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Human Development > Fertility > Flashcards

Fertility Flashcards

1
Q

What is the position of the uterus in relation to the bladder?

A

Antroverted (usually)

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2
Q

What type of feedback is there in the menstrual cycle?

A

Oestrogen causes positive feedback in the first half and negative feedback in the second half

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3
Q

How many eggs does a woman have before birth?

A

7 million eggs

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4
Q

When does atresia of eggs start?

A

20 weeks gestation

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5
Q

Why does a woman’s fertility decrease after age 30?

A

Age related decline in quantity and quality of ovarian reserve
Age related increase in aneuploidy due to non-disjunction

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6
Q

What is the biggest predictor of fertility?

A

Maternal age

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7
Q

What is the biggest predictor of successful ovulation?

A

Regular periods

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8
Q

How is the ovarian reserve measured?

A

Antral follicle count (AFC)

Anti-mullerian hormone (AMH)

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9
Q

What is the life cycle of an ovarian follicle?

A

Primary follicle matures, ovulates and then becomes corpus luteum, which then regresses

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10
Q

What are the 3 phases of the menstrual cycle?

A
  1. Menstrual phase
  2. Proliferative phase
  3. Secretory phase (progesterone rises)
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11
Q

What are the 3 phases of the ovarian cycle?

A
  1. Follicular phase
  2. Ovulatory phase
  3. Luteal phase
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12
Q

Which hormones increase during the follicular phase of the ovarian cycle?

A

FSH –> oestrogen –> GnRH –> LH

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13
Q

What is the corpus luteum on TV ultrasound evidence of?

A

Ovulation

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14
Q

What does the corpus luteum degenerate into?

A

corpus albicans

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15
Q

What causes dysmenorrhea (pain during menstrual period)?

A

Drop in progesterone

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16
Q

When does implantation begin?

A

6-7 days after ovulation (day 21 of menstrual cycle)

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17
Q

What are the 3 types of female infertility?

A
  1. Egg problems
  2. Transport problems
  3. Implantation problems
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18
Q

What causes problems with eggs (anovulation)?

A
  1. Hypothalamic dysfunction
  2. Pituitary dysfunction
  3. Thyroid dysfunction/ovarian failure/ PCOS
    (may be hypog hypog)
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19
Q

What is the most common cause of ovulatory dysfunction?

A

PCOS

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20
Q

Why are obese women more likely to be infertile?

A 
Endogenous oestrogen (produced from fat) causes an ovulation
Weight loss can restore ovulation
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21
Q

How can gonadotrophin-deficient patients be treated?

A

Given hMG to induce ovulation

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22
Q

What drugs can be given to treat anovulation?

A

Clomiphene citrate

Letrozole

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23
Q

How is menopause defined?

A

One year of amenorrhea

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24
Q

Which hormones characterise menopause?

A

High FSH

Low oestradiol

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25
Q

What is climacteric/peri menopause?

A

Time around the last menstrual period (irregular periods, vasomotor symptoms etc)

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26
Q

What are the symptoms of menopause?

A 
Anovulatory cycles
Menstrual irregularities
Menorrhagia (heavy periods)
Physical changes, e.g. night sweats
Psychological changes (lack of oestrogen)
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27
Q

What is the average age of menopause in the UK?

A

52 years

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28
Q

What are the long term consequences of menopause?

A

Osteoporosis
CV disease
Vaginal dryness/atrophy
Alzheimer’s

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29
Q

How is menopause treated?

A

Hormonal replacement therapy (HRT) - given oestrogen, progesterone and testosterone or non-hormonal measures

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30
Q

What are the risks of hormone replacement therapy?

A

VTE
breast cancer
endometrial cancer
CVD

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31
Q

How is premature ovarian insufficiency diagnosed?

A

4 months of amenorrhoea
FSH over 30 on 2 occasions
age < 40

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32
Q

What is the cause of premature ovarian insufficiency? (POI)

A

Inadequate oogenesis

Follicle depletion/dysfunction

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33
Q

What are the implications for women with POI?

A

higher risk of CV disease/bone disease/infertility and depression

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34
Q

How is POI treated?

A

Hormone replacement therapy
Fertility treatment
Psychological support

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35
Q

What are two layers of the blastocyst?

A
  1. Trophoblast (stimulates development of placenta)

2. Inner cell mass (gives rise to embryo)

36
Q

When is the embryo most susceptible to teratogens and infectious agents? (most birth defects)

A

Embryonic period (weeks 3-8)

37
Q

What does TORCH (embryonic defects) stand for?

A 
Toxoplasma
Other viruses (parvovirus, HIV, Zika)
Rubella
Cytomegalovirus
Herpes simplex virus
38
Q

What is hypohidrotic ectodermal dysplasia?

A

Loss of hair, sweat glands and teeth due to defect in Eda pathway

39
Q

What is fetal alcohol syndrome?

A

Microcephaly (decreased Shh)
Epicanthal folds
Epigenetic changes

40
Q

What does failure of closure of neural tube cause?

A

Spina bifida
Myelomeningocoele
Meningocele

41
Q

What factors increase the risk of a spina bifida?

A

Genetic
Poor maternal folate intake
Medication - e.g. valproic acid for epilepsy

42
Q

What is being developed to treat spina bifida?

A

Fetal surgery (must happen before 26 weeks)

43
Q

What causes spondylocostal dysotosis?

A

Defects in paraxial mesoderm

44
Q

What causes achondroplasia?

A

Defects in development of cartilage

45
Q

What is Liebenburg syndrome?

A

Abnormal development of arms (become legs)

Expression of Pitz1 in arms

46
Q

What do mesodermal defects cause?

A

Skeletal/limb patterning defects

47
Q

What do endodermal defects cause?

A

Lung aplasia
Oesophageal atresia/fistula
Omphacele

48
Q

What do defects in neural crest development cause?

A

Bilateral cleft lip

Pierre-robin sequence (underdevelopment of lower jaw)

49
Q

What is Hirchsprung’s disease?

A

Vagal neural crest fails to migrate into posterior gut:

- bowel contents build up and bowel expands

50
Q

What are the 2 functions of the testes?

A
  1. Produce sperm

2. Secrete androgens

51
Q

Which cells are found in the seminiferous tubules?

A

Spermatogonial stem cells
Sertoli cells
Leydig cells

52
Q

What is the function of the Sertoli cells?

A

Support/nutrition/protection

53
Q

What is the function of the Leydig cells?

A

Produce testosterone

54
Q

What is the function of the blood-testicular barrier?

A

Protection against antisperm antibodies

55
Q

Which cells do LH and FSH act on in males?

A

LH acts on leydig cells

FSH acts on seminiferous tubules to produce inhibit and ABP (androgen binding protein)

56
Q

What kind of feedback is there in the HPA axis in females and males?

A

Females - positive and negative

Males - just negative

57
Q

What affect does prolactin have on spermatogenesis?

A

Increases

58
Q

What happens when sperm are hyper activated?

A

Lose cholesterol, gain calcium

Swim faster towards egg

59
Q

How does the oocyte prevent polyspermic penetration?

A

Releases cortical granules - hardens outer egg

60
Q

How can infection affect sperm production?

A

STIs/epididydmitis can damage seminiferous tubules and lower sperm count (lowers fertility)

61
Q

Why has sperm count generally been decreasing over time?

A 
Heat exposure
Radiation
Air pollution
Food chain pollution with excess oestrogen
Stress
Reduced sexual activity
62
Q

What is Kallman syndrome?

A

Lack of formation of anterior pituitary leading to infertility (type of hypog hypog)
Pt looks young ,no smell sense
Treatment is LH and FSH

63
Q

What is androgen insensitivity syndrome?

A

46 XY but appear female

testes insensitive to testosterone

64
Q

What are the three groups of male infertility disorders?

A
  1. Genetic (sex disorders)
  2. Hypothalamic-pituitary (hormonal)
  3. Target tissue (testes problems e.g. infection)
65
Q

Which processes are needed for successful conception?

A 
Ovulation
Spermatogenesis
Intercourse
Ejaculation
Fertilisation
Implantation
66
Q

How is infertility defined?

A

Woman not conceived after a year of unprotected sex

67
Q

How does a couple’s chance of conceiving change over time?

A

Decreases

68
Q

What factors positively affect a woman’s fertility?

A
  1. Less time trying
  2. Previous pregnancy
  3. AGE (under 30)
69
Q

What is the most common cause of infertility in second time pregnancies?

A

Tubal factor (previous pregnancy is risk factor for tubal disease)

70
Q

What are common causes of tubal damage?

A

Infection
Surgery
Ectopic pregnancy
Endometriosis

71
Q

How can women with tubal damage be helped to conceive?

A

IVF

72
Q

What 3 lifestyle factors reduce fertility?

A

Obesity
Smoking
Excessive alcohol

73
Q

What fertility investigations can we do for women?

A

Ovulation test
Pelvic anatomy and tubal latency (laparoscopy/HSG)
Ovarian reserve (AFC and AMH)

74
Q

What fertility investigations can we do for men?

A

Semen fluid analysis (concentration, motility, morphology)

75
Q

What can cause male sub fertility?

A

Azoospermia (no sperm in semen)

Blocked/absent genital tracts due to infection, trauma, drugs, radiotherapy, varicocele, congenital causes

76
Q

What is obstructive azoospermia?

A

Spermatogenesis normal

Obstructive problem

77
Q

What is the most common fertility treatment for male infertility?

A

ICSI (intracytoplasmic sperm injection)

some men may need surgical retrieval of their sperm

78
Q

At what point does a foetus gain legal status?

A

24 weeks (no abortion after this unless medical reasons)

79
Q

What is section 1a of abortion act?

A

‘Social ground’ (mental health of mother etc)

80
Q

What is section 1b of abortion act?

A

Prevent injury to mother

81
Q

What is section 1c of abortion act?

A

Risk to life of mother

82
Q

What is section 1d of abortion act?

A

Risk that child will be seriously handicapped

83
Q

What is conscientious objection?

A

Nobody has to actively participate in controversial procedure like abortion

84
Q

What is reproductive autonomy?

A

Father cannot prevent woman from obtaining an abortion

85
Q

What is pre-implantation genetic diagnosis?

A

Select embryo free of gene (e.g. breast cancer gene) through testing one cell from 8 cell embryo
But discarding embryos - unethical

Human Development (12 decks)

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