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Reproduction, Development and Aging > Fertilisation and Fertility > Flashcards

Fertilisation and Fertility Flashcards

1
Q

Describe how the polar bodies are formed

A

Following the LH surge, meiosis in the primordial follicle resumes from the end of prophase I and the first division is completed, resulting in an oocyte and a polar body. The process then arrests in second metaphase, the state in which it is ovulated. After fertilisation it again resumes and completes the next division, resulting in another polar body.

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2
Q

Where are the polar bodies in relation to the oocyte?

A

Inside the zona pellucida

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3
Q

Liquefaction

A

The process by which the seminal coagulum breaks down after vaginal insemination

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4
Q

Role of the seminal plasma

A

Because the vagina is acidic (around 4.7 pH), sperm motility and survival is inhibited. Seminal plasma buffer the vaginal pH to around 7.2, allowing sperm to become motile.

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5
Q

Role of cervical mucus in fertilisation

A

Apart from a very short window around the time of ovulation, cervical mucus is thick and hostile to sperm. When it is spinnbarkeit, the cadence of the sperm moving in synchronisation causes swaying of the fibres of the cervical mucous, allowing sufficiently motile sperm to move through. If the sperm is abnormal, it retards the progress of the sperm and thus is an efficient barrier to undesirable sperm.

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6
Q

Where are some areas that sperm can wait for an egg?

A

The crypts of the cervix

The isthmus of the fallopian tube

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7
Q

Phagocytosis of sperm

A

Sperm in the female reproductive tract induce an innate immune response causing leukocytosis and phagocytosis of dead or dying sperm
Theory that this allows exposure to paternal antigens, preparing a woman for pregnancy

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8
Q

Induction of the acrosome reaction

A

Granulosa cells of the egg release progesterone, producing a progesterone gradient that the sperm swim up. Together with ZP3, a calcium influx is triggered, allowing the acrosome reaction to begin.

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9
Q

Capacitation

A

The removal of inhibitory substances from the sperm, including a loss of cholesterol, leading to sperm hyperactivation. These sperm move faster and more vigorously, facilitating movement through the fallopian tubes and allowing sperm to undergo the acrosome reaction.

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10
Q

Acrosome

A

Membranous pouch containing proteinases and other enzymes such as hyaluronidase

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11
Q

Partial acrosome reaction

A

Cumulus oophorus releases progesterone, triggering hyaluronidase release from the acrosome. This digests the basement membrane of the egg, allowing the sperm to squeeze between cumulus cells and contact the zona pellucida.

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12
Q

Acrosome reaction

A

Fusion of the acrosomal and plasma membranes of the sperm head, allowing release of acrosomal contents into the environment

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13
Q

Peri-implantation window

A

Time that the egg can survive unfertilised, normally around 24 hours

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14
Q

Corona radiata

A

Layer of tightly packed follicle cells that surrounds the zona pellucida. Sperm must digest through these to make contact with the ZP.

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15
Q

ZP3

A

Protein of the zona pellucida which is considered the primary sperm receptor. Contact between this and the sperm ligand for ZP3 induces the complete acrosome reaction

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16
Q

Perivitelline space

A

Gap between the ZP and the oocyte

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17
Q

What is the cell membrane of the oocyte called?

A

The oolemma

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18
Q

Cortical reaction

A

Entry of a sperm into an oocyte causes intracellular calcium release which is followed by regular spikes of calcium in the oocyte, inducing resumption of meiosis. Cortical granules are then released into the perivitelline space, causing crosslinking of ZP proteins and producing the polyspermy block.

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19
Q

Cortical granules

A

Proteases and beta-hexosaminidase which cleave ZP2 and digest ZP3, linking them together and with ZP1 to make the polyspermy block.

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20
Q

Resumption of meiosis upon fertilisation

A

Calcium rise causes destabilisation of protein complex which help the chromosomes in metaphase II. Loss of this complex allows meiosis to resume.

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21
Q

What part of the zygote becomes the placenta?

A

The trophectoderm

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22
Q

What part of the zygote becomes the embryo?

A

The inner cell mass

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23
Q

Nidation

A

The hatched blastocyst comes into physical contact with the receptive decidua and attaches to it via adhesion molecules

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24
Q

Infertility

A

A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sexual intercourse

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25
Q

Why have the NZ fertility rates fallen to below population replacement level?

A

People are having smaller families and delaying childbearing

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26
Q

How does men’s age impact fertility?

A

With age, there is a decrease in semen volume, sperm motility and sperm morphology

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27
Q

3 ways to assess ovarian reserve

A

Family history of early menopause
Antral follicle count using ultrasound
AMH blood test

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28
Q

Why is AMH testing useful for assessing ovarian reserve?

A

AMH is released from granulosa cells of developing follicles, so lots of AMH = lots of follicles.
Also useful for testing for PCOS for the same reason.

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29
Q

Factors affecting female gamete health

A 
Age
Mediterranean diet
Smoking
Alcohol
Caffeine
Weight
Drugs
Medication
Folic acid and vitamin intake
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30
Q

Factors affecting male gamete health

A 
Age
Mediterranean diet
Smoking
Alcohol
Antioxidants
Weight
Frequent sex
Temperature of testes
31
Q

Oligomenorrhea

A

More than 35 days without menstruation

32
Q

Treatment for anovulation

A

Weight gain or loss
Moderate exercise
Clomiphene citrate
Letrozole

33
Q

Clomiphene citrate

A

Blocks the action of estradiol on the pituitary, thereby increasing FSH release

34
Q

Letrozole

A

Decreases estradiol production in the ovary, therefore increasing FSH release from the pituitary in the absence of the negative feedback mechanism
Also decreases the incidence of twins

35
Q

Endometriosis diagnosis

A

Laparoscopy

36
Q

Endometriosis treatment

A

Laparoscopy
Lipiodol flushing
IUI and IVF for pregnancy

37
Q

Symptoms of PCOS

A 
Irregular/absent periods
Subfertility
Unwanted hair growth
Acne
Metabolic syndrome
38
Q

Ovarian hyperstimulation syndrome

A

Overtreatment in women wanting to have children with letrozole leading to overproduction of FSH

39
Q

Semen analysis

A

Used to check for FSH, chromosomal abnormalities, CFTR mutation, endocrine imbalances e.g. Kallmann’s

40
Q

Physical examination for male infertility

A

Check for varicoeles or abnormal swelling

41
Q

History taking for male infertility

A

Ask about testicular trauma, mumps, vasectomy, chlamydia, previous surgeries, undescended testes

42
Q

Testicular biopsy

A

Can biopsy either testicle itself or epididymis

Confirms presence of sperm

43
Q

IVF ovarian stimulation

A

Stimulation by increasing FSH
Control ovulation by preventing it with GnRH antagonists
Trigger ovulation when needed by stimulating ovarian hCG or using a GnRH agonist
Support the corpus luteum by giving progesterone

44
Q

PGT-A

A

Pre-implantation genetic testing for aneuploidy

45
Q

PGT-SR

A

Pre-implantation genetic testing for structural rearrangements of chromosomes

46
Q

PGT–M

A

Pre-implantation genetic testing for monogenic disorders (single gene defects)

47
Q

Sperm normal limits

A 
15 M/mL
40% progressive
1.5 mL
39 million sperm in total ejaculate
58% live
48
Q

Preimplantation testing

A

Performed on embryos produced by IVF
Test women of advanced menstrual age, recurrent miscarriage, multiple failed IVF cycles
Used to select best embryo for transfer

49
Q

Which contraceptions can be used for emergency contraception?

A

The copper IUD due to prevention of implantation

Levonelle – the emergency contraceptive pill

50
Q

Informed consent around contraception

A

No restriction of prescribing contraception to under 16s without parental consent as long as the assessment of competence is sound i.e., the child should have sufficient understanding and maturity to fully comprehend the proposed treatment

51
Q

Contraceptive

A

The ability to prevent pregnancy via interference with ovulation, fertilisation or implantation

52
Q

Interceptive

A

An agent which prevents implantation rather than preventing fertilisation

53
Q

UK MEC

A

Medical eligibility criteria – evidence based guidance for providers of contraception
MEC 1 –no restriction on use
MEC 2 – Advantages of use of method generally outweighs disadvantages
MEC 3 –Disadvantages of use generally outweigh advantages
MEC 4 –Do not use

54
Q

How does the OCP work?

A

1) Suppresses ovulation
2) Reduces sperm transport in the upper genital tract
3) Alters endometrium, inhibiting implantation
4) Thickens cervical mucus

55
Q

Ginet

A

Type of OCP with anti-androgen properties

Good for acne but increased risk of DVT

56
Q

Advantages of OCP

A 
Cheap
Ability to regulate own periods
Can make periods lighter and less painful
No problems with insertion
No evidence of weight gain or depression
57
Q

Disadvantages of OCP

A

Pill free interval carries pregnancy risk
Increased blood pressure
Risk of DVT/VTE/CVA
Relies on patients ability to adhere to medication

58
Q

Danger of the pill free interval

A

Suppressive effect of oestrogen decreases causing a rise in FSH, which increases the chance of follicular development and ovulation

59
Q

Contraindications of the OCP

A 
Focal migraines
Smoking status
Obese
High blood pressure
Some epileptic medications
60
Q

Protection when starting the OCP

A

If day 1–5 of cycle, protected straight away

Any later in the cycle, 7 days of other contraception/abstinence required

61
Q

OCP interaction with antibiotics

A

No interaction with antibiotics except rifampicin

62
Q

The rules of missed pills

A

1) Don’t miss any pills in the first week because ovulation is not suppressed
2) If a pill is missed or more than 12 hours late, 7 day rule applies –ECP if sex has taken place
3) Can miss 2 pills in week 2 because ovulation is suppressed
4) Can miss 2 pills but PFI should be skipped

63
Q

POP

A

Progesterone only pill
Useful if unable to take OCP or breastfeeding
Lower failure rate because it suppresses ovulation
Unfunded

64
Q

Starting the POP

A

Start up to day 5 of cycle without additional contraception
Any later requires 48 hours additional precautions
1 missed POP or more than 3 hours late requires 48 hours additional precautions

65
Q

Depo Provera

A

Centrally switches off FSH causing ovary to become quiescent
Also thickens cervical mucus, making it harder for sperm to move through
Prolonged amenorrhoea, weight gain, delayed return of fertility
Oestrogen free

66
Q

Jadelle

A

Slow-releasing progesterone
Very effective – failure rate around 0.05%
Stops ovulation and prevents implantation

67
Q

Jadelle mechanism of action

A

1) Prevents endometrium from preparing to accept an egg (progesterone keeps it in constant thin state)
2) Thickens cervical mucus
3) Prevents release of egg by keeping it constantly in progesterone-dominated state

68
Q

Jadelle disadvantages

A

Can be visible
Bleeding
Interactions with enzyme-inducing medication

69
Q

Copper IUD mechanism of action

A

Copper on stem directly toxic to sperm
Induces microscopic reaction in endometrium to prevent implantation (makes it thinner)
Makes cervical mucus thicker

70
Q

Complications of CIUD

A

Can fall out of migrate – both rare

71
Q

Disadvantages of CIUD

A

Painful upon insertion

Can make periods heavier and more painful

72
Q

Indications of Mirena

A

Contraception
Heavy menstrual bleeding
Endometrial protection with hormone replacement therapy

73
Q

Uses of Mirena

A

Dysmenorrhoea
Endometriosis
Endometrial hyperplasia

74
Q

Levonelle mechanism of action

A

Effective for up to 72 hours post intercourse but efficacy decreases with time
Postpones ovulation for 5 days, at which time sperm are dead/gone
Ineffective if ovulation has already occurred

Reproduction, Development and Aging (5 decks)

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