Lecture 3 - Pregnancy

Question 1

Testosterone

Answer 1

• produced in testes
• controlled by FSH and LH
• principal hormone in male RS
• responsible for reproductive growth

Question 2

Spermatogenesis

Answer 2

origin and develop of sperm w/n testes
- testes hang outside of body b/c optimal temp. for spermatogenesis is lower than body temp
- stored for four weeks before release

Question 3

Ejaculation

Answer 3

• semen is released, contains sperm

Question 4

Male arousal

Answer 4

• blood goes to penis during arousal, engorging spongy tissue, which allows for sperm to be delivered higher up into the vaginal canal

Question 5

What hormones are present in the female reproductive system?

Answer 5

• estrogen and progesterone (sustain pregnancy)
• produced by ovaries
• controlled by FSH and LH

Question 6

In simple terms, what is the process of an egg on the ovaries?

Answer 6

1. egg released
2. pro and est produced
3. egg travels down fallopian tube - gets fertilized here
4. egg goes to uterus and if fertilized, will implant there

Question 7

Do both ovaries release eggs every cycle?

Answer 7

No, just one

Question 8

How long is an avg. mestrual cycle?

Answer 8

approx 28 days

Question 9

How do progesterone and estrogen influence the menstrual cycle?

Answer 9

• low levels = endometrium is shed, cramps are caused by contraction of blood vessels to prevent bleeding out
• high levels = new lining of uterus is created to receive egg

Question 10

What does FSH do during the menstrual cycle?

Answer 10

• levels increase during cycle, causing maturation of 15-20 follicles per month
• one of these follicles will fully mature and release an egg

Question 11

What does LH do during the menstrual cycle?

Answer 11

causes ovulation

Question 12

Ovulation

Answer 12

• week 2 of menstrual cycle, the release of the most fertile egg
• fertility window is 5 days (how long sperm can live in body) before ovulation to 12-24 hours (shelf life of egg) after
• egg reduces chromosomes from 46 to 23

Question 13

What are the signs of ovulation?

Answer 13

• lower abdominal pain
• higher basal body temperatures
• changes in cervical mucus

Question 14

Barrier methods - contraception

Answer 14

• cervical cap or a condom
• ideally 97-98% effective

Question 15

IUD (intrauterine device) - contraception

Answer 15

• T-shaped device inserted into the top of the uterus to prevent ovulation and thin the uterine lining
• some release progesterone or some are made of copper which is detrimental to sperm
• coverage for 10 years

Question 16

Hormonal methods - contraception

Answer 16

• estrogen or progesterone - the pill
• tricks body into thinking its pregnant
• usually used for acne treatment or for heavy periods
• plan B is a high dose of this

Question 17

Pregnancy spacing

Answer 17

• waiting 18-24 months after a live birth reduces risk of pregnancy complications and other health problems
• too soon can cause prematurity

Question 18

Fertility

Answer 18

• 2 million egg follicles at birth, after puberty most have been absorbed, and only about 400 will go through ovulation
• egg quality and fertility falls with age
• @ about 35, male and female fertility drops

Question 19

What are the percentages of chromosomal abnormalities at different ages?

Answer 19

• early 20s - 17% of eggs
• 40s - over 75% of eggs

Question 20

Intrauterine insemination

Answer 20

• fertility treatment in which sperm is injected at the top of the uterus
• more likely in 20s

Question 21

In Vitro Fertilization (IVF)

Answer 21

• fertility treatment that is more likely given to 30-40 y.o.
  1) daily injection of pro and est causes release of high amount of eggs
  2) eggs are surgically removed and fertilized in vitro
  3) eggs are injected into uterus

Question 22

Conception

Answer 22

• approx a 6 day window
• 250 million sperm per ejaculation, but only 200 reach egg b/c vagina is very acidic and many sperm will die and get lost

Question 22

Home pregnancy tests

Answer 22

• cannot be used prior to missed period
• detects level of human chorionic gonadotropin
• 98-99% effective

Question 22

Only 1 sperm enters the egg and creates a protective barrier to prevent any other sperm enter, then what happens?

Answer 22

• after 2 weeks, the egg reaches the uterus, and releases hCG, in which levels will double every 72 hours and prevent menstrual cycle

Question 23

Miscarriage

Answer 23

• spontaneous loss before week 20
• early miscarriages are usually due to structural or chromosomal abnormalities or fibroids (fibrous tissue)

Question 24

What are the rates of miscarriages?

Answer 24

• 50% before implantation (egg implanting elsewhere or never implants, does not effect future pregnancies)
• 33% before week 5
• 25% before weeks 5-7
• <1% after week 12 (due to trauma or genetic abnormality)

Question 25

What are the early signs of pregnancy?

Answer 25

• missed menstrual cycle
• morning sickness (could be due to rapidly rising levels of hCG)
• hyperemesis gravidarum (extreme morning sickness)
• breast changes (increase 2”, colostrum is produced by 16 weeks, darkened and erect nipples)
• urinary frequency

Question 26

What does GDF15 have to do with hyperemesis gravidarum?

Answer 26

• levels of this determine morning sickness and how mother reacts to fetus producing this hormone
• high preexisting levels = low risk
• low preexisting levels = potential hyperemesis or bad morning sickness

Question 27

Nutrition during pregnancy

Answer 27

• mother is sole source of nutrition for baby, so must increase caloric intake by 10-20%
• recommend folic acid for closure of neural tube
• weight gain of 25-30 lbs

Question 28

What could too much weight gain by either mom or baby result in during pregnancy?

Answer 28

• difficult delivery
• health complications
• increased diabetes and obesity risk for children

Question 29

Ectopic pregnancy

Answer 29

• embryo develops outside uterus
• baby not getting nutrients or O2
• if implanted in fallopian tube: could burst or hemorrhage, causing loss of fertility of life; most common; could result in mother not knowing shed pregnant
• has to be terminated

Question 30

Gestational diabetes

Answer 30

• diabetes developing for first time, only during pregnancy
• could be due to family Hx, multiple babies, or larger baby

Question 31

Preeclampsia

Answer 31

• pregnancy-induced hypertension
• possible development of eclampsia
• the only treatment is to give birth

Question 32

Physical changes of pregnancy

Answer 32

• “Showing” - fundal height, distance btwn pelvis and top of uterus
• pregnancy “glow” - increased blood volume, dilation of blood vessels
• skin changes like stretch marks, linea nigra, chloasma

Question 33

Physical changes of pregnancy cont.

Answer 33

• Quickening - first fetal movement felt usually btwn weeks 18 and 24
• center of gravity shifts backwards as fundus height increases
• relaxin relaxes ligaments and tendons in pelvis
• sex drive decreases w/ time, also decreased w/ production of prolactin