(M) Lec 5: Reproductive Function (Females)

Question 1

Regulation of Female Reproduction

1. Each ovary has ____ million primordial follicles at birth
2. Maturation is blocked until ____
3. This refers to the recruitment of a few primordial follicles for maturation
4. A single mature follicle is produced each normal menstrual cycle at approximately day ____
5. When you run out of follicles, ____ will occur

Answer 1

1. 2 to 4 million
2. Puberty
3. Puberty
4. Fourteen (14)
5. Menopause

Question 2

Ovarian Cycle

• Refers to Day 1 to 14
• Starts with the onset of menses and ends on the day of the LH surge
• Follicular growth and development occurs

Answer 2

Follicular Phase

Question 3

Ovarian Cycle (Follicular Phase)

1. FSH stimulates ____ production which will cause a ____ feedback effect
2. However upon reaching the ____, it will shift to a ____ feedback mechanism further resulting in a surge of GnRH, FSH, and LH
3. If estrogen is the dominant hormone in this phase, what happens to the uterine lining?

Answer 3

1. Estrogen; Negative
2. Peak; Positive
3. Cell Proliferation occurs

Question 4

Ovarian Cycle (Follicular Phase)

1. This is a sign that an ovum is about to be released, usually 24 hours later from this event
2. If estrogen is the dominant hormone in this phase, what happens to the uterine lining?

Answer 4

1. LH Surge
2. It thickens as estrogen promotes cell proliferation

Question 5

Ovarian Cycle

• Refers to Day 14 to 15
• Starts with the extrusion of an ovum (ovulation) and ends with the onset of menses
• The corpus luteum secretes progesterone, estrogen, and inhibin
• The corpus luteum eventually turns into corpus albicans which can no longer maintain the uterine lining causing it to shed

Answer 5

Luteal Phase

Question 6

Ovarian Cycle (Luteal Phase)

1. After a woman ovulates, the follicle that just released the egg turns into ____
2. This is rich in ____ and a very good source of progesterone
3. The function of progesterone is to influence the ____ activity of the endometrium
4. TOF: Estrogen levels decrease again in this phase

Answer 6

1. Corpus Luteum
2. Cholesterol
3. Secretory
4. False (increase again)

Note: Progesterone also stabilizes the uterine lining, preventing menses

Question 7

Ovarian Cycle

1. Dominant ovarian hormone during the follicular phase?
2. Dominant ovarian hormone during the luteal phase?

Answer 7

1. Estrogen
2. Progesterone

Question 8

Endometrial Cycle

• Covers days 1 to 5 of menstruation and days 6 to 14 of proliferation
• Estrogen restores the endometrium via cell proliferation and growth

Answer 8

Proliferative Stage

Question 9

Endometrial Cycle

• Refers to Day 15 to 28
• The estrogen and progesterone cause the development of numerous exocrine glands
• There is preparation of the endometrium for implantation of the embryo
• If no fertilization occurs, it will lead to the shedding of the endometrium

Answer 9

Secretory Stage

Question 10

Ovarian Cycle

If fertilization did not occur:
1. What happens to the corpus luteum?
2. What happens to progesterone levels?
3. What happens to the uterine lining?

Answer 10

1. Turns into corpus albicans
2. Progesterone drops because the source is lost (corpus luteum)
3. The lining will destabilize and slough off because of the absence of progesterone

Question 11

Functions of FSH:
1. In the ovaries, it stimulates the development of ovarian ____
2. In the testes, it regulates ____

Answer 11

1. Follicles
2. Spermatogenesis

Question 12

Functions of LH:
1. In the ovaries, it causes ____, formation of corpus luteum, and production of estrogen and progesterone
2. In the testes, it facilitates the production of ____

Answer 12

1. Ovulation
2. Testosterone

Question 13

Ovarian Hormone Production

This is used as a substrate for hormonal production

Answer 13

Cholesterol

Question 14

Ovarian Hormone Production

What are the 3 forms of estrogens?

Answer 14

1. E1 - Estrone
2. E2 - Estradiol
3. E3 - Estriol

Question 15

Ovarian Hormone Production

• An 18-carbon steroid hormone not produced by the ovaries after menopause
• Works hand in hand with progesterone for uterine growth, regulation of the mestrual cycle, and maintenance of pregnancy

Answer 15

Estrogen

Question 16

Forms of Estrogen

• Most abundant in post-menopausal women
• Comes from the adrenal glands and is produced from the adipose cells

Answer 16

E1 (Estrone)

Question 17

Forms of Estrogen

• The most potent/estrogenic (major estrogen)
• Most abundant in pre-menopausal women
• Synthesized from testosterone and it is what is measured during the reproductive stage

Answer 17

E2 (Estradiol)

Question 18

Forms of Estrogen

• Seen in pregnant women as this is secreted by the placenta
• A metabolite of estradiol found in maternal urine
• A marker for Down Syndrome

Answer 18

E3 (Estriol)

Question 19

Ovarian Hormone Production

• A 21-carbon compound produced by the lutein cells of the corpus luteum
• Facilitates the secretory activity of the endometrial glands
• Has a thermogenic effect and is dominant during the luteal phase
• If there is a deficiency of this, it could lead to a failure in implantation

Answer 19

Progesterone

Question 20

Ovarian Hormone Production

• A 19-carbon compound produced by the ovaries (from testosterone to estradiol)
• An excess of this leads to hirsutism, loss of female characteristics, and a development of male characteristics
• Only present after menopause

Answer 20

Androgens

Question 21

Ovarian Hormone Production

1. These are produced by the ovaries which inhibit FSH production
2. This enhances FSH secretion

Answer 21

1. Inhibins A and B
2. Activin

Question 22

Ovarian Hormone Production

Among Inhibins A and B, which is for the corpus luteum and which is for the follicles?

Answer 22

1. Inhibin A - corpus luteum
2. Inhibin B - developing follicles

Question 23

Pubertal Development in Females

1. Refers to the development of breast tissue and pubic hair
2. Refers to the initiation of menses (around 9-11 years old)

Answer 23

1. Thelarche
2. Menarche

Question 24

Menstrual Cycle Abnormalities

1. No menstruation by age 16
2. An abnormal cycle for a minimum of 3 to 6 months
3. Infrequent and irregular cycles greater than 35-40 days
4. Uterine bleeding in excess of 7 days

Answer 24

1. Primary amenorrhea
2. Secondary amenorrhea
3. Oligomenorrhea
4. Menorrhagia

Question 25

# Tests for Amenorrhea - This assesses estrogen status and endometrial responsiveness to progesterone - Can be given intramuscularly either in 10mg doses for 5-10 days or just one dose of 100-200mg - Bleeding should be monitored within 2-7 days of stopping the drug

Answer 25

Progestin Withdrawal Test

Question 26

# Tests for Amenorrhea Progestin Withdrawal Test Results: - This occurs due to a lack of estrogen, obstruction, primary ovarian failure, or hypothalamic-pituitary insufficiency

Answer 26

Absence of bleeding

Question 27

# Tests for Amenorrhea Progestin Withdrawal Test Results: - Outflow tract is intact - There is estrogenic chronic anovulation due to excess androgens (estrogens are present but the patient cannot ovulate) - Other causes may include adrenal tumor, hyperplasia, or hyperthecosis

Answer 27

Presence of bleeding

Question 28

# Evaluation of Ovulatory Function TOF: Basal body temperature measurement is not reliable

Answer 28

True

Question 29

# Evaluation of Ovulatory Function - Aka preconception test - It is a colorimetric assay done 2-3 days before the LH surge - Not reliable in patients who have PCOS

Answer 29

Urinary Ovulation Predictor Kits (for LH)

Question 30

# Evaluation of Ovulatory Function - Measured on Day 21 of the menstrual cycle - A level > 3ng/mL indicates ovulation and production of progesterone

Answer 30

Mid-Luteal Phase Serum Progesterone Levels

Question 31

# Tests for Ovarian Reserves - This is a non-steroidal estrogen receptor modulator (blocks the hypothalamic receptors) - It stimulates the release of FSH to recruit more follicles - Not usually done and is replaced by estrogen testing (estradiol)

Answer 31

Clomid Challenge Test/Clomiphene Citrate Challenge Test

Question 32

# Tests for Ovarian Reserves Clomid Challenge Test Results: 1. FSH returns to baseline 2. FSH remains high

Answer 32

1. Normal 2. Abnormal (poor ovarian reserve)

Question 33

# Tests for Ovarian Reserves Anti-Mullerian Hormone Test 1. AMH levels are higher in ____ fetuses, as this prevents them from developing female reproductive organs 2. Female fetuses need a ____ amount of AMH for their development 3. In females, cells inside the ____ are the ones that produce AMH

Answer 33

1. Male 2. Small 3. Follicles

Question 34

# Tests for Ovarian Reserves Anti-Mullerian Hormone Test 1. Higher AMH means (more/less) eggs and a (higher/lower) ovarian reserve 2. Lower AMH means (more/less) eggs and a (higher/lower) ovarian reserve

Answer 34

1. More; Higher 2. Less; Lower

Question 35

# Female Reproductive Abnormalities - Refers to ↓ estrogen and ↓ LH and FSH (gonadotropin deficiency) - Type 1 classification according to WHO - Examples are hypothalamic-pituitary disorders

Answer 35

Hypogonadotropic Hypogonadism

Question 36

# Hypothalamic-Pituitary Disorders - Aka postpartum hypopituitarism - Caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth - The lack of oxygen damages the pituitary gland

Answer 36

Sheehan's Syndrome

Question 37

# Female Reproductive Abnormalities - A type 2 classification of amenorrhea according to WHO - FSH and LH are normal - Examples are PCOS, hyperthecosis, adrenal hyperplasia, and adrenal tumors

Answer 37

Estrogenic Chronic Anovulation

Question 38

# Female Reproductive Abnormalities - A disorder involving infrequent, irregular, or prolonged menstrual periods, and often excess male hormone (androgen) levels - LH is elevated but with normal FSH

Answer 38

Polycystic Ovary Syndrome

Question 39

# Female Reproductive Abnormalities - Patient is of a female genotype (46,XX) - Female pseudohermaphroditism - They have ovaries but present with secondary sexual characteristics or external genitalia of a male - Due to a deficiency in 21-hydroxylase

Answer 39

Congenital Adrenal Hyperplasia

Question 40

# Female Reproductive Abnormalities - A type 3 classification according to WHO - Characterized by ovarian failure (primary hypogonadism) - Estrogen is ↓ but FSH and LH are ↑

Answer 40

Hypergonadotropic Hypogonadism

Question 41

# Pregnancy - This is an LH-like hormone which increases in maternal blood - Is synthesized and secreted by the syncytiotrophoblasts of the developing placenta

Answer 41

Human Chorionic Gonadotropin (hCG)

Question 42

# Human Chorionic Gonadotropin (hCG) 1. Has the same ____ sub-unit as LH, FSH, and TSH 2. The ____ sub-unit of LH and hCG are almost the same 3. hCG can interact with LH ____ on luteal cells 4. It prevents the ____ of corpus luteum into corpus albicans

Answer 42

1. Alpha 2. Beta 3. Receptors 4. Regression

Question 43

# Human Chorionic Gonadotropin (hCG) 1. After the 1st trimester, the ____ is able to produce steroid hormones (estriol) 2. Increased hCG can indicate germ cell ____ and gestational ____ disease

Answer 43

1. Placenta 2. Tumors; Trophoblastic

Question 44

# Pregnancy During pregnancy: 1. Estrogen and Progesterone (increase/decrease) 2. Aside from the placenta, fetal adrenal glands and liver also contribute to ____ synthesis

Answer 44

1. Increase 2. Steroid

Question 45

# Pregnancy During pregnancy, ____ assesses fetal well-being in late pregnancy and promotes uteroplacental blood flow

Answer 45

Estriol

Question 46

# Pregnancy - This is synthesized by the placenta during the last 2 trimesters - Is similar to PRL and GH; it has weak lactogenic and growth-promoting activities - An insulin antagonist may play a role in maternal glucose utilization

Answer 46

Human Placental Lactogen (HPL)