fertile Flashcards

1
Q

semen deposition

A

□Generally into the posterior fornix of the vagina which is hostile:

•pH 5.5-6.0 due to presence of lactobacilli

partly buffered by alkaline semen

•semen initially ‘clots’ breaks down in about 10-20 mins due to action seminal enzymes

□ Most semen is lost from vagina after sex □ 1% or less retained by cervix

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2
Q

semen analysis

A
  • volume >1.5 ml
  • density > 15 x 10^6/ml
  • motility > 40% progressively motile
  • morpholgy >4% normal
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3
Q

sperm capacitation

A

“Switching on” of sperm - HYPERACTIVE
 Takes about 4 hours after ejaculation
Cholesterol loss and calcium influx

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4
Q

subfertility

A

Is an arbitrary diagnosis:
failure to conceive after 1 year regular unprotected intercourse
• Is a common problem: 1 in 7 couples
• Should be managed as a couple

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5
Q

causes of anovulation

A

• Hyperprolactinaemia - raised prolactin (PRL)
• Hypothyroidism - Low T4/T3: Raised TSH
• Hyperthyroidism -Raised T4/T3 Low TSH
• Hypogonadotrophic hypogonadism - Low FSH and LH and oestradiol
• Hypergonadotrophic hypogonadism (ovarian failure)
- Raised FSH and low oestradiol
• Polycystic ovary syndrome - tonic elevation of LH
- mildly elevated testosterone
• Anorexia - Low body mass & low FSH/LH

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6
Q

estrogens

A

Cardiovascular adaptation to pregnancy: □↑blood vessel compliance → accommodates more blood □↑eNOs→ ↑NO

○Growth of uterus

○Primes uterus for labour → coordinates, synchronises uterine contractions

○weak antiinsulinic activity via ↑cortisol → creates [glu] gradient between mum and fetus

○onset of labour?

○cervical ripening

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7
Q

progesterone

A

prepares, maintains endometrium for implantation

○initially produced by corpus luteum (up to 55d) then placenta

○may suppress maternal immune response to fetal antigens

○role in parturition

a substrate for fetal adrenal gland production of glucocorticoids and mineralocorticoids

○growth of mammary glands

maintains pregnancy → inhibits uterine contractions, prevents cervical ripening

○induces overbreathing → ↓CO2 maternal

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8
Q

kalmann syndrome

A

f isolated hypogonadotropic hypogonadism where there is an associated lack of sense of smell.

Hypogonadotrophic hypogonadism -> defective hypotalamic cells that secrete GnRH. Absence of sense of smell

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9
Q

progesterone normally not prego

A

During mestrual cycle:
Cause a rise in body temperature, the production of secretory endometrium and secretion of thick cervical mucus with leucocytes; has negative feedback on pituitary and hypothalamus
In pregnancy: cuases a reduction of contractions and reduces muscle tone. Rise in body temperature
Cellular effects:

Stimulates formation of 17-hydroxysteroid dehydrogenase whuch leads to inactivation of oestradiol in target tissue by converting it to oestrone

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10
Q

lactation

A

However, although prolactin levels are very high during pregnancy, lactation does not occur because estrogen and progesterone block the action of prolactin on the breast.

A_fter parturition, when estrogen and progesterone levels fall precipitously, their inhibitory effects on the breast are removed, and lactation can proceed._ As described in Chapter 9, lactation is maintained by suckling, which stimulates the secretion of both oxytocin and prolactin.

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11
Q

hCG

A

○rescues, maintains corpus luteum → entirely dependent on it

○stimulates maternal thyroid: □hCG binds TSH receptors □LH-hCG receptor is expressed in the thyroid

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12
Q

hPL human placental lactogen

A

○↑maternal lipolysis →↑NEFAs which are a source of energy for maternal metabolism, fetal nutrition

○anti-insulin/diabetogenic action: □↑maternal insulin, ↑protein synthesis, glucose transport for fetus ○angiogenic → formation of fetal vasculature

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13
Q

CRH corticotropin releasing hormone

A

○immnunosuppression? ○CRH levels rise near the end of gestation (CRH-binding protein ↓) → induces myometrical contractions? ○prostaglanding formation in placenta, amnion, chorion leave and deciduas is increased by CRH → controls timing of parturition?

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14
Q

Leptin

A

○secreted by cytotrophoblasts and syncytiothrophoblasts

○maternal levels are higher than normal and in fetus ○stimulates placental amino acid/NEFA transport

○fetal leptin levels correlate positively with birthweight ○role in development and growth

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15
Q

Maternal adrenala hormones increase

BP?

A

Na retention →>>↑volume →>>↑CO:

□oestrogen →↑renin-aldosterone

_□progesterone, _ vasodilatory PGs→↑aldosterone

□shunting of blood to uterine circulation stimulates sympathetics →↑renin

□renal Na loss due to ↑GFR →↑renin □hCG→↑renin

○↓peripheral resistance: □↑NO, prostacyclin □relaxin?

□shear stress: mechanical transduction into chemical response: ↑PGI2→↑cAMP; ↑NO→↑cGMP; ↑EDHF → relaxation

◊preeclamptic women don’t have such vascular responses

○skin blood flow predominantly ↑ in hands and feet: ↑skin temperature, nail growth, %of hairs growing, disappearance of Raynauld’s syndrome, nose bleeds, stuffed, snoring

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16
Q

renal syst in pregnancy

A

○in pregnancy, there is no high diuresis because ADH is ↑↑, so low blood osmolarity is maintained.

↑GFR because needs to excrete waste
○plasma markers: urea, creatinine

glycosuria → GFR too high to have sufficient time to reabsorb ○calciuria ○urinary frequency ↑

○urinary stasis due to dilation of collecting system

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17
Q

pregnancy pulmonary fx

A

○↑tiadial volume due to progesterone

○respiratory rate unchanged ○↓expiratory reserve

○↓pCO2, ↑pO2, pH unchanged, (HCO3↓)

○costal margin and diaphragm altered

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18
Q

pregnancy coagulation

A

○induced low grade coagulability – good at delivery: ↑FVII, FVIII, FX, fibrinogen; ↓fybrinolysis

19
Q

GI pregnancy

A

○↓smooth muscle tone → □↓cardiac sphincter tone, motility → biliary stasis,↑gastric reflux, nutrient absorption, water reabsorption

20
Q

Glucose transport: to fetus

21
Q

fetal bilirubin excretion

A

fetus produces unconjugated bilirubin (has no enzymes to conjugate) → binds to albumin and is transported to mother where it is conjugated & excreted

22
Q
  1. Sitting unsupported
  2. Closure of the ductus arteriosus
  3. Linking two words in speech
  4. Reaching the full number of nephrons in the kidney
  5. Closure of the ductus venosus
  6. Smiling responsively
A
  1. Around 7 months old
  2. Around 1 day of birth
  3. Around 2 years old
  4. About 35 weeks gestation
  5. Within minutes of birth
  6. Around 6 weeks old
23
Q

contraception effectiveness

A

pearl index

total accidental pregnancies X 1200 / total months of exposure

expressed as failure rates per 100 women-years

24
Q

sperm survive for

25
ova survive for
24 h
26
progestogen
progesterone - naturally made or from plants but identical progestin - from plants, different structure
27
Ethinyl estradiol
1. Supress FSH 2. Stabilise endometrium 3. Potentiates actions of progestogens
28
Progestogen actions
1. Supress LH 2. Thicken cervical mucus 3. Produces unreceptive endometrium 4. Affects tube motility
29
Delivery emthods
combined: pills, rings, patches Progestogen only pils, implants, injections
30
emergency IUD
**Must be copper**  May be inserted up to 5 days after earliest calculated ovulation OR 5 days after earliest UPSI  Very effective
31
what is menopause
What is the menopause? **– Defined as the Last Menstrual Period.** • **Retrospective diagnosis – after one year of amenorrhoea.** _• What is the climacteric?_ – Defined as the period of time around the last menstrual period.
32
age of menopause
avg western 51
33
what happens in climacteric\>?
_due to to limited pool of oocytes:_ **– Oocytes decrease – Reduction in oestrogen (no ovulation) – FSH increases (lack of inhibitory feedback from oestrogen)** Which leads to: **– Anovulatory cycles – Mennorhagia – Irregular periods**
34
Sx of climacteric
Physical changes – The Hot Flush/The night sweat – Headaches – Palpitations – Leg Cramps – Uro-genital symptoms – Reduced libido Psychological changes – Depression – Loss of memory – Irritability – Poor concentration – Tiredness – Loss of libido – Loss of confidence
35
HRT
Reasons for starting HRT: • Control of symptoms • Protection from osteoporosis • Prevention of ageing Reasons for discontinuing HRT: • Withdrawal/breakthrough bleeding • Side-effects • Fear of cancer _Benefits of HRT_ • Alleviate symptoms • Protect bones • Reduces incidence of Colorectal cancer • ? Protect CVD • Improve quality of life _Risks of HRT_ • VTE • Breast Cancer • Endometrial cancer • ? CVD
36
NON-HORMONAL ALTERNATIVES TO HRT
* Lifestyle measures * Replens * Alpha 2 agonists - clonidine * Beta blockers * SSRI’S * Gabapentin
37
contraception with HRT
HRT is not contraceptive • If LMP \<50 years continue contraception for 2 years • If LMP \>50 years continue contraception for 1 year • Methods increase in effectiveness with increasing age due to decreasing fertility
38
Intersex Conditions
0.1-02% live births major ambiguity 1-2% minor ambiguity  Complete/partial androgen insensitivity  Congenital adrenal hyperplasia  Trus Hermaphrodites  Vaginal agenesis  Non XX females or non XY males
39
Gender identity
 **By 2 to 3 yrs conviction about male or female**  Psychological aspects of behaviour related to masculinity and femininity  Sex biological  **Gender identity** – family, cultural, social, biological influences  Transgender individuals – highlight difference between gender and sex
40
causes of homosexuality
Biological Factors **(3rd Interstitial nucleus of the anterior hypothalamus is larger in men than women and intermediate in size in homosexual men**)  Higher mono-zygotic concordance  Familial more brothers of homosexuals are homosexual
41
Gender identity disorders
**More common in men**  Stated desire to be other sex  Incongruent Gender identity and Biological Sex ** Needs to be separated from sexual orientation**
42
social development of baby
Early social responsiveness e.g. smiling nonspecific  Specificity after 1st few months (towards main caretakers)  About 8 months - separation anxiety - fear of stranger _** 10 months – social referencing  Attachment: 6 months – 2 years Critical period**_
43
different androgens affect different tissues
Adrenal : l Axilla/pubic hair– low levels of androgens required – stimulation occurs in both sexes Testis Face, beard: high levels of ndrogen requireds Marker for elevated androgen levels