fertile Flashcards
semen deposition
□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
semen analysis
- volume >1.5 ml
- density > 15 x 10^6/ml
- motility > 40% progressively motile
- morpholgy >4% normal
sperm capacitation
“Switching on” of sperm - HYPERACTIVE
Takes about 4 hours after ejaculation
Cholesterol loss and calcium influx
subfertility
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
causes of anovulation
• 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
estrogens
○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
progesterone
○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
kalmann syndrome
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
progesterone normally not prego
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
lactation
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.
hCG
○rescues, maintains corpus luteum → entirely dependent on it
○stimulates maternal thyroid: □hCG binds TSH receptors □LH-hCG receptor is expressed in the thyroid
hPL human placental lactogen
○↑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
CRH corticotropin releasing hormone
○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?
Leptin
○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
Maternal adrenala hormones increase
BP?
○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
renal syst in pregnancy
○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
pregnancy pulmonary fx
○↑tiadial volume due to progesterone
○respiratory rate unchanged ○↓expiratory reserve
○↓pCO2, ↑pO2, pH unchanged, (HCO3↓)
○costal margin and diaphragm altered
pregnancy coagulation
○induced low grade coagulability – good at delivery: ↑FVII, FVIII, FX, fibrinogen; ↓fybrinolysis
GI pregnancy
○↓smooth muscle tone → □↓cardiac sphincter tone, motility → biliary stasis,↑gastric reflux, nutrient absorption, water reabsorption
Glucose transport: to fetus
GLUT 1
fetal bilirubin excretion
fetus produces unconjugated bilirubin (has no enzymes to conjugate) → binds to albumin and is transported to mother where it is conjugated & excreted
- Sitting unsupported
- Closure of the ductus arteriosus
- Linking two words in speech
- Reaching the full number of nephrons in the kidney
- Closure of the ductus venosus
- Smiling responsively
- Around 7 months old
- Around 1 day of birth
- Around 2 years old
- About 35 weeks gestation
- Within minutes of birth
- Around 6 weeks old
contraception effectiveness
pearl index
total accidental pregnancies X 1200 / total months of exposure
expressed as failure rates per 100 women-years
sperm survive for
7 days
ova survive for
24 h
progestogen
progesterone - naturally made or from plants but identical
progestin - from plants, different structure
Ethinyl estradiol
- Supress FSH
- Stabilise endometrium
- Potentiates actions of progestogens
Progestogen actions
- Supress LH
- Thicken cervical mucus
- Produces unreceptive endometrium
- Affects tube motility
Delivery emthods
combined:
pills, rings, patches
Progestogen only
pils, implants, injections
emergency IUD
Must be copper
May be inserted up to 5 days after
earliest calculated ovulation OR 5 days after earliest UPSI
Very effective
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.
age of menopause
avg western 51
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
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
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
NON-HORMONAL
ALTERNATIVES TO HRT
- Lifestyle measures
- Replens
- Alpha 2 agonists - clonidine
- Beta blockers
- SSRI’S
- Gabapentin
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
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
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
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
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
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_
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
