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Medicine year 3 > Repro - Female physiology and fertilisation > Flashcards

Repro - Female physiology and fertilisation Flashcards

1
Q

Where in the fallopian tube is the egg fertilised?

A

The Ampulla

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2
Q

What are the 3 layers of the uterus called?

A

Perimetrium
Myometrium
Endometrium

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3
Q

Which layer of the ovary contains the ovarian follicles (1 oocyte surrounded by 1 layer of cells)

A

The Cortex (peripheral part) - contains the primordial follicle pool which makes up the egg resevere of the ovary.

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4
Q

Which layer of the ovary contains blood vessels which supply the ovary?

A

The Medulla (central part)

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5
Q

Name 2 functions of the ovaries

A
  1. Oocyte production (1 mature egg generated per menstrual cycle)
  2. Steroid hormone production (estrogen, progesterone, testosterone)
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6
Q

50% of the testosterone in the female body is produced by the ovaries before menopause

a. true
b. false

A

a. True

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7
Q

Describe the structure of a primordial follicle?

A

Primary oocyte (stuck in the first meiotic division) surrounded by one layer of sqaumous pre-granulosa cells

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8
Q

Name the 4 stages of follicular development?

A
  1. Primordial Follicles
  2. Primary Follicle
  3. Seconday Follicle
  4. Tertiary/Graffian Follicle
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9
Q

Describe the structure of a primary follicle?

A

Oocyte surround by Zona Pellucida***

and 2 cell layers of CUBOIDAL granulosa cells (start to proliferate)

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10
Q

Describe the structure of a secondary follicle (pre antral)?

A

Oocyte grows in diamter

There are mutiple layers of granulosa cells

Appearance of Theca cells**

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11
Q

Describe the structure of a graffian (tertiary) follicle?

A

Follicular fluid between cells combine to form ANTRUM

first meiotoic division is complete -> secondary oocyte is formed and second meitoic division starts (pre-ovulatory)

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12
Q

Where are FSH and LH (gondaotrophins) released from?

A

The Anterior pituitary gland

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13
Q

Where do FSH and LH act upon in the female body?

A

The ovary

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14
Q

Which hormones do the the ovaries produce? and what organ do they act upon?

A

Estrogen and progesterone (steroid hormones)

Act on the uterus to co-ordinate the mentsrual cycle?

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15
Q

What structure releases GnRH?

A

The hypothalamus (gondotrophin releasing hormone)

Acts on the Anterior pituitary to release LH and FSH

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16
Q

Estrogen and Progesterone always exert negative feedback within the hypothalamic pituitary axis

a. True
b. False

A

False

Estrogen exerts positive feed during days 12-14 (mid-cycle) - increasing the production of GnRH, FSH and LH. This is to help mid cycle ovulation and is responsible for LH surge seen mid-cycle.

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17
Q

Describe the follicular phase of the ovarian cycle

A

FSH causes the follicle to mature and produce estrogen (inhibiting the development of other follicles)

  • Follicles produce estrogen and increase thickness of endometrium
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18
Q

Describe the ovulation phase of the ovarian cycle

A

Follicle rupture and the secondary oocyte is released due to an LH surge

Estrogen is high and progesterone is low

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19
Q

Describe the luteal phase of the ovarian cycle

A

The ruptured follicle forms the corpus luteum and secretes progesterone and (some) estrogen

progesterone is high

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20
Q

Describe the menstruation phase of the ovarian cycle?

A

The corpus leteum degenerates and forms the corpus albicans

A new ovarian cycle can then begin.

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21
Q

Effect of estrogen on the endometrium?

A

proliferation

Estrogen is the primary regulator of endometrial proliferation.

During the proliferative phase, estrogen causes the endometrium to thicken and grow, preparing the uterus for pregnancy.

This phase can last 10–20 days, but is typically around 14 days.

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22
Q

Progesterone transforms the endometrium into a secretory structure

a. true
b. false

A

a. True

Ensures the structure is ready to recieve embryo.

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23
Q

Which hormone causes ovulation mid-cycle?

A

LH surge (due to positive feedback of estrogen on AP and hypothalamus)

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24
Q

What is menarche

A

The onset of bleeding - at puberty - 1st mentrual period

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25
Q

What is amenorrhoea ?

A

No periods!!!

can be

  1. primary - never had
  2. secondary - stopped for 6 months
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26
Q

What additional 2x history must be taken during a gynae history taking?

A
  1. obstetric
  2. sexual
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27
Q

Menorrhagia means?

A

heavy periods (HMB)

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28
Q

Parity means?

A

number of pregnancies - regardless of the outcome

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29
Q

Para 2 + 1

A

parity = number of pregnancies

= 3 pregnancies

1st number = births after 24 weeks (alive or still)

= 2 births after 24 weeks

2nd number = births, terminations, miscarriages, still births before 24 weeks

= 1

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30
Q

How is fundal height measured?

A

Palpate the fundus (top of uterus) with two hand and measure to the top of the pubic symphysis with tape.

Semi-recumbant position with empty bladder.

24 weeks = around 24 cm +/-

(is lie longitudinal, oblique, transverse)?

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31
Q

What is the ideal position of the foetus

A

Longitudinal - Cephalic

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32
Q

How do you know when the head is engaged and descended into the pelvis?

A

Only 2/5 of head is palpable abdominally

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33
Q

How is the sperm first able to interact with the egg during fertilisation?

A

The acrosome (head of sperm) reacts with the zona pellucida and periviteliine space (surrounding egg) by releasing hydrolytic enzymes

  • The sperm then can react with protein receptors
  • The plasma membranes of sperm and egg the fuse
  • Sperm releases nucleus which enters the egg
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34
Q

What stops other sperm from releasing their nucleus into the egg?

A

Cortical granules are released which renders the vitelline layer impenetrable to other sperm

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35
Q

What is a morula?

A

ball of cells 16+

(cell division, 2, 4, 6, 8, 16+ cells on day 4 or 5)

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36
Q

What is a blastocyst

A

Forms day 5 after fertilisation

Morula develops into 2 distinct cell groups

  1. Trophoblasts (outer)
  2. Inner cell mass (endoderm)
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37
Q

Which layer of the blastocyst invades the maternal endometrium for plantation?

A

The trophoblast layer

Merge with the placenta

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38
Q

What are the two cell groups in the blastocyst (day 5)

A
  1. Trophoblasts
  2. Inner cell mass
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39
Q

16+-ball of cells which are undifferentiated during embyro development is called?

A

Merula (early embyro enters the uterine cavity in morula phase)

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40
Q

Which group of cells within the blastocyst give rise to the baby?

A

inner cell mass

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41
Q

outline the correct order of implantation steps

(appposition , ahdesion, hatching, invasion)

A
  1. hatching - trophoblast cells produce protease that dissolves zona and allows blastocyt to come out
  2. apposition - first connection between blastocyst and endometrium
  3. adhesion - trophoblast adheres to the epithelial layer of the maternal endometrium (hCG secreted by embryonic tissue)
  4. invasion - trophoblast proliferate, differentiate and cross the epithelial basement membrane/invade endometrial stroma to form the placenta.
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42
Q

what is appostion? in regards to implantation of the embryo

A

The first connection between the blastocyt (microvilli) and the endometrium (pinopodes)

pinopodes are microvilli like structures expressed on receptive endometrium.

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43
Q

steps of implantation (4)

A
  1. hatching - blastocyts hatches out of zona which is dissolved (trophoblast cekks secrete protease)
  2. apposition - attaches to pinopodes of endometrium
  3. adhesion - trophoblasts adhere and hCG produced
  4. invasion - proliferation of trophoblasts/ connection with uterine vessels
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44
Q

How does the embyro hatch out of the zona pellucida during the 5th day after fertilisation?

A

trophoblast cells secrete proteases

inability to hatch results in infertility - and premature hatching can result in abnormal implantation in the uterine tube (ectopic)

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45
Q

what is decidualisation

A

preparation of the endometrium for implantation prior to trophoblast invasion and placentation

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46
Q

List 3 changes to the endothelium in preparation for implantation

A
  1. stroma cell differientation (FLC fibroblast like elongated cells) -> rounded epithelial cells
  2. angiogenesis (+ increased vascular permeability)
  3. increased macrophages, lymphocytes and decidual leukocytes (uterine natural killer cells) for maternal immune tolerance

under the influence of progesterone (proliferative stage) - becoming vascular receptive tissue

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47
Q

The placenta is composed of tissue almost fully derived from foetal tissue

a. true

b. false

A

a. true

trophoblast cells (from blastocyt which has hatched)

48
Q

What are the two layers of the trophoblast called?

A
  1. Cytotrophoblast (outer) - invade endometrium and remodel spiral arteries to increase blood flow
  2. Syncytiothrophoblast (inner)

form primary, secondary and then tertiary chorionic villi (tertiary when capillaries form)

49
Q

The umbilical vein carries?

A

02 rich blood from the placenta TO foetus

50
Q

The umbilical artery carries

A

02 poor blood and waste products from the foetus TO the placenta

51
Q

Two layers of the trophoblast cells

A
  1. cytotrophoblast (outer)
  2. synctiotrophoblast (inner)
52
Q

functions of the placenta

A
  1. immunological barrier
  2. gas exchange
  3. nutrient exchange
  4. waste excretion
  5. endocrine - hCG secreted
53
Q

When to refer a couple for infertility investigations?

A

after 1 year of regular unprotected intercourse

earlier if > 35 or known cause

54
Q

investigations to test for ovarian reserve

A
  1. Blood tests
  • FSH on D1-D5 of cycle (<10 iu/L)
  • AMH (5-0 - 25.0 pmol/L)
  1. USS - Antral follicilar count
55
Q

approaches couples can take to see if ovulation is happening?

A

1.BBT - basal body temp increase (increases during ovulation and stays higher for a few days)
2. cervical muscus
3. LH ovulation kits
4. ovulation calender

56
Q

clinical test for ovulation

A

D21(day 21) serum progesterone

only works if normal 28-30 day cycle

> 20nmol/l are satisfactory!!normal

57
Q

normal sperm count

A

15 million/ml

58
Q

how is fallopian tube patency determined ?

A
  1. HSG scan - hysterosalpingogram

(if no pelvic infection or gynaecological problem in the past)

  1. Laparoscopic dye test
59
Q

how is uterine cavity normally investigated?

A

pelvic USS

60
Q

medications that induce ovulation

A
  1. clomiphene citrate (oral tablets)
  2. gonadotrophins (direct FSH)

try lifestyle factors first

61
Q

risks of IVF

A
  • ovarian hyperstimulation syndrome
  • mutiple pregnancies
62
Q

the ovary ejects the oocyte into the fallopian tube in what stage of development?

A

secondary oocyte

in metaphase 2

63
Q

attachments of cardinal ligament

A

cervix - lateral pelvic wall

64
Q

function of bartholins gland

A

secretes mucus into the vestibule (area with vaginal and urethral opening) surrounded by labia minora

65
Q

type of epithelium in the vagina

A

stratified sqaumous - deals with abraision/friction

66
Q

females are born with a set amount of oogonium (diploid stem cells)

a. true
b. false

A

a.true

get converted to primordial follicles (frozen in prophase1)

at puberty - localised androgens stimulate primoridal follicles -> primary follicles

67
Q

primary follicles have undergone mieosis 1

a. true
b. false

A

b. false

FSH stimulation -> start proliferating and making layers of granulosa cells

68
Q

FSH stimulates proliferation of granulosa cells

a. true
b. false

A

a. true

69
Q

FSH affects

A
  1. proliferation of granulosa cells
  2. formation of zona pellucida (layer of glycoprotein)
  3. stimulate cells to produce estrogen

cause granulosa cells to produce estrogen (androgens -> estrogen)

70
Q

What do theca cells do

A

takes cholesterol and produces androgens

androgens then enter granulosa cells (and are converted to estrogens)

71
Q

which hormone stimulates theca cells?

A

LH - stimulates theca cells to produce androgens (cholesterol -> androgens)

Androgens then enter granulosa cells

72
Q

FSH stimulates enzymes in granulosa cells to convert androgens to estrogens

a. true
b. false

A

a. true

73
Q

Secondary follicles are primary oocytes

a. true
b. false

A

a. true

hasnt finished mieosis 1

74
Q

When pockets of follicular fluid coalase it is called?

A

ANTRUM

-> graffian follicle

75
Q

primary factor stimulating follicular phase of cycle

A

FSH!!

(help of LH to produce androgens via theca cells)

76
Q

describe the follicular phase (day 1-14 of cycle)

A
  • mitosis of granulosa cells
  • estrogen is produced
  • follicular fluid is produced
77
Q

what hormone rises around mid-cycle (day 14)

A

estrogen - exerts positive FB

tonnes of GnRH, LH

rise of LH and estrogen**

graffian follicle produce inhibin B - prevents rise of FSH

78
Q

How does the LH surge act of graffian follicle

A
  • increases permeability and blood flow to the antrum
  • increased follicular fluid
  • proteases activated which eat tissue around graffian follicle
  • enzymes cut the structure holding egg and egg pops out of follicle
79
Q

how are the fimbrie effected by the LH surge

A

become stiff and scrape across the surface of the ovary

this creates a fluid filled current which pushes the oocyte towards the fallopian tubes

secondary oocyte is caught when still in metaphase 2

cilia beat oocyte into the ampulla

80
Q

what happens during the luteal phase

A

the remaining ruptured graffian follicle is converted into the corpus luteum

under influence of LH, corpus luteum is stimulated to produce progesterone (day 15-28)

81
Q

what are the 3 phases of the mentsrual cycle

A
  1. menstruation - shedding of the stratum functionalis of the endometrium (day 1-5)
  2. proliferative (regeneration of layer) - (day 6-14 under influence of estrogen)
  3. secretory phase
82
Q

which layer of the uterus gets shed during menstruation

A

stratum functionalis (has coily /spiral arteries)

arteries are branches of the uterine artery (internal iliac)

83
Q

Which hormone is released after ovulation occurs and can be used as a marker of fertility?

A

Day 21 progesterone, also known as mid-luteal cycle progesterone, is used to test for ovulation if the woman has a regular cycle. If irregular, then you need to test progesterone a week before predicted menstruation.

Ovulation is a sign that an egg is being released, which is obviously a basic requirement for fertilisation to occur.

84
Q

progesterone increases body temperature

a. true
b. false

A

a. true

85
Q

which hormone is responsible for spiral artery development

A

progesterone

86
Q

progesterone decreases myometrial excitability

a. true
b. false

A

a. true

87
Q

estrogen effect on cervical mucous

A

stimulates uterine glands to produce thin cervical mucous

thin to prevent blocking sperm but has chemicals that help activate the sperm

88
Q

which hormone is prevalent during proliferative phase of mentsrual cycle?

A

estrogen

  • regeneration of stratum functionalis of endometrium and spiral coily arteries (angiogenesis)
  • stimulates production of uterine glands**
89
Q

what hormone is prevalent during the secretory phase of mentsrual cycle?

A

progesterone

produced by the corpus luteum

90
Q

effects of progesterone on uterus

A
  • thickens the stratum functionalis even more
  • increases spiral coily arteries
  • makes uterine gland start producing fluid that is rich in both glycogen, lipids and proteins
  • switches to thick cervical mucous - plugs up the cervix (no access to protect the embyro
91
Q

what stimulates the corpus luteum to continue producing progesterone

A

hCG - human gonadotrophin

stimulates corpus luteum to produce progesterone continuously

92
Q

how does mentsruation occur? (days 1-5)

A

if no fertilisation occurs there are no signals from the embyro to the corpus luteum to produce progesterone

progesterone levels drop

spiral arteries spasm, are weak and fragile, vasoconstriction so hard - that they rupture -> blood accumulates in the stratum functionalis

-> no blood /02 to functionalis -> necrosis/tissue dies

93
Q

if there are no signals from the embyro - what does the corpus luteum become?

A

corpus albicans

cannot produce progesterone or response to LH

94
Q

what happens the corpus luteum if fertilisation occurs?

A

corpus luteum will produce progesterone until placenta develops in week 12

95
Q

describe a primordial follicle

A

oocyte with 1 layer of simple squamous cells

96
Q

GnRH is released at puberty

a. true
b. false

A

a. true

starts production of localised androgens that stimulate primordial follicles -> primary follicle -> (FSH)-> seconday follicle - (FSH) -> Graffian

97
Q

what phase is day 1-14 of ovarian cycle

A

follicular

98
Q

LH acts on theca cells to?

A

produce androgens

(cholesterol is converted)

99
Q

FSH effect on granulosa cells

A

stimulates to convert androgens which enter

into estrogen

via aromatase enzyme

*estrogen is a byproduct of follicular phase

100
Q

inhibin B is released by graffian follicles , what is its action?

A

inhibits FSH midcycle (means there is only an LH surge)

101
Q

effect of LH surge

A
  • increase in permeability of blood vessels
  • triggers ovulation - proteases pop out the secondary oocyte
102
Q

LH stimuates the corpus luteum to produce progesterone

a. true
b. false

A

a. true

103
Q

Theca cells function

A

convert cholesterol -> androgens (androsterendre)

104
Q

Granulosa cells function

A

Androsternede -> estrogen

via aromatase enzyme

105
Q

secondary follicle (pre antral) defining feature

A

theca cells

106
Q

how does progesterone facilitate embyro implantation?

A
  • spiral artery development
  • uterine contractions/excitability are reduced
  • endometrium is maintained
  • cervical mucus thickening
107
Q

What receptor on the zona pellucida does the sperm bind to

A

ZP3 receptor

108
Q

ammenorrhea

A

no periods

109
Q

dopamine inhibits prolactin

a. true
b. false

A

a. true

110
Q

what phase of the mentsrual cycle happens during the follicular ovarian cycle?

A

follicular phase is day 5-13

profilerative phase of cycle -> estrogen is produced by follicles (resulting in thickening of endometrium, formation of spiral arteries, increased vascularity and formation of glands)

111
Q

what days in the cycle does ovulation occur

A

day 13-14

112
Q

what phase of the menstrual cycle takes place during the luteal phase (day 15-28)

A

secretory

  • corpus luteum
  • endometrium changes to secretory lining under the influence of progesterone
  • progesterone rises (thick cervical mucus, body temperature rises following ovulation in response to high progesterone)
  • if no fertilisation - corpus luteum degenerates and progesterone falls
  • estrogen will start rising again
113
Q

body temperature falls prior to ovulation

a. true
b. false

A

a. true

and rises after when progesterone rises

114
Q

What phase of development is the secondary oocyte frozen in until fertilisation?

A

Metaphase 2

(sits in ampulla)

115
Q
A

Medicine year 3 (9 decks)

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