte (4N) –> Primordial follicle (4N) –> Primary follicle (4N) –> Secondary follicle (4N) –> Early tertiary follicle (4N) –> First mitotic division completed –> Graafian follicle (Has a secondary oocyte with 2N and 1st polar body with 2N) –> Beginning of 2nd meiotic division, fertilization, and completion of 2nd meiotic division –> Ovulated ovum

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2
Q

___ represents the earliest and simplest follicular structure in the ovary, consists of the primary oocyte with a surrounding single layer of pregranulosa cells and has a basement membrane. It usually appears ~6 weeks into intrauterine life and the generation of these is complete by ~6 months after birth

A

Primordial follicle

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3
Q

Growing primordial follicles restrain development of too many primordial follicles by release of ___

A

Anti-mullerian hormone (AMH)

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4
Q

The gamete in primordial follicles is derived from oogonia that have entered the first meiotic division and are now called ___

A

Primary oocytes

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5
Q

Primary oocytes progress through most of prophase I over a 2-week period and then arrest in the __ stage and the nucleus of the oocyte (germinal vesicle) remains intact at this stage

A

Diplotene

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6
Q

One of the 1st visible signs of follicle growth is the appearance of cuboidal granulosa cells. At this point, the follicle is known as a __

A

Primary follicle –> contains a larger primary oocyte than the one in the primordial follicle

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7
Q

As granulosa cells proliferate, they form a multilayered epithelium around the oocyte. At this point the follicle is known as ___

A

Secondary follicle –> contains a primary oocyte surrounded by several layers of cuboidal granulosa cells, have theca cells, and a zona pellucida

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8
Q

The progression of secondary follicles involves the formation of ___ and an increase in __ to developing follicular units

A

Capillaries

Vascular supply

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9
Q

The ___ provides a species-specific binding site for sperm during fertilization

A

Zona pellucida

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10
Q

__ cells are analogous to testicular Leydig cells, the major product of which is androstenedione (opposed to testosterone in leydig cells)

A

Thecal

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11
Q

Swelling of the antral cavity (as seen in a graafian follicle) increasingly divides granulosa cells into these 2 discrete populations:

A

1) Mural granulosa cells (stratum granulosum)

2) Cumulus cells (cumulus oophorus or corona radiata)

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12
Q

Early antral follicles are dependent on __ for normal growth

Large antral follicles become highly dependent on __ for their growth and sustained variability

A

FSH

FSH

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13
Q

___ form the outer wall of the follicle, are close to outerlying thecal cells, become highly steroidogenic, and remain in the ovary after ovulation to differentiate into the corpus luteum

A

Mural granulosa cells

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14
Q

___ are inner cells surrounding the oocyte and the innermost layer (relative to the oocyte) of these cells maintains gap and adhesion junctions with the oocyte.

A

Cumulus cells

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15
Q

During ovulation, ___ cells are released from the ovary with the oocyte and are crucial for the ability of the fimbriated end of the oviduct to grab and move the oocyte along the length of the oviduct to the site of fertilization

A

Cumulus

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16
Q

At the antral stage, larger antral follicles gain meiotic competence but still maintain meiotic arrest until the midcycle ___ surge

A

LH

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17
Q

Meiotic arrest during the antral stage is achieved by maintenance of elevated ___ levels in the mature oocyte

A

cAMP

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18
Q

___ cells of large antral follicles produce significant amounts of androstenedione and testosterone (to a lesser extent)

Androgens are converted to estradiol-17-beta by the ___ cells

___ stimulates proliferation of granulosa cells and induces the expression of CYP19-aromatase

The mural granulosa cells of the large antral follicles produce increasing amounts of ___ during the early follicular phase

A

Thecal

Mural granulosa

FSH

Inhibin B

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19
Q

Low levels of ___ exert a negative feedback effect on FSH secretion, thereby contributing to the selection of the follicle with the most FSH-responsive cells

A

Estrogen and inhibin

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20
Q

As FSH levels decline, the rapidly growing follicles progressively undergo atresia, until __ follicle is left

The largest follicle with the most ___ receptors of the recruited crop becomes the dominant follicle

By midcycle, the dominant follicle becomes a large ___

A

1

FSH

Preovulatory follicle

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21
Q

___ cells express LH receptors and produce androgens

___ cells express FSH receptors

A

Thecal –> basal LH levels stimulate production of steroidogenic enzymes (3beta-HSD, CYP17, CYP11A1), LDL receptors

Granulosa –> FSH up-regulates aromatase gene expression and activity which converts androstenedione to estrone and testosterone to estradiol-17-beta. They also express activating isoforms of 17beta-HSD

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22
Q

___ induces expression of inhibin B during the follicular phase and also induces the expression of LH receptors in the mural granulosa cells during the 2nd half of the follicular phase

A

FSH

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23
Q

___ period can be defined as the time from the onset of the LH surge to ovulation. It lasts 32-36 hours in women

A

Periovulatory

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24
Q

Luteinization culminates in the formation of a ___, which is capable of producing large amounts of progesterone, along with estrogen, within a few days after ovulation

A

Corpus luteum

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25
Q

The __ surge induces dramatic structural changes in the dominant follicle that involve its rupture, ovulation of the cumulus-oocyte complex, and the biogenesis of corpus luteum from the remaining thecal cells and mural granulosa cells

A

LH

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26
Q

MAJOR STRUCTURAL CHANGES ASSOCIATED WITH LH SURGE:

Before ovulation, the follicle presses against the wall of the ovary to form a bulge called the ___

__ cells detach from granulosa cells and the oocyte is freed within the antral cavity. As an indirect response to the LH surge, the oocyte releases TGF-beta and ___, which stimulates the cumulus cells to secrete hyaluronic acid and other ECM components which causes expansion of the oocyte complex, making it easier for capture by the oviduct and easier for sperm to locate

The __ of the mural granulosa cells is then enzymatically degraded and blood vessels and outer-lying theca can push into the granulosa cells

A

Stigma

Cumulus

GDF9

Basal lamina

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27
Q

Before ovulation, the primary oocyte is competent to complete meiosis but is arrested in prophase I as a result of high ___ levels
—>
___ induces release from arrest and completion of meiosis I with extrusion of the 1st polar body
–>
The secondary oocyte then progresses to ___ where it arrests again until fertilization

A

cAMP

LH surge

Metaphase II

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28
Q

During the luteal phase, the major products of the corpus luteum are the __, although estradiol is still substantial

A

Progestins

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29
Q

After ovulation, the antral cavitity fills with blood from ruptured vessels (corpus hemorrhagicum). The ___ is formed and the granulosa cells now become granulosa lutein cells which enlarge and fill with cholesterol esters. These cells collapse and fill in the antral cavity

A

Corpus luteum

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30
Q

The LH surge induces these 2 parallel events:

A

Ovulation and Luteinization

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31
Q

___ production by the corpus luteum increases steadily from the onset of the LH surge and peaks during the mid-luteal phase

__ production transiently decreases in response to the LH surge but then rebounds and also peaks at mid-luteal phase

Granulosa lutein cells secrete ___ which further suppresses FSH secretion

A

Progesterone

Estrogen

Inhibin A

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32
Q

__ is the demise of an ovarian follicle, is the predominant process in the ovary, and can occur at any time during development

A

Follicular atresia

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33
Q

During follicular atresia, ____ undergo apoptosis, while __ cells persist and re-populate the cellular stroma of the ovary

A

Granulosa cells and oocytes

Thecal

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34
Q

___ phase is associated with the recruitment/growth of antral follicles, selection of one dominant follicle, and growth of dominant follicle until ovulation

A

Follicular

35
Q

The LH surge is associated with ___

A

Ovulation

36
Q

___ phase is associated with hormonal secretion by the corpus luteum

A

Luteal

37
Q

Neurovascular elements run into the ___ of the ovary

The ___ is the functional unit of the ovaryt

A

Medulla

Ovarian follicle

38
Q

___ = beginning of menstrual cycles

___ = breast development

___ = increase in adrenal androgen secretion

A

Menarche

Thelarche

Adrenarche

39
Q

The follicular phase and luteal phase are associated with the ___ cycle

Menses, proliferative phase, and secretory phase are associated with the ___ cycle

A

Ovarian

Endometrial

40
Q

The follicular phase of the ovarian cycle coincides with the phase(s) of the endometrial cycle?

A

Proliferative phase (and most of menses)

41
Q

The luteal phase of the ovarian cycle coincides with what phase(s) of the endometrial cycle?

A

Secretory phase (small amount of menses)

42
Q

During follicular phase of the ovarian cycle:

___ stimulates a follicle to complete its development

It begins with onset of menses and ends on day of ___ (~14 days)

___ cells of the follicles increase production of the estrogen estradiol, which stimulates the endometrium to undergo rapid and continuous growth and maturation

Follicular phase coincides with the __ phase of the endometrial cycle

A

FSH

LH surge

Granulosa

Secretory

43
Q

During the follicular phase of the ovarian cycle, a rapid rise in ovarian estradiol secretion eventually triggers a surge in ___, which causes ovulation

A

LH

44
Q

During luteal phase of the ovarian cycle:

Follicle transforms into a ___

___ cells produce progesterone and estrogen, which stimulate further endometrial growth and development

Begins on day of LH surge and ends at onset of next ___ (~14 days)

The luteal phase of the ovarian cycle coincides with the ___ phase of the endometrial cycle

A

Corpus luteum

Luteal

Menses

Secretory

45
Q

Granulosa cells can secrete ___ which negatively feedsback on the AP but can also secrete ___ which positively feedsback on the AP

A

Inhibins

Activins

46
Q

GnRH stimulates gonadotroph secretion of FSH and LH, which stimulates ovarian cells to secrete ___

A

Estrogens and progestins

47
Q

Which part of the follicular phase is there a much larger release of LH?

A

Later in the follicular phase–> gonadotrophs in the AP become much more sensitive to the GnRH in the portal blood, each burst of GnRH triggers a much larger release of LH

48
Q

Before ovulation, the LH and FSH secreted by the gonadotrophs act on cells of the developing follicle.
–>
___ cells of the follicle have LH receptors

___ cells have both LH and FSH receptors

A

Theca

Granulosa

49
Q

Both LH and FSH are required for ___ production because neither the theca cell nor the granulosa cell can carry out all of the required steps.

After ovulation, LH acts on the cells of the ___

A

Estrogen

Corpus luteum

50
Q

___ specifically stimulates the granulosa cells to produce inhibins

Just before ovulation, after the granulosa cells acquire LH receptors, LH also stimulates production of ___ by granulosa cells

Inhibins “inhibit” ___ production by gonadotrophs of the AP

A

FSH

Inhibin

FSH

51
Q

Ovarian steroids (estrogen and progesterone) exert positive feedback at the end of the __ phase

A

Follicular

52
Q

Levels of ___ rise gradually during the first half of the follicular phase of the ovarian cycle and then steeply during the second half

A

Estradiol

53
Q

When the HP axis reverses its sensitivity to estrogens during the latter half of the follicular phase, positive feedback will promote a surge of ___ and the rising levels of ___ during the late follicular phase also produce a positive feedback response and contribute to the surge of ___

A

LH

Progesterone

LH

54
Q

As the luteal phase of the menstrual cycle begins, circulating levels of ___ rapidly decrease and this fall-off in levels reflects negative feedback by estradiol, progesterone, and inhibin

A

LH and FSH

55
Q

During the luteal phase, the rise in concentration of ___ causes negative feedback on the release of LH and FSH (causes decreased secretion)

A

Estradiol, progesterone, and inhibin

56
Q

During the late luteal phase, the gradual demise of the __ leads to decreases in the levels of progesterone, estradiol, and inhibin.

A

Corpus luteum

57
Q

In a nonpregnant woma, estradiol, the primary circulating estrogen, is secreted principally by the __

Cells in the ovaries have an __ enzyme that can convert androstenedione to estrone and testosterone to estradiol

Estrone can be converted into the more powerful estrogen estradiol, and vice-versa by the enzyme ___

A

Ovary

Aromatase

17beta-HSD

58
Q

During the follicular phase, the major product of the follicle is ___

A

Estradiol

59
Q

In the follicular phase of the menstrual cycle, the ___ synthesizes estrogens, whereas in the luteal phase, the ___ synthesizes estrogens

A

Follicle

Corpus luteum

60
Q

Estradiol synthesis requires the contribution of which 2 cell types?

A

Theca and granulosa cells within the follicle

AND

Theca-lutein and granulosa-lutein cells within the corpus luteum

61
Q

During the luteal phase, the major products of the corpus luteum are the ___

A

Progestins, although estradiol synthesis is still substantial

62
Q

The ___ hormones drive the morphological and functional changes of the endometrium during the monthly cycle

A

Ovarian

63
Q

The higher levels of estrogen present during the pre-ovulatory (follicular) phase of the menstrual cycle have what effect on basal body temperature?

The higher levels of progesterone released by the corpus luteum after ovulation has what effect on basal body temperature?

A

Lowers the BBT

Raise the BBT

64
Q

The disintegration of the corpus luteum (if pregnancy does not occur) has what effect on basal body temperature?

A

Lowers the BBT–> coincides with the onset of the next menstruation

65
Q

During the menstrual phase of the endometrial cycle:

If the oocyte was not fertilized and pregnancy did not occur in the previous cycle, a sudden dimunition in ___ secretion will signal the demise of the corpus luteum

A

Estrogen and progesterone

66
Q

As hormonal support of the endometrium is withdrawn, the endometrium degenerates, the tissue breaks down, and menstrual bleeding ensues; this moment is defined as day __ of the menstrual cycle

A

1

67
Q

This phase of the endometrial cycle follows menstruation and the endometrium is restored by about the 5th day of the cycle

A

Proliferative phase

68
Q

During the proliferative phase of the endometrial cycle:

Proliferation of the basal stromal cells occurs in the ___

Proliferation of epithelial cells from other parts of the ___

The __ gives rise to the connective tissue components of the endometrium

Proliferation and differentiation of the endometrium are stimulated by ___, which is secreted by developing follicles

Levels of ___ rise early in the follicular phase and peak just before ovulation. This hormone causes the stromal components of the endometrium to become highly developed and also induces the synthesis of progestin receptors in endometrial tissue

___ opposes the action of estrogen on the epithelial cells of the endometrium and functions as an anti-estrogen which inhibits epithelai cell proliferation but promotes proliferation of endometrial stroma. It also stimulates 17-beta-HSD and sulfotransferase

A

Zona basalis

uterus

Stroma

Estrogen

Estrogen

Progesterone

69
Q

__ is the final phase of the endometrial cycle and corresponds to the luteal phase of the ovarian cycle

A

Secretory

70
Q

The early secretory phase of the endometrial cycle is stimulated by ___

A

Progesterone

71
Q

During the middle to late secretory phase of the endometrial cycle, vascularization of the endometrium increases, glycogen content increase, thickness of endometrium increases, and endometrial glands become engorged with secretions.

Also, ___ promotes the differentiation of the stromal cells into predicidual cells, which must be prepared to form the decidua of pregnancy, or to orchestrate menstruation in the absence of pregnancy

A

Progesterone

72
Q

The net effect of oral contraceptive pills is suppressed secretion of ___

A

FSH and LH

-Low FSH levels are insufficient to stimulate normal folliculogenesis, the low LH levels obviate the LH surge and therefore inhibit ovulation

73
Q

The progestin effect of the OCP causes the cervical mucus to __

A

Thicken, become sticky and insufficient–> inhibits sperm penetration into the uterus

74
Q

___ is a loss of > 80 mL of blood

___ is painful periods

___ is existence of few, irregular periods

___ is absence of periods

A

Menorrhagia

Dysmenorrhea

Oligomenorrhea

Amenorrhea

75
Q

__ and __ are often due to dysfunction or cessation of the H-P-Ovarian axis, as opposed to local pelvic pathophysiology

A

Oligomenorrhea and amenorrhea

76
Q

___ most commonly affects women of reproductive age, is a common cause of female sterility, and is a painful disorder in which tissue that normally grows inside the uterus grows outside of it (presence of endometrial glands and stroma outside the uterus)

A

Endometriosis

77
Q

List the clinical presentation of endometriosis:

A
  • chronic pelvic pain linked to menses
  • dymenorrhea
  • dyspareunia (painful sex)
  • rectal pain and constipation
  • infertility
78
Q

___ is the most common cause of infertility in women, frequently becomes manifest during adolescence. Part of this dysfunction is characterized by abnormal ovarian steroidogenesis and folliculogenesis that are manifested clinically by androgen excess and anovulation

A

Polycystic ovarian syndrome (PCOS)

79
Q

Enlarged polycystic ovaries are known to be associated with increased __ levels which promote atresia in developing follicles and disrupt feedback relationships

A

Androgen levels (DHEA)

Presentation: young, obese, hirsute females of repro age; oligomenorrhea or secondary amenorrhea; infertility

80
Q

List the levels of LH, FSH, and testosterone in PCOS

A

Elevated LH, low FSH, elevated testosterone

81
Q

___ is the most common cause of congenital hypogonadism; in about 50% of cases, it results from the complete absence of the second X chromosome. Germ cells do not develop and each gonad consists of a CT-filled streak. A pt would present with short stature, webbed neck, low set ears, shield-shaped chest, short 4th metacarpals, and sexual infantilism

A

Turner syndrome

82
Q 
Describe the levels of the following in menopause:
Estrogen: \_\_\_
Inhibin: \_\_\_
Feedback status for LH and FSH:\_\_\_\_
Levels of FSH and LH: \_\_\_
A

Reduced estrogen

Low levels of inhibin

No negative feedback of FSH and LH

High levels of LH and FSH

83
Q

What are treatment options for relieving signs and symptoms or preventing/managing chronic conditions that may occur with aging and menopause?

A
  • estrogen therapy
  • vaginal estrogen
  • low-dose anti-depressants
  • gabapentin (treatment of hot flashes)

Reproductive And Development (16 decks)

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