LMP301 Lecture 10: Infertility Flashcards
Infertility
Define: infertility
failure to conceive after 1 year of regular, unprotected sex
% distribution of factors that cause infertility
40% male
50% female
10% unknown
1/3 of the female causes for infertility is due to…
This is ___ in males.
endocrine abnormalities (hormones)
Rare
Sources of sex hormones
- Gonads (testis, ovary)
- Peripheral conversion (adrenal gland, adipose tissue)
DHEA and DhEA is produced by…
adrenal cortex
source of testosterone in women
1/2 from ovary
1/2 from peripheral conversion (DHEA & DHEAS)
DHEAS is a differential marker for…
excess androgen production in women (problem at ovaries and adrenal gland)
What are the sex hormones?
- Testosterone
- Androgens
- Estradiol
- Estrogens
- Sex hormone binding globulin (SHBG)
SHBG
Sex hormone binding globulin
SHBG has higher affinity for… than …
testosterone
estradiol
___ stimulates SHBG synthesis in the liver thought…
Estradiol
gene regulation
_____ inhibits SHBG synthesis
testosterone
concentration of SHBG in females vs. males
2x as much in females
Factors which alter [SHBG] also alter…
ratio of unbound testosterone to unbound estradiol
What hormones are needed for spermatogenesis and virilization to occur?
- Hypothalamus: GnRH
- a. pituitary: FSH + LH
- FSH -> spermatogenesis
- LH -> testosterone -> dihydrotestosterone & virilization
Feedback system for FSH in male
Inhibin neg feedback on a. pituitary
Activin pos feedback on a. pituitary
Feedback system for LH in male
Testosterone neg feedback on a. pituitary and hypothalamus
Dihydrotestosterone functions
- important for male fetus development
- development of sex organs for males
- more potent than testosterone
DHT
Dihydrotestosterone
Testosterone -?-> DHT
5a-reductase
testosterone can be converted into…
- DHT
- Estradiol
testosterone -?-> estradiol
aromatase
Disorders of male sex hormones
- Hypogonadism
- Defects in androgen action
Hypogonadism is divided into…
- primary
- secondary
- tertiary
Primary Hypogonadism
= hypergonadotropic hypogonadism
= testicular failure
hypergonadotropic because low testosterone causing other signals to be high
Primary Hypogonadism defects are due to…
- congential
- acquired
secondary + tertiary hypogonadism
= hypogonadotropic hypogonadism
hypogonadotropic because source of problem
Causes of secondary + tertiary hypogonadism
- pituitary tumours
- hypothalamus disorders
Example of a hypothalamus disorder that may cause secondary + tertiary hypogonadism
Kallmann’s syndrome (GnRH deficiency)
Defects in androgen action is divided into…
- testicular feminization syndrome
- 5a-reductase deficiency
testicular feminization syndrome is also known as…
androgen insensitivity syndrome