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Conditions + definitions > Repro > Flashcards

Repro Flashcards

1
Q

Where are sperm produced? (be specific)

A

In the seminiferous tubules in spermatid cells

Found in testis

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2
Q

What are the functions of the sertoli cells?

A

Form blood-testis barrier
Isolate secondary spematocytes, spermatids/ spermatozoa from immune system
Nutrients/waste to sperm
Support spermiation (getting sperm to lumen)

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3
Q

What are the main glands that add fluid to sperm to make semen?

A

Bulbourethral gland
Prostate gland
Seminal vesicles

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4
Q

How many sperm develop from each spermatogonium ?

A

512

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5
Q

How long does it take to produce sperm?

A

75 days

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6
Q

Where do sperm become motile, how long can they be stored?

A

Epididymis, 15 days

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7
Q

What are the stages of sperm production?

A

Spermatocytogenesis
Meiosis
Spermiogensis

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8
Q

What is the counter current heat exchange?

A

A mechanism to reduce heat in testis
The capillary network allows heat exchange between the veins and arteries of the testis before reaching the spermatic cord

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9
Q

What factors affect spermatogenesis?

A 
Testis temperature
Endocrine
Loss of blood testis barrier
Immunological reactions
Environment
Medication
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10
Q

Where do andeogens act?

A

Systemic - Deepning voice,
male body hair,
increased sebacous gland activity
Protein anabolism

CNS - aggressive behaviour
Hypothalamus
Penis (errective, copulatory, ejaculatory effectiveness) 
Striated muscle
Testis (sperm angiogensis)
Prostate
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11
Q

How long does it ake from the LH surge to ovulation?

A

36 hours

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12
Q

When does the first meiotic division take place of an egg cell? (primary to secondary)

A

IN utero, to be completed at ovulation

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13
Q

What is the LH surge associated with?

A

Ovulation

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14
Q

When does oestrogen have a negative feedback system?

A

Under low concentrations
Oestrogen and progesterone inhbit oestrogen release
Also inhibit FSH and LH

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15
Q

When does oestrogen have a positive feedback route?

A

Under high concentrations

LSH + FH together release oestrogen

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16
Q

What is the role of GnRH in females?

A

Stimulates LSH/FH release from anterior pituitary

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17
Q

What is the role LH?

A

Maintain dominant follicle
Induce follicular maturation and ovulation
Stimulate CL development

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18
Q

What is the role of FSH?

A

Stimulates follicular recruitment + development

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19
Q

What is the role of oestrodiol (type of oestrogen)?

A

supports female secondary sexual characteristics and reproductive organs,
negative feedback control of LH and GnRH EXCEPT for late follicular phase - positive control of LH surge,
stimulates proliferative endometrium,
negative control of FSH

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20
Q

Where is oestrodiol produced?

A

Granulosa cells

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21
Q

What is the role of progesterone?

A

Maintanence of secretory endometrium

Negative feedback control of HPO (hypothalamus hypophyseal ovarian axis)

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22
Q

What are the targets for oestrogen?

A

Systemic - protein, carbohydrate + lipid metabolism
Water + electrolyte balance
Blood clotting

Anterior pituitary
Hypothalamus
CNS
Fat distribution
Mammary gland
Uterus/vagina/fallopian tube/ovaries
Bone maturation + turnover
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23
Q

What are the levels of progesterone in the follicular + leuteal phases of ovation?

A

Follicular - 1-4nmol/L

Leuteal - 12-70nmol/L

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24
Q

What happens to LH + FSH in meopause?

A

The levels continue to grow as the positive feedback loop of oestrogen is not working
Nor do they have enough oestrogen to inhibit its production

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25
Q

How many women are affected by morning sickness?

A

80-85%

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26
Q

What conditions make morning sickness worse?

A

Conditions where there is higher Human Chorionic gonadotrophin
I.e Twins
Molar pregnancy

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27
Q

What can morning sickness progress to?

A

Hyperemesis gravidarum

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28
Q

In which tirmester does maternal blood pressure drop?

A

Second trimester

Returns to normal in 3rd trimester

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29
Q

Why does maternal blood pressure drop in the second trimester?

A

Expansion of the uteroplacental circulation
A fall in systemic vascular resistance
A reduction in blood viscosity
A reduction in sensitivity to angiotensin

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30
Q

Why does urine output increase in pregnancy?

A

Decreased space
Renal plasma flow increases
GFR increases

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31
Q

Why is there an increased risk of UTIs in pregant women?

A

Due to increased urinary stasis

Hydronephrosis occurs in third trimester (physiological) meaning pyelonephritis more common

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32
Q

What are UTIs in pregnancy associated with?

A

Preterm labour

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33
Q

Who should recieve pre-pregnancy counselling?

A

Ideally every woman, although this is not the case due to unplanned pregnancies

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34
Q

What is involved in pre-pregnancy counselling?

A

Discussion of health risks associated with getting pregnant / to the baby
General health measures
-BMI (before, difficult to lower in pregnancy)
-Improve diets (before, not recommended in pregnancy)
-Reduce alcohol (before!)
Smoking cessation
Folic acid (ideally 3 motnhs before)
Confirm immunity to rubella
Suitibility of drugs?
Psychiatric health

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35
Q

What does an antenatal exam involve?

A 
Routine examinations of fetal movements
Checking that mother is feeling well
Blood pressure/urinalysis
Abdominal palpations 
Fetal heartbeat
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36
Q

What is palpated for in an antenatal exam?

A

Symphyseal fundal height
Estimate size of baby
Estimate of liquor volume
Fetal presentation (longitudinal vs transverse)

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37
Q

What is antenatal screening?

A

A non-compulsory screen for conditions to be detected early
Appropriate counselling should be undertaken beforehand
Infection
Isoimmunisation (resus)
Downs
US

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38
Q

What infections are screened for in pregnancy?

A 
Hep B
Syphylis
HIV
MSSU
Rubella
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39
Q

What isoimmunisation markers are screened for?

A 
Rhesus type (if mother is negative)
Anti-C, Anti-Kell
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40
Q

What is the purpose of the first ultrasound scan?

A

To ensure viable pregnancy
Multiple pregnancies?
Identify abnormalities
Down’s screening

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41
Q

What is considered high risk for downs syndrome?

A

1/200

42
Q

What tests are available for detecting downs syndrome?

A

First nuchual translucency abnormal

Then CVS
Amniocentesis

43
Q

When is the first ultrasound carried out?

A

10-14 weeks gestation

44
Q

What is screened in first trimester screening?

A

serum b-human chorionic gonadotrophin (b-hCG)
pregnancy associated plasma protein A (PAPP-A)
fetal nuchal translucency (NT) measurement

45
Q

What is the nuchual translucency test?

A

Checks for size (not appearance) of the nuchual translucency (area around neck of baby)
Abnormalities increase with age

46
Q

When can CVS be carried out?

A

10-14 weeks

47
Q

When can amniocentesis be carried out?

A

15 weeks plus

48
Q

What is the difference between CVS and amniocentesis?

A

CVS takes cells from placenta, comes with 1-2% miscarriage risk

Amniocentesis takes amniotic fluid, 1% risk of miscarriage

49
Q

What is non-invasive parental testing?

A

Maternal blood taken to check for abnormalities (not done on NHS)
Can look for trisomes
If high risk, still advised to take invasive test to be sure

50
Q

How are nueral tube defects screened for?

A

First trimester prgnancies for ancocephaly
Second trimester biochemical screening if unable to get nuchual transluency + alpa-fetoprotein
2nd trimester US detects 90% of NT defects

51
Q

When is the 2nd trimester US done?

A

20wks

52
Q

What is the purpose of 2nd trimester US?

A

Detecting major abnormalities

Although poor in detecting chromosomal abnormalities

53
Q

What hormones are associated with the female reproductive tract?

A

Gonadotrophin releasing hormone
Gonadotorphins (LH + FSH)
Steroid hormones - oestrogen, progesterone, Testosterone

54
Q

When can foetal heart pulsation be seen on a transvaginal US?

A

6 weeks gestation

55
Q

What is the first sign of pregnancy on an ultrasound?

A

Thickening of uterus lining

56
Q

Ho is gestation age calculated in the first trimester?

A

Crown rump length

57
Q

When would a thir trimester US scan be indicated?

A

If baby feels large/small
Fluid volume abnormal
May be a problem

58
Q

What features are used to monitor foetal growth?

A

Femur length
Abdominal length
Head circumfrence

59
Q

How often would you monitor foetal frowth?

A

every 4 weeks if abnormal

60
Q

What marker is raised in open nueral ube defects?

A

Alphafoetal protein

61
Q

What are the types of combined contraception?

A

Combined oral pill
Vaginal ring
Patch

62
Q

What are the types of progesterone only contraception?

A

Implant
Injectable
Progesterone only pill
Hormonal coil

63
Q

What are the types of emergency contraception?

A

IUD (copper coil) - best
Morning after pill - Levaonorgestrel (72hrs)
Ella - one (up to 120 hrs)

64
Q

How are clinical trials for contraception measured?

A

Either pearl index

Life table analysis (better)

65
Q

What are the types of abortion you can get?

A

Medical (before 20 weeks)

Surgical (before 24 weeks - must be in England)

66
Q

What is the regime for the OCP?

A

21 days
7 days off
Can be taken back to back

67
Q

What hormones does the OCP contain?

A

Eithinyl estradiol

Synthetic progesterone

68
Q

What is the method of action of the combined oral pill?

A

Prevent ovulation through altering FSH/LH levels
Prevents teh surge
PPrevents implantation by stopping endometrial growth
Inhibits sperm penetration of cervical mucus by altering it

69
Q

Hoe long does the OCP take to work?

A

7 days

Need other contraceptive methods during that time

70
Q

What are the other, non contraceptive, benefits of the oral contraceptive pill?

A 
Regular periods
Reduction in heavy menstration
Reduction in ovarian cysts
Reduction in ovarian dna endometrial cancer
Improves acne
71
Q

What are the risks associated with the pill?

A

Safe for most women
3x risk of DVT, however only extra 0.0001% more affected
Cervical cancer doubles with 10yrs use, potentially

72
Q

Who is at increased risk for VTE?

A 
Major surgery/immonbility
Thrombophilias
Famil history under 45
BMI over 30
Underlying vascular disease
Postnatal (21 days)
73
Q

When does the progesterone only pill have to be taken?

A

Ideally at same time every day

However, you have a 12 hr period the next day following the time you took the previous pill

74
Q

How does the progesterone only pill work?

A

Cervical mucus inpentetrable to sperm
Effect lost if not taken within time period (older agents 3 hrs)
Effects ovulation as well

75
Q

What is the injection otherwise known as?

A

DepoProvera

76
Q

What is DepoProvera

A

IM injection every 12 weeks

77
Q

What is the MOA of devoprovera?

A

Prevents ovulation
Alters cervical mucus making it hostile
Prevents implantation by rendering endometrium unsuitable

78
Q

What are teh advantages of devoprovera?

A

Good for forgetfull pill takes
Oestrogen free#
70% don’t bleed
Works regardless of weight

79
Q

What are the disadvantages in depoprovera?

A

A delay in return to fertility
Reduction in bone density (reversible)
Problematic bleeding
Weight gain

80
Q

What are the failure rates of female sterilisation?

A

1 in 500 lifetime risk

81
Q

What is the failure rate of a vasectomy?

A

1 in 2,000

82
Q

What pills are given for a medical abortion?

A 
Mifepristone (stops pregnancy hormone)
Then misoprostol (uterine contraction)
83
Q

What are the complications of medical termination of pregnancy?

A

Failure in roughly 5%
Haemorrhage in ~ 5%
Infection

84
Q

How does the copper coil work?

A

Is spermacidic

Also reduces heavy menstral bleeding

85
Q

What is maternal mortality?

A

Death of a woman while pregnant or within 42 days of a termination of pregnancy

86
Q

What is maternal morbidity?

A

Severe health complications occurring in pregnancy and delivery not resulting in death

87
Q

What are the types of deaths in pregnancy?

A

Direct deaths - obstetric complications during pregnancy, labour or puerperium or from any treatment
Indirect deaths - disorder associated with pregnancy
Late deaths - after 42 days after pregnancy, within 1 year

88
Q

What are the phases to the ovarian cycle?

A

Follicular phase

Luteal phase

89
Q

What is the follicular phase of the ovarian cycle?

A

Gonadotrophins released which stimulate growth of new follicles
When follicle ready to release egg LH surges and releases it

90
Q

What is the luteal phase of the ovarian cycle?

A

Occurs after ovulation
Follicle becomes Corpus luteum and produces progesterone
This causes changes to lining of womb
Degenerates to corpus albicans if pregnancy doesn’t occur

91
Q

What are the phases to the menstal cycle?

A

Mesntral phase
Proliferative phase
Secretary phase
Premenstral phase

92
Q

What is the menstral phase of the mesntral cycle?

A

4 days where bleeding occurs

93
Q

What is the proliferative phase of the menstral cycle?

A

Phase between day 4 and 14
Oestrogen thickens endometrim
Follicle matures within ovary
Ovulation occurs at end of this phase

94
Q

What is the secratory phase?

A

After ovulation

Progesterone causes blood vessels to dilate within the endometrium

95
Q

What is the premenstral phase of the menstral cycle?

A

Where hormone levels drop as pregnancy has not occurred

96
Q

What are the stages to oogenesis?

A

Oognium undergo mitotic division to form primary oocytes. Completed at birth
Meiosis arrested in prophase
Primary oocytes respond to hormone each cycle - one goes under meiotic division. Release polar body
Secondary oocyte undergoes second meiosis when fertilised by sperm. Releases second polar body (and mature ovum)

97
Q

What are the male reproductive hormones?

A

GnRH (from hypothalamus)
Gonadotrophics - FSH/LH (from anterior pituitary)
Testosterone (from testis)

98
Q

What do sertoli cells produce?

A

Inhibin

99
Q

What do leydig cells produce?

A

Testosterone

100
Q

Where does FSH act in males?

A

Spermatogonia in semiferos tubules

results in spermatogenesis

101
Q

Where does LH act in males?

A

Leydig cells
Interstitial cells of testis

(results in androgens)

102
Q

What are the amin factors that affect oogensis/spermatogensis?

A

Problem with hormonal control - genetic, tumours, medications or functional

Problem with site of production (genetic, surgery/trauma, infections, medication sideeffects - cancer)

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