Female fertility Flashcards
Comment on other metabolic and clinical abnormalities of PCOS (3-7)
- *menstrual irreg.
- *hyperandrogenism
- *Polycystic ovaries
- Galactorrhea (high prolactin)
- infertility
- acne
- hirsutism (excess hair in females almost like male)
List some causes of female hyPOgonadotrophic hypogonadism
- stress, inc exercise, kallman’s syndrome (defective neurons =delay/prevent puberty)
- pituitary cause: pituitary adema, Sheehan’s syndrome, hyperprolactinaemia (bc Think logically prolactin inhibits mens. in breast-feeding mom)
List some causes of female hyPERgonadotrophic hypogonadism
- premature ovarian failure
- loss of ovarian function (from infection, trauma, cystic degeneration, menopause) = so can’t induce ovulation
Describe expected gonadotrophin levels in a post-menopausal woman (assume the subject is not being treated with any hormone supplements).
Inc FSH/LH but dec oestrogen
- lack neg feedback
5 causes of infertility in women
- Age: menopausal
- systemic disease (illness)
- drugs
- pelvic inflammations/infections
- freq. of intercourse
Biochemical tests & other test for assessment of ovulation.
- Measure progesterone: pos. for ovulation if:
>30nmol/L= Hi (LH inc); mid cylce; or
>16nmol/L = in luteal phase - Ix dec capacity to maintain preg. (e.g. anti-phospholipid Aby)
- Assessment of oocyte passage (by tubal patency)
- Assess. implantation (by hysteoscopy)
What is Polycystic ovarian syndrome
> 50% obese
- family Hx of NIDDM (non-insulin dependent diabetese mellitus)
- insulin resistant aka hyperinsulinaemia
- irreg mens. => infertile
What does 1º and 2º infertility mean?
1º: had no previous successful pregnancies
2º: had previous successful pregnancy/s (e.g. miscarriage, ectopic pregnancy)
What’s amenhorrhea & oligomenhorrhea
Amen: no menstruation cycle
Oligo: irregular mens. cycle
Describe the WHO classification of group 1 anovulation
- Dec LH/FSH (gonadotropins) & Dec oestrogen
- Hypothalamic hypogonadism
what’s kallmann’s syndrome
GnRH neurons fail to migrate to hypothal. = dec gonadotropins
=> hypothalamic hypogonadism (group 1 anovulation)
Describe the WHO classification of group 3 anovulation
- Inc LH/FSH (gonadotropins) & Dec oestrogen
- Hyperthalamic hypogonadism
Describe the WHO classification of group 2 anovulation
- N LH/FSH (gonadotropins) & N oestrogen
- Polycystic ovarian syndrome (PCOS)
- *LH/FSH ratio usually inc but depend on assay
- *inc serum androgens: testost, DHEAS, androstenedione
- SHBG reduced (sex hormone binding globulin)
Polycystic ovarian syndrome (PCOS): biochemical and clinical profile, and it’s investigation
2 of the following 3
- menstrual irreg. *
- hyperandrogenism *need to exclude adrenal tumours, CAH, Cushing’s
- Polycystic ovaries
How does insulin resistance lead to PCOS?
inc insulin = dec SHBG & IGF binding protein
=> IGF (growth of tiss) & androgen more active? (bc not bound to globulins)
Hormones involved in menstrual cycle & brief process
- FSH -> follicular growth ->
- Oestrogen ->
- LH -> Ovulation -> Corpus luteum ->
- Progesterone (early) & oestrogen (late) -> maintain endometrial wall & neg FB on FSH & LH
-> as Corpus luteum degrades = dec prog. & oest. => Inc FSH
*Progesterone is secreted from placenta after 6 wks
Recap about CAH (congenital adrenal hyperplasia):
a) cause, manifestation, lab findings
a) Enz deficiency (11 beta hydroxylase) => Hi cortisol & aldosterone secretion (*not due to destruction of gland).
b) inc ACTH = adrenal hyperplasia = Inc androgen secretion, Ald & cortisol
c) **Plasma 17-OH-progesterone OR pregnanetriol (it’s urine metabolite)
- Androgens
- ACTH
Recap about Cushings syndrome:
a) cause
b) manifestation
a) High Enz activity > breakdown & inc cortisol
b) - Low K+/ Hi HCO3-, Hi Na & water
- hypertension
- hyperglycemia, hyperlipidemia
how can hypothyroidism lead to infertility (or amenhorhea)
get hyperprolactinaemia (elevated from TRH?) = inhibit LS & FSH secretion = amenhorrhea
