5: Conception, Contraception & Infertility Flashcards
What are the components of Semen? (5 things)
- Clotting factors
- Fructose
- Alkaline fluid
- Prostaglandins
- Proteolytic Enzymes
- Alkaline fluid (yes again)
CFAPPA
What Semen components are from the Seminal Vesicles? (4 things)
- Clotting factors
- Fructose
- Alkaline fluid
- Prostaglandins
What Semen components are from the Prostate? (1 thing)
- Proteolytic enzymes
Pro and Pro
What Semen components are the Bulbourethral glands? (1 thing)
- Alkaline fluid
What is the purpose of Alkaline fluid (from Seminal Vesicles) in Semen?
Neutralises acid in female genital tract
What is the purpose of Prostaglandins in Semen?
Stimulate female reproductive tract
What is the purpose of Proteolytic enzymes in Semen?
Breaks down clotting factors → allows reliquification of semen → moves easier through reproductive tract
What is the purpose of Alkaline fluid (from Bulbourethral glands) in Semen?
Lubricate end of penis & urethral lining
What is the 4 steps of of penile erections mechanism?
- Stimulation
- Spinal Reflex
- PS Activation
- Haemodynamic Changes
Sexy Sexy Punani Humpme
What are the stimulations for penile erections? (2 things)
- Psychogenic
- Tactile (sensory afferents) of penis and perineum
Mind and Touch
Where are the spinal nuclei for PS activation of penil erections located?
S2 - S4
What must happen to central arteries of the Corpora Cavernosa to maintain an erection?
Vasodilation
What does vasodilation of the central arteries of the Corpora Cavernosa depend on?
Low intracellular Calcium levels in the smooth muscle cells of arteries
What causes calcium levels in the smooth muscle cells of arteries to decrease? (3 things)
- Sympathetic arterial vasoconstrictor nerves inhibition
- Acivation of PS NS
- Activation of Non-adrenergic & Non-cholinergic autonomic nerves to arteries to release nitrous oxide (NO)
NO is what maintains the erection
What does Nitrous Oxide (NO) do?
Diffuses into vascular SM → Decreases calcium levels → Relaxation of SM (Vasodilation)
In general what is the mechanism of maintaining penile erections? (2 main steps)
- Reduce Calcium levels in the smooth muscle cells of arteries by:
- Sympathetic arterial vasoconstrictor nerve inhibition
- Activation of PS NS
- Activation of Non-Adrenergic & Non-Cholinergic Autonomic Nerves → Release NO
- Low Calcium levels → Vasodilation of Central Arteries of Corpora Cavernosa → Maintains Erection
What are the causes of erectile dysfunction? (5 causes)
- NO blocking factors (alcohol / anti-hypertensives / diabetes)
- Psychological
- Drugs
- Tears in fibrous tissue of Corpora Cavernosa
- Vascular defects
No Pointing Dick To Vagina
Why is the “pull-out” method ineffective?
Ejaculate is held in the prostatic urethra → leakage can occur
What is ejaculation controlled by?
Sympathetic Control (L1 and L2)
Remember: Point & Shoot
What occurs during ejactulation? (3 things)
- Glands & Ducts (SM) contraction
- Bladder internal sphincter control
- Rhythmic striatal musclular contractions
What muscles are involved in the rhythmic striatal musclular contractions during ejactulation? (4 muscles)
- Pelvic floor
- Ischiocavernous
- Bulbospongiosus
- Hip & Anal muscles
What are the phases of the female sexual response? (3 phases)
- Sexual excitement
- Plaeau phase
- Orgasm
What occurs in Sexual Excitement phase of the Female Sexual Response?
Blood engorgement & erection of
- Clitoris
- Vaginal mucosa
- Breast
- Nipples
What occurs in the Plateau phase of the Female Sexual Response?
Glandular activity
What is special about the Female orgasm?
No refractory period
What happens to the sperm immediately after ejaculation?
Coagulates (because of fibrinogen clotting factors)
What is the purpose of sperm coagulating?
Prevents sperm being lost in the vagina
What happens after the sperm coagulates?
Liquefies (because of prostatic proteolytic enzymes)
What happens to the sperm that enters the vagina?
Travels 15-20cm to the uterine tubes
What is capacitation?
The maturation of sperm during its passage into the uterus
What is the purpose of sperm capacitation?
Gives sperm the “capacity” to fertilise the ovum
What happens in sperm capacitation? (2 things)
- Removal of glycoprotein coat → changes cell membrane
- Tail movements become whip-like thrashing
How long does sperm capacitation last?
Several hours
What happens after capacitation?
Sperm push through granulosa cells (around oocyte) and bind to proteins on zona pellucida → triggers acrosomal reaction
What triggers the acrosomal reaction?
Sperm binding to proteins on the Zona Pellucida
What is the acrosomal reaction?
Acrosomal enzymes released from sperm → break down Zona Pellucida
What occurs during fertilisation?
Sperm moves into cytoplasm → forms zygote
How is polyspermia blocked?
By cortical reaction → Zona Pellucida hardened to prevent more sperms entering
What are the 7 methods of contraception?
- Natural
- Prevent Sperm entering Ejaculate
- Prevet Sperm reaching Cervix (BARRIER Method)
- Prevent Ovulation
- Inhibit transport along Fallopian Tube
- Inhibit Sperm passing through Cervix
- Inhibit Implantation
What are the Natural methods of contraception?
- Abstinence
- Coitus interruptus (pull out method) (sounds like a HP spell lol)
- Rhythm method
How does Preventing Sperm entering Ejactulate work?
Divide vas deferens bilaterally
How does Preventing Sperm reaching Cervix (BARRIER Method) work? (3 things)
- Condoms
- Diaphragm (thing diagonally across cervix)
- Cap (fits across cervix)
What are the types of Preventing Ovulation? (4 types)
- COCP
- Depot Progesterone Injection
- Progesterone Only Pill
- Progeserone Implants
How does the COCP (Combined Oral Contraceptive Pill) work?
Inhibits follicular development by negative feedback to the hypothalamus / pituitary → oestrogen reduces positive feedback so there’s no LH surge
What is the Combined Oral Contraceptive Pill made up of
Oestrogen and Progesterone
How does Inhibiting Transport along the Fallopian Tube work?
Block fallopian tube using:
- Clips
- Rings
- Ligation
What is used to Inhibit Sperm passing through the Cervix? (2 things)
- Progesterone Only Pill (POP)
- Progesterone Implant
What are the 3 types of Inhibiting Implantation?
- Hormonal
- Post-coital
- Inta-Uterine Device (IUD)
What Hormonal methods are used to Inhibit Implantation? (4 things)
- COCP
- POP
- Progesterone Implant
- Depot Progesterone Injection
What Post-Coital methods are used to Inhibit Implantation?
Combined HIGH dose of Oestrogen / Progesterone
How long after intercourse can Post-Coital methods of Inhibiting Implantation be used?
Upto 72 hours after intercourse
What is the definition of infertility?
Inability to conceive within 1 year
What are the 2 general male factors of infertility?
- Poor semen quality
- Coital impairement
What are the factors of Poor semen quality? (4 things)
- Low sperm count
- Poor sperm morphology / motility
- Low ejaculation volume
- Sperm autoimmunity (antibodies kill sperm)
What are the factors of Coital impairement? (2 things)
- Erectile dysfunction
- Retrogade ejactulation (early ejac innit)
What are the 3 general female factors of infertilty?
- Ovulatory Failure
- Impaired Gamete / Zygote transport
- Implantation Defects
What are the factros of Ovulatory Failure? (2 things)
- Hormone Imbalance
- Polycystic Ovarian Syndrome (PCOS)
What are the factors of Impaired Gamete / Zygote Transport? (3 things)
- Tube defects
- Anti-sperm antibodies
- Non-optimal cervical mucus
What are the factors of Implantation defects? (2 things)
- Chromosomal abnormalities
- Endometrial abnormalities
What are the KEY causes for infertility? (2 things)
- Coital Problems
- Anovulation
What are coital problems?
When sperm can’t enter at the cervix so no fertilisation occurs
What is anovulation?
Failure to ovulte
What are the reasons for anovulation? (8 things)
- Stress
- Hyperprolactinaemia
- Ovarian failure
- PCOS (Polycystic Ovarian Syndrome)
- Premature menopause
- Excercise
- Weight Loss
- Pituitary problems
SHOP PEWP
How is anovulation diagnosed?
Low serum progesterone @ mid-luteal phase (day 21)
This indicates no Corpus Luteum therefore no ovulation has occured
What is the differential diagnosis of infertility causes if:
- LH: High
- FSH: Very High
- Oestrogen: Low
Menopause
What is the differential diagnosis of infertility causes if:
- LH: High
- FSH: High
- Oestrogen: Low
Ovarian Failure
What is the differential diagnosis of infertility causes if:
- LH: Low
- FSH: Low
- Oestrogen: Low
Hypothalamus / Pituitary Failure
What is the differential diagnosis of infertility causes if:
- LH: Very High
- FSH: Low
- Oestrogen: Normal
PCOS
What are the 3 treatment types of infertility?
- Drugs to correct hormone problems
- Overcome tubal occlusion (surgery
- Overcome timing / fertilisation issues by IVF
How do Drugs to correct hormone problems of infertility work?
They induce ovulation
What are the ovulation inducing drugs for treating infertility? (3 types)
- Anti-oestrogen
- Gonadotrophins (FSH administration)
- GnRH agonists
How does anti-oestrogen work to treat infertility?
Induces ovulation by:
- Reduces negative feedback to hypothalamus / pituitary
- Increases GnRH
- Increases FSH
What are the 5 steps of IVF?
- Stimulate ovary + retrieve oocyes
- Retrieve sperm
- Fertilise invitro
- Allow embryo to develop invitro
- Transfer embryo to uterus
What are the variations of IVF if there is inadequate sperm / sperm transport? (5 things)
- ZIFT (Zygote Intrafallopian Transfer)
- GIFT (Gamete Intrafallopian Transfer)
- TESA (Testicular Sperm Aspiration)
- ICSI (Intracytoplasmic Sperm Injection)
- IUI (Intrauterine Insemination)
Ya zift adil hadiya lel tesa di 3ashan ana CSI agent 6ayb? IUI
What are the variations of IVF if there are inadequate eggs? (2 things)
- Egg donation
- CT (Cytoplasmic Transfer)
