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(4003) Biochem > Female fertility > Flashcards

Female fertility Flashcards

1
Q

Comment on other metabolic and clinical abnormalities of PCOS (3-7)

A
  • *menstrual irreg.
  • *hyperandrogenism
  • *Polycystic ovaries
  • Galactorrhea (high prolactin)
  • infertility
  • acne
  • hirsutism (excess hair in females almost like male)
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2
Q

List some causes of female hyPOgonadotrophic hypogonadism

A
  • 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)
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3
Q

List some causes of female hyPERgonadotrophic hypogonadism

A
  • premature ovarian failure
  • loss of ovarian function (from infection, trauma, cystic degeneration, menopause) = so can’t induce ovulation
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4
Q

Describe expected gonadotrophin levels in a post-menopausal woman (assume the subject is not being treated with any hormone supplements).

A

Inc FSH/LH but dec oestrogen
- lack neg feedback

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5
Q

5 causes of infertility in women

A
  • Age: menopausal
  • systemic disease (illness)
  • drugs
  • pelvic inflammations/infections
  • freq. of intercourse
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6
Q

Biochemical tests & other test for assessment of ovulation.

A
  1. Measure progesterone: pos. for ovulation if:
    >30nmol/L= Hi (LH inc); mid cylce; or
    >16nmol/L = in luteal phase
  2. Ix dec capacity to maintain preg. (e.g. anti-phospholipid Aby)
  3. Assessment of oocyte passage (by tubal patency)
  4. Assess. implantation (by hysteoscopy)
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7
Q

What is Polycystic ovarian syndrome

A

> 50% obese
- family Hx of NIDDM (non-insulin dependent diabetese mellitus)
- insulin resistant aka hyperinsulinaemia
- irreg mens. => infertile

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8
Q

What does 1º and 2º infertility mean?

A

1º: had no previous successful pregnancies
2º: had previous successful pregnancy/s (e.g. miscarriage, ectopic pregnancy)

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9
Q

What’s amenhorrhea & oligomenhorrhea

A

Amen: no menstruation cycle
Oligo: irregular mens. cycle

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10
Q

Describe the WHO classification of group 1 anovulation

A
  • Dec LH/FSH (gonadotropins) & Dec oestrogen
  • Hypothalamic hypogonadism
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11
Q

what’s kallmann’s syndrome

A

GnRH neurons fail to migrate to hypothal. = dec gonadotropins
=> hypothalamic hypogonadism (group 1 anovulation)

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12
Q

Describe the WHO classification of group 3 anovulation

A
  • Inc LH/FSH (gonadotropins) & Dec oestrogen
  • Hyperthalamic hypogonadism
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13
Q

Describe the WHO classification of group 2 anovulation

A
  • 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)
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14
Q

Polycystic ovarian syndrome (PCOS): biochemical and clinical profile, and it’s investigation

A

2 of the following 3
- menstrual irreg. *
- hyperandrogenism *need to exclude adrenal tumours, CAH, Cushing’s
- Polycystic ovaries

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15
Q

How does insulin resistance lead to PCOS?

A

inc insulin = dec SHBG & IGF binding protein
=> IGF (growth of tiss) & androgen more active? (bc not bound to globulins)

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16
Q

Hormones involved in menstrual cycle & brief process

A
  1. FSH -> follicular growth ->
  2. Oestrogen ->
  3. LH -> Ovulation -> Corpus luteum ->
  4. 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
17
Q

Recap about CAH (congenital adrenal hyperplasia):
a) cause, manifestation, lab findings

A

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

18
Q

Recap about Cushings syndrome:
a) cause
b) manifestation

A

a) High Enz activity > breakdown & inc cortisol
b) - Low K+/ Hi HCO3-, Hi Na & water
- hypertension
- hyperglycemia, hyperlipidemia

19
Q

how can hypothyroidism lead to infertility (or amenhorhea)

A

get hyperprolactinaemia (elevated from TRH?) = inhibit LS & FSH secretion = amenhorrhea

(4003) Biochem (14 decks)

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