Clinical Scenarios - Reproduction 5 Flashcards
Key learning objectives
* Understand variabilities that can exist in sexual differentiation
* Understand how hormonal regulation of the reproductive systems can be
used to develop contraceptives
* Have an overview of the major causes of infertility - Endometriosis
What does PMDS stand for?
Persistent Mullerian duct syndrome
See slide 21
Shows a 1.5 year old male with PMDS
1. What does this cause?
2. What is normal in size?
- Both testis absent from scrotum since
birth - Phallus normal in size
What is the serum hormonal profile or someone with PMDS?
Testosterone, DHT and AMH levels normal
MRI of PMDS shows what?
Testes intra-abdominal, behind urinary bladder
Rudimentary uterus, oviducts and 2 structures resembling ovaries
Karyotype of PMDS?
46XY
What is a Karyotype?
An individual’s complete set of chromosomes
See slide 22 with diagrams
Treatment of PMDS involves?
Surgery to correct the position of the testes
Remove the uterus, fallopian tubes, or other female structures
How rare is PMDS?
Very rare ~300 cases reported
Is PMDS multi-factorial?
YES
85% cases of PMDS involve variants in which genes?
85% cases involve what kind of inheritance?
Variants in either the AMH gene or AMHR2 gene
85% cases with autosomal recessive inheritance genetic
15% of PMDS cases are?
Unknown what causes
What is contraception?
Process of avoiding pregnancy while engaging in sexual intercourse
4 Contraceptions mechanisms?
- Blocking sperm transport to the ovum
- Preventing ovulation
- Blocking implantation
- Blocking sperm production
Female hormonal contraception explain how the progesterone - progestins works?
– Prevent ovulation and follicular development
– Negative feedback to prevent GnRH pulse frequency – Decrease FSH and LH
- Thicken cervix mucus – Inhibit sperm
How does oestrogen contraception work
– Some negative feedback on AP – Reduced FSH
– Stability to endometrium (breakthrough bleeds)
– Increases potency of progesterone effects – Less progestin needed
Oestrogen contraception uses what synthetic versions of the hormone?
Estradiol, ethinylestradiol and estetrol
Emergency (female) contraception uses LNG
1. LNG stands for?
2. How much vs what for IUD day?
3. Prevents/delays/impairs what?
- Levonorgestrel (LNG)
- 1.5mg emergency vs 20ug/day IUD
- Prevent/delay ovulation, impair CL function
Emergency contraception (female) of Ulipristal acetate -
1. Inhibits/delays?
2. Reduces and delays?
Inhibit or delay ovulation
Reduce endometrial thickness, delay
endometrial maturation
See diagram on slide 25
Male hormonal contraception
How does it work?
Suppress LH and FSH - reversible inhibition of
testicular function (spermatogenesis and testosterone production
Male hormonal contraception
It results in a decrease of?
Results in decrease of Sertoli cell function for
germ-cell maturation.
Male hormonal contraception
To maintain androgen-dependent physiological functions what must be part of this scheme?
To maintain androgendependent physiological
functions an androgen (usually testosterone)
must be part of the contraceptive regimen
Male hormonal contraception - give an example?
How much of it?
E.g.: Nestorone-testosterone gel [sperm]< 1 x 106 /ml
What does nestorone do?
Nestorone – Progestin – Suppress FSH and LH
Testosterone for male contraception?
Some negative feedback but not efficient enough alone
Synergy of progestin+testosterone causes?
Lower testosterone dose – Avoid side effects
Synergy means?
Combined action/operation
Infertility in males is due to? 2
- Disturbances of sperm maturation
- Sperm transport disorders
Infertility in females can be due to? 5
- Disturbance of oocyte maturation (Hormonal imbalance)
- Partial or complete blockade of fallopian tubes
- Abnormalities of ovaries, fallopian tubes, or the uterus
- Antibodies against oocytes or sperm
- Endometriosis
How much of population of female is estimated to have endometriosis?
2-10%
Up to how much of those with endometriosis are infertile?
50%
Theories for endometriosis?
see diagram slide 27
- Retrograde menstrual flux
- Genetic/anatomical/endocrine/environmental
What happens with endometriosis?
Endometrium-like epithelium and/or stroma outside the endometrium and myometrium
What is there a build up with endometriosis?
Build up outside uterus (not removed during menstruation) – Inflammation, scarring, cysts
5 symptoms of endometriosis?
- Dysmenorrhea
- Bladder/bowel symptoms
- Chronic pelvic pain
- Fatigue
- Nausea
See diagrams on slide 28
What 5 things happen in endometriosis to the body?
- Chronic intraperitoneal inflammation
- Disturbed folliculogenesis
- Luteinized unruptured follicle
- Progesterone resistance
- Dysfunctional uterotubal motility
