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1. Endocrine > Infertility physiology > Flashcards

Infertility physiology Flashcards

1
Q

How is GnRH released?

A

synsthesised by neurones in the hypothalamus

released in pulses

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2
Q

What does oestrogen do to the frequency of GnRH release?

A

increases it

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3
Q

What does prgesterone do to the frequency of GnRH release?

A

decreases it

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4
Q

Are GnRH pulses constant?

A

men - YES

females - change during the menstrual cycle

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5
Q

What do high frequency GnRH pulses stimulate?

A

LH pulses

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6
Q

What do low frequency GnRH pulses stimulate?

A

FSH pulses

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7
Q

What cells does FSH act on?

A

granulosa cells

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8
Q

What is the role of FSH in males?

A

stimulates sertoli cells and spermatogenesis

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9
Q

What is the role of FSH in females?

A

stimulates follicular development
oestrogen secretion
thickens the endometrium

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10
Q

What is the compostion of FSH?

A

glycoprotein containing 2 subunits

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11
Q

What is the compostion of GnRH?

A

deca peptide hormone - neuropeptide

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12
Q

What does LH act on?

A

theca cells

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13
Q

What is the role of LH in females?

A

peak stimulates ovulation
thickens endometrium
stimulates corpus luteum development to produce progesterone

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14
Q

What is the role of LH in males?

A

stimulates Leydig cells
testosterone secretion
spermatogenesis

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15
Q

What is oestrogen secreted from?

A

primarily the follicles in the ovaries and the adrenal cortex, also by the placenta in pregancy

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16
Q

What is the role of oestrogen?

A

stimulates endometrium thickening

creates a fertile cervical mucus

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17
Q

What is the role of oestrogen in the follicular phase?

A

stimulates gonadotrophin secretion

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18
Q

What is the role of oestrogen in the luteal phase?

A

increased oestrogen inhibits the secretion of FSH and prolactin so decreases the viscosity of the cervical mucus to facilitate sperm penetration and reduces vaginal pH by causing lactic acid production

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19
Q

Where is progesterone secreted from? Why?

A

the corpus luteum to maintain early pregnancy

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20
Q

Where is progesterone secreted from during pregnancy?

A

the placenta

21
Q

What is the role of progesterone?

A

inhibits LH
responsible for the infertile thick cervicle mucus produced during pregnancy
maintains the thickness of the endometrium
increases basal body temperature
relaxes smooth muscles

22
Q

What is GnRH pulsitiliy signalled through?

A

the kisspeptin receptor

23
Q

How long does the luteal phase last for?

A

14days

24
Q

What is oestrogens effect on LH and FSH?

A

increases them

25
Q

At what time is GnRH at its peak?

A

during the night

26
Q

What is the result of the action of LH on theca cells?

A

uptake of cholesteral

conversion of androgens to oestrogen

27
Q

What happens during the follicular phase?

A

increase in the number of follicular cells and an accumulation of follicular fluid resulting in an increase in the diameter and overall size of the follicle

28
Q

What is a follicle?

A

oocyte surrounded by follicular cells (granulosa cells and theca cells)

29
Q

What is folliculogenesis?

A

many cells grow under FSH but only one is picked to become the dominant follicle and is selected for ovulation

30
Q

What does the dominant follicle possess?

A

most FSH receptors and high vascularity

31
Q

What volume of oestrogen is reqeuired to stimulate an Lh surge (through increase in GnRH pulses)

A

200Pg/ml oestrogen

32
Q

What the formation of the corpus luteum?

A

formation occurs due to LH
granulosa and theca cells develop in luteal cells
causes an increase in progensterone production due to a delivery of cholesterol
LH stimulates angiogenesis

33
Q

Where are the sertoli and germ cells found?

A

seminiferous tubules

34
Q

How long does spermatogensis take? Where does it occur?

A

seminiferous tubules

70days

35
Q

What is the role of testosterone?

A

maintains the integrity of the blood brain barrier and releases mature spermatoza from Sertoli cells by influecing myoid cells

36
Q

What is the role of LH on lyedig cells?

A

LH binds to lyedig cels and stimulates the production of enzymes that synthesise testosterone from cholesterol

37
Q

What day in the female cycle is the midluteal day?

A

21

38
Q

What is oligiomenorrhea?

A

cycles >35days

39
Q

What is amenorrhea?

A

absent menstruation

40
Q

What is primary amenorrhea?

A

never had a period

41
Q

What is secondary amenorrhea?

A

once had a period, but now they have stopped

42
Q

What are Group 1,2 and 3 of the WHO classification of ovulatory disorders?

A

1 - Hypogonadotrophic hypogonadism
2 - PCOS
3 - Premature ovarian failure

43
Q

What is Hypogonadotrophic hypogonadism?

A

hypothalamus doesnt produce GnRH so pituitary cannot release LH and FSH, also oestrogen deficiency

44
Q

What can cause Hypogonadotrophic hypogonadism?

A 
stress
excessive exercise
low BMI
pituitary/brain tumours 
head trauma
drugs - steroids, opiates
Kallmans syndrome
45
Q

What is the diagnostic test for Hypogonadotrophic hypogonadism?

A

progesterone challenge test - menstrual bleed in response to 5 day course of progesterone indicates normal oestrogen levels

46
Q

What is the management of Hypogonadotrophic hypogonadism?

A

BMI >18.5
folic acid 400mcg
rubella immunisation
Hormone therapy - gonadotrophin injections, pulsitile GnRH

47
Q

What are fibroids?

A

growths that grow around the uterus

48
Q

What are the different types of fibroids?

A

intramural
submucus
pednuculated - massive, sticks out
subserous

49
Q

What is the treament for fibroids?

A

hysteroscope

laprascopic myomectomy - for intramural

1. Endocrine (32 decks)

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