Repro Flashcards
Where are sperm produced? (be specific)
In the seminiferous tubules in spermatid cells
Found in testis
What are the functions of the sertoli cells?
Form blood-testis barrier
Isolate secondary spematocytes, spermatids/ spermatozoa from immune system
Nutrients/waste to sperm
Support spermiation (getting sperm to lumen)
What are the main glands that add fluid to sperm to make semen?
Bulbourethral gland
Prostate gland
Seminal vesicles
How many sperm develop from each spermatogonium ?
512
How long does it take to produce sperm?
75 days
Where do sperm become motile, how long can they be stored?
Epididymis, 15 days
What are the stages of sperm production?
Spermatocytogenesis
Meiosis
Spermiogensis
What is the counter current heat exchange?
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
What factors affect spermatogenesis?
Testis temperature Endocrine Loss of blood testis barrier Immunological reactions Environment Medication
Where do andeogens act?
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
How long does it ake from the LH surge to ovulation?
36 hours
When does the first meiotic division take place of an egg cell? (primary to secondary)
IN utero, to be completed at ovulation
What is the LH surge associated with?
Ovulation
When does oestrogen have a negative feedback system?
Under low concentrations
Oestrogen and progesterone inhbit oestrogen release
Also inhibit FSH and LH
When does oestrogen have a positive feedback route?
Under high concentrations
LSH + FH together release oestrogen
What is the role of GnRH in females?
Stimulates LSH/FH release from anterior pituitary
What is the role LH?
Maintain dominant follicle
Induce follicular maturation and ovulation
Stimulate CL development
What is the role of FSH?
Stimulates follicular recruitment + development
What is the role of oestrodiol (type of oestrogen)?
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
Where is oestrodiol produced?
Granulosa cells
What is the role of progesterone?
Maintanence of secretory endometrium
Negative feedback control of HPO (hypothalamus hypophyseal ovarian axis)
What are the targets for oestrogen?
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
What are the levels of progesterone in the follicular + leuteal phases of ovation?
Follicular - 1-4nmol/L
Leuteal - 12-70nmol/L
What happens to LH + FSH in meopause?
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
How many women are affected by morning sickness?
80-85%
What conditions make morning sickness worse?
Conditions where there is higher Human Chorionic gonadotrophin
I.e Twins
Molar pregnancy
What can morning sickness progress to?
Hyperemesis gravidarum
In which tirmester does maternal blood pressure drop?
Second trimester
Returns to normal in 3rd trimester
Why does maternal blood pressure drop in the second trimester?
Expansion of the uteroplacental circulation
A fall in systemic vascular resistance
A reduction in blood viscosity
A reduction in sensitivity to angiotensin
Why does urine output increase in pregnancy?
Decreased space
Renal plasma flow increases
GFR increases
Why is there an increased risk of UTIs in pregant women?
Due to increased urinary stasis
Hydronephrosis occurs in third trimester (physiological) meaning pyelonephritis more common
What are UTIs in pregnancy associated with?
Preterm labour
Who should recieve pre-pregnancy counselling?
Ideally every woman, although this is not the case due to unplanned pregnancies
What is involved in pre-pregnancy counselling?
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
What does an antenatal exam involve?
Routine examinations of fetal movements Checking that mother is feeling well Blood pressure/urinalysis Abdominal palpations Fetal heartbeat
What is palpated for in an antenatal exam?
Symphyseal fundal height
Estimate size of baby
Estimate of liquor volume
Fetal presentation (longitudinal vs transverse)
What is antenatal screening?
A non-compulsory screen for conditions to be detected early
Appropriate counselling should be undertaken beforehand
Infection
Isoimmunisation (resus)
Downs
US
What infections are screened for in pregnancy?
Hep B Syphylis HIV MSSU Rubella
What isoimmunisation markers are screened for?
Rhesus type (if mother is negative) Anti-C, Anti-Kell
What is the purpose of the first ultrasound scan?
To ensure viable pregnancy
Multiple pregnancies?
Identify abnormalities
Down’s screening
What is considered high risk for downs syndrome?
1/200
What tests are available for detecting downs syndrome?
First nuchual translucency abnormal
Then CVS
Amniocentesis
When is the first ultrasound carried out?
10-14 weeks gestation
What is screened in first trimester screening?
serum b-human chorionic gonadotrophin (b-hCG)
pregnancy associated plasma protein A (PAPP-A)
fetal nuchal translucency (NT) measurement
What is the nuchual translucency test?
Checks for size (not appearance) of the nuchual translucency (area around neck of baby)
Abnormalities increase with age
When can CVS be carried out?
10-14 weeks
When can amniocentesis be carried out?
15 weeks plus
What is the difference between CVS and amniocentesis?
CVS takes cells from placenta, comes with 1-2% miscarriage risk
Amniocentesis takes amniotic fluid, 1% risk of miscarriage
What is non-invasive parental testing?
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
How are nueral tube defects screened for?
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
When is the 2nd trimester US done?
20wks
What is the purpose of 2nd trimester US?
Detecting major abnormalities
Although poor in detecting chromosomal abnormalities
What hormones are associated with the female reproductive tract?
Gonadotrophin releasing hormone
Gonadotorphins (LH + FSH)
Steroid hormones - oestrogen, progesterone, Testosterone
When can foetal heart pulsation be seen on a transvaginal US?
6 weeks gestation
What is the first sign of pregnancy on an ultrasound?
Thickening of uterus lining
Ho is gestation age calculated in the first trimester?
Crown rump length
When would a thir trimester US scan be indicated?
If baby feels large/small
Fluid volume abnormal
May be a problem
What features are used to monitor foetal growth?
Femur length
Abdominal length
Head circumfrence
How often would you monitor foetal frowth?
every 4 weeks if abnormal
What marker is raised in open nueral ube defects?
Alphafoetal protein
What are the types of combined contraception?
Combined oral pill
Vaginal ring
Patch
What are the types of progesterone only contraception?
Implant
Injectable
Progesterone only pill
Hormonal coil
What are the types of emergency contraception?
IUD (copper coil) - best
Morning after pill - Levaonorgestrel (72hrs)
Ella - one (up to 120 hrs)
How are clinical trials for contraception measured?
Either pearl index
Life table analysis (better)
What are the types of abortion you can get?
Medical (before 20 weeks)
Surgical (before 24 weeks - must be in England)
What is the regime for the OCP?
21 days
7 days off
Can be taken back to back
What hormones does the OCP contain?
Eithinyl estradiol
Synthetic progesterone
What is the method of action of the combined oral pill?
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
Hoe long does the OCP take to work?
7 days
Need other contraceptive methods during that time
What are the other, non contraceptive, benefits of the oral contraceptive pill?
Regular periods Reduction in heavy menstration Reduction in ovarian cysts Reduction in ovarian dna endometrial cancer Improves acne
What are the risks associated with the pill?
Safe for most women
3x risk of DVT, however only extra 0.0001% more affected
Cervical cancer doubles with 10yrs use, potentially
Who is at increased risk for VTE?
Major surgery/immonbility Thrombophilias Famil history under 45 BMI over 30 Underlying vascular disease Postnatal (21 days)
When does the progesterone only pill have to be taken?
Ideally at same time every day
However, you have a 12 hr period the next day following the time you took the previous pill
How does the progesterone only pill work?
Cervical mucus inpentetrable to sperm
Effect lost if not taken within time period (older agents 3 hrs)
Effects ovulation as well
What is the injection otherwise known as?
DepoProvera
What is DepoProvera
IM injection every 12 weeks
What is the MOA of devoprovera?
Prevents ovulation
Alters cervical mucus making it hostile
Prevents implantation by rendering endometrium unsuitable
What are teh advantages of devoprovera?
Good for forgetfull pill takes
Oestrogen free#
70% don’t bleed
Works regardless of weight
What are the disadvantages in depoprovera?
A delay in return to fertility
Reduction in bone density (reversible)
Problematic bleeding
Weight gain
What are the failure rates of female sterilisation?
1 in 500 lifetime risk
What is the failure rate of a vasectomy?
1 in 2,000
What pills are given for a medical abortion?
Mifepristone (stops pregnancy hormone) Then misoprostol (uterine contraction)
What are the complications of medical termination of pregnancy?
Failure in roughly 5%
Haemorrhage in ~ 5%
Infection
How does the copper coil work?
Is spermacidic
Also reduces heavy menstral bleeding
What is maternal mortality?
Death of a woman while pregnant or within 42 days of a termination of pregnancy
What is maternal morbidity?
Severe health complications occurring in pregnancy and delivery not resulting in death
What are the types of deaths in pregnancy?
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
What are the phases to the ovarian cycle?
Follicular phase
Luteal phase
What is the follicular phase of the ovarian cycle?
Gonadotrophins released which stimulate growth of new follicles
When follicle ready to release egg LH surges and releases it
What is the luteal phase of the ovarian cycle?
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
What are the phases to the menstal cycle?
Mesntral phase
Proliferative phase
Secretary phase
Premenstral phase
What is the menstral phase of the mesntral cycle?
4 days where bleeding occurs
What is the proliferative phase of the menstral cycle?
Phase between day 4 and 14
Oestrogen thickens endometrim
Follicle matures within ovary
Ovulation occurs at end of this phase
What is the secratory phase?
After ovulation
Progesterone causes blood vessels to dilate within the endometrium
What is the premenstral phase of the menstral cycle?
Where hormone levels drop as pregnancy has not occurred
What are the stages to oogenesis?
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)
What are the male reproductive hormones?
GnRH (from hypothalamus)
Gonadotrophics - FSH/LH (from anterior pituitary)
Testosterone (from testis)
What do sertoli cells produce?
Inhibin
What do leydig cells produce?
Testosterone
Where does FSH act in males?
Spermatogonia in semiferos tubules
results in spermatogenesis
Where does LH act in males?
Leydig cells
Interstitial cells of testis
(results in androgens)
What are the amin factors that affect oogensis/spermatogensis?
Problem with hormonal control - genetic, tumours, medications or functional
Problem with site of production (genetic, surgery/trauma, infections, medication sideeffects - cancer)
