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1. Human Development > Fertility and Conception > Flashcards

Fertility and Conception Flashcards

1
Q

What three layers does the uterus consist of?

A
  1. Thin outer layer of connective tissue
  2. Myometrium (thick middle layer with smooth muscle cells)
  3. Endometrum
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2
Q

What are the two parts of the ovaries?

A
  1. Thick cortex with developing follicle

2. Medulla with blood supply and nerves

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3
Q

What is a primordial follicle enclosed by?

A
  1. Single layer of granulosa cells

2. Basal lamina

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4
Q

How does a primordial follicle develop into a primary follicle and then secondary follicle??

A

Enlargement of oocyte

Then growth of thecal cells outside the basal lamina. Granulusa cells will start to secrete fluid that collects in a central cavity. This will finally become a tertiary follicle

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5
Q

What are the two primary functions of an ovary?

A
  1. Release oocyte for reproduction and menstruation

2. Hormone production for female phenotype

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6
Q

How many oocytes are present before birth?

A

7 million

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7
Q

What is the ovarian reserve?

A

Number of follicles visible in the ovary at any given time

Usually 10-20 follicles

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8
Q

What are the three phases of the ovarian cycle?

A
  1. Follicular phase (1-13)
  2. Ovulatory phase (14)
  3. Luteal phase (15-28)
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9
Q

What is the main reason for the growing follicle during the follicular phase?

A

Growing antrum due to secretion of fluid from the granulosa cells

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10
Q

What are the two main cell types of the ovaries? What hormones act on what cells?

A

Granulosa cells and thecal cells

  1. FSH acts on granulosa cells to increase AMH and oestrogen production
  2. LH acts on thecal cells to increase androgen production
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11
Q

What are the four suspensory ligaments of the uterus?

A

Broad ligament
Uterosacral ligament
Round ligament
Lateral ligament

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12
Q

What are the four main functions of the uterus?

A
  1. Transport sperm from the site of deposition to uterine tubes
  2. Provides a suitable environment for implantation and nourishment
  3. Provides mechanical protection of the foetus
  4. Expels the mature foetus at the end of pregnancy
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13
Q

What are the stages of the uterine cycle?

A
  1. Menstrual phase (1-5)
  2. Proliferative phase (6-14)
  3. Secretory phase (15-28)
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14
Q

What are the three parts of the uterine tube?

A
  1. Infundibulum
  2. Ampulla
  3. Isthmus
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15
Q

Infertility can be caused by (three mains)?

A

Issue with eggs
Issue with transport
Issue with implantation

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16
Q

In what stage are primordial oocytes arrested at birth?

A

Prophase 1 of meiosis 1

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17
Q

In what stage is the secondary oocyte arrested?

A

Metaphase II

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18
Q

When is meiosis II completed?

A

At fertilisation

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19
Q

What are 4 long-term consequences of menopause?

A
  1. Osteoporosis
  2. CVD
  3. Vaginal dryness and atrophy
  4. Alzheimers
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20
Q

What are the hormonal treatment options for menopause?

A
  1. Oestrogen (reverses symptoms of low oestrogen)
  2. Progesterone
    - Protects endometrium
    - Not required in women without uterus
  3. Testosterone
    - Increases overall energy level
    - Enhances sexual desire and arousal
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21
Q

What are the non-hormonal treatment options for menopause?

A
  1. Lifestyle measures
  2. Replens
  3. SSRIIs
  4. Gabapentin
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22
Q

Risk of hormone replacement?

A

Can increase chances of breast and endometrial cancer

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23
Q

Benefits of hormone replacement therapy?

A

Can alleviate symptoms, protect bones, reduce incidence of colorectal cancer and improve quality of life

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24
Q

How do you diagnosis premature ovarian insufficiency?

A
  1. Women under 40
  2. Amenorrhoea for 4 months
  3. FSH > 30U/L on two occasions 6 weeks apart
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25
Q

What are the risks of POI?

A

CVD, memory loss, osteoporosis, fertility issues, death, decreased sex drive, atherosclerosis, depression

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26
Q

Treatment of POI?

A
  1. Hormone replacement
  2. Fertility treatment
  3. Psychological support
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27
Q

How does POI go over in families?

A

X-linked dominant inheritance

28
Q

What cells line the seminiferous tubules?

A

Spermatogonial stem cells (lumen of tubule); for sperm production

Sertoli cells (in between stem cells, from lumenal to basal); key for nutrition

Leydig cells can be found in between tubules

29
Q

What is the barrier created by sertoli cells?

A

Blood testes barrier

Creates luminal and interstitial compartment

30
Q

How much sperm is produced every day?

A

120 cells

31
Q

What hormones do sertoli cells secrete?

A

Inhibin
AMH
ABP
Growth factors

32
Q

What do LH and FSH act on?

A

LH acts on Leydig cells to secrete more testosterone

FSH acts on sertoli cells to simulate sperm development

33
Q

Describe the acrosome reaction?

A
  1. Triggered by sperm coming in contact with oocyte
  2. Interaction with ZP3 protein on oocyte membrane
  3. Leads to exposure of hyaluronidase and acrosin enzymes
  4. Facilitates oocyte penetration
34
Q

Describe oocyte activation?

A

Release of cortical granules, blocks polyspermic penetration

Resumption of meiosis

Formation of male and female pronuclei

35
Q

What factors can affect sperm?

A
  1. Anabolic abuse
  2. Environment
  3. Radiation
  4. Air pollution
  5. Food chain pollution
36
Q

How prevalent is infertility?

A

1/7 couples

37
Q

What is the most significant predictor of infertility?

A

Woman’s age

38
Q

What are the 4 steps os assessing infertility in couples?

A
  1. History
  2. Basic investigations
  3. Semen analysis
  4. Assessment of pelvic anatomy and fallopian tube potency
39
Q

What are the three classes of ovulatory disorder:

A
  1. Group I; hypothalamic amenorrhoea or hypogonadotrophic hypogonadism
  2. Group II; HP-ovarian dysfunction
  3. Ovarian insufficiency
40
Q

What is PCOS?

A

Polycystic ovarian syndrome

41
Q

What are the main symptoms of PCOS?

A
  1. Irregular periods
  2. Excess androgens, causing facial or body hair
  3. Polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs
42
Q

What are the three treatment options for PCOS?

A
  1. Clominphene citrate
  2. Letrozole
  3. Gonadotrophins
43
Q

What are the three germlayers?

A
  1. Endoderm
  2. Mesoderm
  3. Ectoderm
44
Q

What does the endoderm form (2)

A

Epidermis

NS

45
Q

What does the mesoderm form? (6)

A 
Skeleton
Muscle
Dermis
Kidney
Blood
Reproductive system
46
Q

What does the ectoderm form? (5)

A 
Gut
Liver
Pancreas
Lungs
Endocrine glands
47
Q

What is the first organ to become functional?

A

Heart

48
Q

What does the neural crest arise from?

A

Neural tube (ectoderm derivative)

49
Q

What is azoospermia?

A

Lack of sperm in semen

Non-obstructive (primary) vs obstructive (secondary)

50
Q

What are causes of primary azoospermia?

A

Impaired spermatogenesis, due to hypopituitarism, hyperprolactinemia, exogenous testosterone, chemotherapy, Klinefelter, cryptorchidism, Sertoli cell-only syndrome, orchitis, trauma, radiation

Spermatogenesis - decreased
Size of testes - small
FSH level - raised

51
Q

What does the wolffian duct become in men?

A

internal reproductive organs

Testosterone from testis causes development of Wolffian duct into the epididymis, vas deferens and seminal vesicles

52
Q

What does the wolffian duct become in women?

A

Absence of AMH causes regression of the Wolffian duct

53
Q

What does the Mullerian duct become in men?

A

AMH from testis causes regression of the Mullerian duct

54
Q

What does the Mullerian duct become in women?

A

Mullerian duct persists, becoming the female internal reproductive organs

Oestrogen from ovaries causes development of Mullerian duct into the fallopian tubes, uterus and upper vagina.
Absence of testosterone leads to development of female external genitalia

55
Q

What does the SRY gene cause?

A

Development of testes

56
Q

What is the risk of Chorionic villus sampling?

A

Miscarriage ( higher rate of miscarriage than amniocentesis)

Chorionic villus sampling can be performed weeks 11-14, whereas amniocentesis can be performed 15+ weeks.

57
Q

Define gastrulation?

A 
During the development of the embryo
A blastula (single layer of cells) develops into a gastrula, ultimately leading to the development of the ectoderm, mesoderm and endoderm.
58
Q

Define the puerperium

A

Time from delivery of placenta until the body returns to the pre-pregnant state ~6-8 weeks.

Here the uterus shrinks from being palpable around the umbilicus to being unpalpable after a few weeks.

Goes from weighing 1kg just after birth, to weighing 50-100g after 6-8 weeks.

59
Q

How would you define infertility?

A

A woman of reproductive age who has not conceived after 1 year of unprotected sexual intercourse

60
Q

What is a Robertsonian translocation?

A

fusion of two acrocentric chromosomes leading to loss of the short arms of both chromosomes and thus a fusion chromosome is produced (less common)

61
Q

What is a Reciprocal translocation?

A

exchange of material between two non-homologous chromosomes (more common).

62
Q

What are the features of Trisomy 13 (Patau)?

A 
Learning difficult - severe
Dysmorphic features - Cleft lip/palate, holoprocencephaly, postaxial polydactlyl
Organ defects - renal and cardiac
Frequency - 1:5000 live births
Frequency @ maternal age 43 - 1:1100

45% die within 1 month
85% within 1 year

63
Q

What are the features of Trisomy 18 (Edwards)?

A 
Learning difficulty - severe
Dysmorphic features - Micrognathia, prominent occiput, clenched overlapping fingers, Rocker-bottom feet
Organ defects - cardiac
Frequency - 1:3000 live births
Frequency @ maternal age 43 - 1:500

Micrognathia - small lower jaw
Rocker bottom feet

30% die within 1 month
90% within 1 year

64
Q

What are the features of Trisomy 21?

A

Learning difficult - mild to moderate
Dysmorphic features - Flat nasal bridge, upslanting palpebral fissures, epicanthal folds, protruding tongue, single palmer crease, clinodactyly, sandal gap
Organ defects - cardio, usually AV septal defect
Frequency - 1:700 live births
Frequency @ maternal age 43 - 1:50 live births

Clinodactyly - palmar curvature of a finger or digit
Sandal gap - as if you were wearing sandals, space between big toe and 2nd

65
Q

What are the two main functions of oxytocin?

A

Two main functions of the hormone oxytocin are milk ejection and uterine myometrial contraction.

1. Human Development (18 decks)

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