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LMP301 > LMP301 Lecture 10: Infertility > Flashcards

LMP301 Lecture 10: Infertility Flashcards

Infertility

1
Q

Define: infertility

A

failure to conceive after 1 year of regular, unprotected sex

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2
Q

% distribution of factors that cause infertility

A

40% male
50% female
10% unknown

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3
Q

1/3 of the female causes for infertility is due to…

This is ___ in males.

A

endocrine abnormalities (hormones)

Rare

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4
Q

Sources of sex hormones

A
  • Gonads (testis, ovary)

- Peripheral conversion (adrenal gland, adipose tissue)

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5
Q

DHEA and DhEA is produced by…

A

adrenal cortex

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6
Q

source of testosterone in women

A

1/2 from ovary

1/2 from peripheral conversion (DHEA & DHEAS)

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7
Q

DHEAS is a differential marker for…

A

excess androgen production in women (problem at ovaries and adrenal gland)

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8
Q

What are the sex hormones?

A
  • Testosterone
  • Androgens
  • Estradiol
  • Estrogens
  • Sex hormone binding globulin (SHBG)
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9
Q

SHBG

A

Sex hormone binding globulin

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10
Q

SHBG has higher affinity for… than …

A

testosterone

estradiol

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11
Q

___ stimulates SHBG synthesis in the liver thought…

A

Estradiol

gene regulation

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12
Q

_____ inhibits SHBG synthesis

A

testosterone

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13
Q

concentration of SHBG in females vs. males

A

2x as much in females

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14
Q

Factors which alter [SHBG] also alter…

A

ratio of unbound testosterone to unbound estradiol

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15
Q

What hormones are needed for spermatogenesis and virilization to occur?

A
  • Hypothalamus: GnRH
  • a. pituitary: FSH + LH
  • FSH -> spermatogenesis
  • LH -> testosterone -> dihydrotestosterone & virilization
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16
Q

Feedback system for FSH in male

A

Inhibin neg feedback on a. pituitary

Activin pos feedback on a. pituitary

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17
Q

Feedback system for LH in male

A

Testosterone neg feedback on a. pituitary and hypothalamus

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18
Q

Dihydrotestosterone functions

A
  • important for male fetus development
  • development of sex organs for males
  • more potent than testosterone
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19
Q

DHT

A

Dihydrotestosterone

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20
Q

Testosterone -?-> DHT

A

5a-reductase

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21
Q

testosterone can be converted into…

A
  • DHT

- Estradiol

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22
Q

testosterone -?-> estradiol

A

aromatase

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23
Q

Disorders of male sex hormones

A
  • Hypogonadism

- Defects in androgen action

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24
Q

Hypogonadism is divided into…

A
  • primary
  • secondary
  • tertiary
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25
Q

Primary Hypogonadism

A

= hypergonadotropic hypogonadism
= testicular failure

hypergonadotropic because low testosterone causing other signals to be high

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26
Q

Primary Hypogonadism defects are due to…

A
  • congential

- acquired

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27
Q

secondary + tertiary hypogonadism

A

= hypogonadotropic hypogonadism

hypogonadotropic because source of problem

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28
Q

Causes of secondary + tertiary hypogonadism

A
  • pituitary tumours

- hypothalamus disorders

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29
Q

Example of a hypothalamus disorder that may cause secondary + tertiary hypogonadism

A

Kallmann’s syndrome (GnRH deficiency)

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30
Q

Defects in androgen action is divided into…

A
  • testicular feminization syndrome

- 5a-reductase deficiency

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31
Q

testicular feminization syndrome is also known as…

A

androgen insensitivity syndrome

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32
Q

testicular feminization syndrome

A

The androgen receptor doesn’t work

33
Q

5a-reductase deficiency

A
  • DHT deficiency (testosterone can’t be converted to DHT due to lack of 5a-reductase)
  • only affect chromosomal 46XY males (no females are affected)
  • can’t develop testes
  • males look like females
34
Q

If sperm analysis of males is normal, what can be ruled out?

A

endocrine disorder for infertility

35
Q

If sperm analysis of males is abnormal, what is next measured?

A
  • testosterone
  • FSH
  • LH
  • prolactin
36
Q

high prolactin in males

A

hyperprolactinemia

37
Q

Low testosterone & low gonadotrophins in males

A

Hypogonadotrophic hypogonadism
If GnRH is low, cause is tertiary
If GnRH is normal, cause is secondary

38
Q

gonadotrophins

39
Q

Low testosterone & high gonadotrophins in males

A

Testicular failure

40
Q

When GnRH pulses fast, what is released from the a. pituitary?

41
Q

When GnRH pulses slow, what is released from the a. pituitary?

42
Q

Female: FSH stimulates…

A

follicle growth

43
Q

Female: LH stimulates…

A
  • ovulation

- corpus luteum

44
Q

Feedback of FSH in female

A

neg feedback by inhibin B (secreted by follicle growth)

neg feedback by inhibin A and estradiol (secreted by ovulation & corpus luteum)

45
Q

Feedback of LH in female

A

neg feedback by progesterone & testosterone (secreted by ovulation & corpus luteum)
- this also neg feedbacks on GnRH

pos feedback by inhibin A and estradiol (secreted by ovulation & corpus luteum)

46
Q

Relationship between estrogen and LH / FSH

A

LH: positive feedback: as estrogen increases, LH will too

FSH: neg feedback: as estrogen increases, FSH decreases

47
Q

When does the slow FSH rise occur?

A

When menses begins (late luteal - early follicular)

48
Q

___ is secreted after ovulation, and if pregnancy occurs, will continue to be high. However, if menses occurs, it will fall.

A

Progesterone

49
Q

What causes the LH peak?

A

pos feedback on LH by ovarian steroids

50
Q

what causes the slow FSH rise?

A

Neg feedback on FSH by estradiol & inhibin

51
Q

FSH rise indicates…

A

next wave of follicular maturation (new cycle)

52
Q

What are the indications of ovulation?

A
  1. Progesterone rise
  2. Increased body temp
  3. LH surge estimates when ovulation occurs
  4. Ultrasound detection of maturing follicle & ovulation
53
Q

Disorders of female sex hormones

A
  1. hypogonadism
  2. amenorrhea
  3. Hirsutism
54
Q

hypogonadism is divided into…

A
  • Primary
  • Secondary
  • Tertiary
55
Q

Primary hypogonadism

A

hypergonadotropic hypogonadism
= ovarian failure
- ovaries can’t produce enough estrogen
- feedback causes high LH/FSH

56
Q

Secondary & tertiary hypogonadism

A

Hypogonadotropic hypogonadism

  • problems with a. pituitary
  • problems with hypothalamus (Kallmann’s syndrome)
57
Q

amenorrhea is divided into…

A
  • primary
  • secondary
  • oligomenorrhea
58
Q

Primary amenorrhea

A

Didn’t establish spontaneous periods by the age of 16

59
Q

secondary amenorrhea

A

Had period before, but somehow stopped for >6 months

60
Q

Examples of primary amenorrhea

A
  • resistant ovary syndrome

- Kallmann’s syndrome

61
Q

resistant ovary syndrome is a problem at…

A

FSH receptor

62
Q

Examples of secondary amenorrhea

A
  • pregnancy
  • hyperprolactinemia
  • PCOS
63
Q

Oligomenorrhea

A

Irregular, infrequent periods (< 9 times per year)

64
Q

Hirsutism

A
  • female with male body hair
  • due to genetics or idiopathic
  • mostly caused by PCOS if severe
65
Q

PCOS

A

polycystic ovarian syndrome

66
Q

What is the first thing to look at when examining infertility in women?

A

Regular periods?

regular vs. amenorrhea / oligomenorrhea

67
Q

If a women’s period is normal, what is measured next? Outcome?

A

Progesterone to determine if she is ovulating

  • ovulating = no problem
  • measure FSH, LH, prolactin if she isn’t
68
Q

In a women with abnormal periods, what is next tested? Outcome?

A

Screening for pregnancy

  • Pos = pregnant = no problem
  • Neg = not pregnant = go on to test LH, FSH, prolactin
69
Q

High prolactin in women

A

Hyperprolactinemia

70
Q

high FSH, high LH in women

A

ovarian failure (primary)

71
Q

low FSH, high LH in women

72
Q

test LH, FSH, prolactin all normal

A

Further investigation (maybe side effect of another disease)

73
Q

Low FSH, low LH in women

A

Hypogonadotropic hypogonadism (secondary or tertiary)

74
Q

PCOS symptoms

A
  • many small cysts in ovaries
  • menstruation, but not always ovulate
  • infertility
  • hirsutism
  • obesity
  • irregular menstruation
  • hyperinsulinemia
  • insulin resistance
75
Q

PCOS is thought to be caused by…

A
  • hypothalamic disorder

- genetics

76
Q

PCOS does not involve diseases in…

A
  • adrenal gland

- pituitary gland

77
Q

Biochemical characteristics of PCOS

A
  • high serum estrogens
  • (pos feedback) high LH
  • (neg feedback) low FSH
  • high serum testosterone (free & total)
  • decreased SHBG
  • high DHEAS
78
Q

Why does ovulation not occur in PCOS?

A

LH surge continues to be high. Ovulation typically occurs after LH peaks and DROPS

LMP301 (18 decks)

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