Female Fertility/Implant/Infertility/Contraception

Question 1

How does the PS system effect female reproductive organs during orgasm

Answer 1

discharge from perineum and vagina->dilation of arterioles and constriction of venules in clitoris and introitus->clitoral erection and tightening of vagina around shaft of penis->massaging action to assist in male orgasm

Question 2

What gland is responsible for the vaginal secretions during coitus?

Answer 2

bartholin glands

Question 3

What are spinal reflexes responsible for during orgasm?

Answer 3

vigorous upward contraction of muscles of perineum, vagina, cervix, uterus and oviducts

Question 4

After orgasm how long does the cervix remain open? Why?

Answer 4

20-30 min, sperm entry

Question 5

Hwo are sperm transported inside the female?

Answer 5

200-300mil deposited near cervix, sperm swim through open cervix and uterus to oviducts, uterine contractions and oviductal ciliary movements generate upward current to aid sperm, ~200 reach ampulla; viable 48-72 hrs after ejaculation; egg only 24-48hrs

Question 6

What is capacitation and where does it occur?

Answer 6

shed cholesterol deposit from head of spermatozoa, Ca influx occurs and flagellar beating increases and epididymal glycoproteins are removed from sperm surface unmasking binding proteins; fallopian tube; reason sperm is washed in IVF

Question 7

What is the acrosome reaction?

Answer 7

release of hyaluronidase and acrosin from acrosome (sac opens)

Question 8

What changes occur in the oocyte resulting in fertilization?

Answer 8

hyalronidase disperses cumulus cell, spermatozoa reaches zona pellucida and bind to ZP3 receptor->acrosin perforates zona->spermatozoon enters perivitelline space-> cortical granules make the zona protease resistant to further sperm penetration (polyspermy)-> swelling of egg and sperm nuclei to form femal and male pronuclei which fuse making the zygote

Question 9

What causes polyspermy?

Answer 9

abnormality in zona pelucida; especially in older eggs

Question 10

What are some chromosomal abnormalities?

Answer 10

absence of one X (Turner syndrome), superneumerary chromosome (Klinefelter syndrome or fatal), increased postanatal aging can cause trisomy of various types (trisomy 21- downs)

Question 11

What are the steps of implantation?

Answer 11

6-7 days, in uterus morula transform into blastocyst containing inner cell mass and outer trophectoderm, before implanation blastocyst sheds zona (hatching), blastocysts attches on endometrial surface, trophoblast cells phagocytose and penetrate endometrium (Luteal Phase)

Question 12

After implantation what leas to secretion of hCG?

Answer 12

inner cytotrophoblast layer is composed of mitotic cells, outer syncytiotrophoblast layer (post mitotic surface layer derived by fusion of plasma membrane of cytrophoblast ->multinuclear syncytium are highly differentiated and secrete CG

Question 13

What does CG do?

Answer 13

rescues CL from demise=maternal recognition of pregnancy

Question 14

What prevents the endomtetiurm from having an immune response to the blastocyst?

Answer 14

syncytiotrophoblast or cytotrophoblasr do not express functional MHC antigens; if infection present at same time can result in loss of embryo

Question 15

What is decidualization?

Answer 15

growth factors secreted by syncytial induce endometrial differentiation into cobble stome like decidual cells; begins in endometrium closely apposed to the implanting embryo, spreads with progress of implantation and placentation

Question 16

What do decidual cells secrete?

Answer 16

pregnancy associated protein A, CA125 (glycoprotein), prolactin, B-endorphin, plasminogen activator (protease participating in trophoblast penetration, and diamine oxidase (forms spermidine-strong immunosuppressant)

Question 17

What are the four main causes of infertility?

Answer 17

tubal patency, endometriosis, luteal phase defect, problems with male counterpart

Question 18

What causes tubal patency issues?

Answer 18

PID, septic abortion, long-term IUD use, tubal damage from previous ectopic pregnancy

Question 19

Why does endometriosis cause infertility?

Answer 19

hampers tubal movement and induces breakthrough bleeding

Question 20

What causes luteal phase defect?

Answer 20

retarded follicular growth, anovulation, inadequate progesterone support of endometrium- breakthrough bleeding

Question 21

What problems can IVF address?

Answer 21

tubal defects (surgery or disease), endometriosis (refractory to surgical or medical treatments), idiopathic infertility, oligospermia, antisperm antibodies, and cervical factors

Question 22

What are the major components of IVF?

Answer 22

ovarian stimulation and induction of ovulation (harvest), preparation of sperm, IVF and embryo development, and embryo transfer

Question 23

How is ovarian stimulation done during IVF?

Answer 23

follicular recruitment induced by clomiphene citrate or recombinant FSH (rFSH), for favorable recruitment controlled ovarian hyperstimulation needed-> GnRH agonist (Lupron) injected midluteal phase~1 week from ovulation and continued for 10 days or onset of meses(many use GnRH anatgonsit to avoid transient rise in LH-linked to poor eggs), rFSH injected 3rd day of menses for 7-12 days or until 18-20mm follicles seen on ultrasound; CG injected 36hr before retrieval (ensure matrutiy-complete meisosis 1)

Question 24

How are eggs retrieved?

Answer 24

cumulus cell-enclosed eggs collected into synthetic culture medium using ultrasound guided aspiration needle laparoscopy- 1st polar body should be visible

Question 25

how is the sperm prepared in IVF?

Answer 25

semen collected, spermatozoa purified by washing, capacitated in insemination medium and motile sperm added to culture containing an egg

Question 26

What is done differently in IVF for low sperm count/ high percentage abnormal morphology or abnormal motility?

Answer 26

motile sperm concentrated further using density centrifugation

Question 27

In severe cases of azoospermia, oligospermia or older eggs what is done differently in IVF?

Answer 27

one motile spermatozoon is microinjected into oocyte cytoplasm bypassing ZP- ICSE

Question 28

What are the criteria for successful fertilization in IVF?

Answer 28

2nd poar body, presence of male and female pronuclei, contracted egg cytoplasm or normal cleavage

Question 29

At what stage of development does embryo transfer occur?

Answer 29

blastocyst develop by 5th day; either 3 day (8 cell) or 5 day; usually 5 day

Question 30

How do combo OCs work?

Answer 30

estrogen is ethynyl estradiol or mestranol- breaks down to estradiol- resistant to liver so effective in small doses, progestin is norethindrone, norgestrel, norethindrone acetate, ethynodiol diacetate; 21 day active 7 day hormone free; can be mono, bi or triphasic

Question 31

How do progestin only OCs work?

Answer 31

minipill, continuous low dose progestin, causes endometrial involution and thickening of cervical mucus, pills must be taken continuously w/o hormone free period for max effectiveness; slightly less effective, often irregular menses because gonadotropins are not consistently suppressed resulting in varied ovarian stimulation

Question 32

how do postcoital contraception OC work?

Answer 32

ethinyl estradiol with levonorgestrel or high dose levenorgestrel- withnin 72 hrs, functions by altering egg transport through oviduct

Question 33

What can cause a spontaneous abortion?

Answer 33

luteal phase defect, infection- (B toxins trigger immune cells to secrete cytokines (IL-1 and PG); PG cause uterine contractions, IL-1 causes cervical ripening via collagenase activity and fetus is expelled, or abdominal trauma

Question 34

What methods are used for voluntary abortion?

Answer 34

RU486 (blocks progesterone receptors), Vacuum aspiration, Dilation and Cutterage, or PG infusion (uterine contraction and expulsion of embryo); often combo of PG and RU486