Reproduction Flashcards
How long is a typical menstrual cycle?
28 days
What is classed as day 1 of the menstrual cycle?
The first day of bleeding
What hormones peak at day 14?
LH
This occurs just before ovulation
In the first half of the cycle, what hormone(s) is/are produced?
Oestrogen only
In the second half of the cycle, what hormone(s) is/are produced?
Oestrogen and progesterone
When does an embryo begin to secrete HCG?
When it has been implanted.
What is the role of oestrogen and progesterone?
To develop the uterine wall sufficiently to give implantation the greatest chance of success.
As an implanted embryo continues to develop, what hormones does it produce?
Human placental lactogen
Placental progesterone
Placental oestrogen
What does the release of placental progesterone and HPL do to insulin resistance levels?
Increases them.
A physiological process to ensure growing baby gets nutrients it requires. However can be problematic level of resistance already present in mother - causes gestational diabetes.
Are ACE inhibitors and statins safe to continue in pregnancy?
No - they are teratogenic.
If BP management needed, give labetalol.
What is a recommended therapy in ANY pregnancy deemed to be high-risk?
150mg of aspirin daily after 12 weeks of pregnancy.
How should levothyroxine dose be altered during pregnancy?
Increase by 25ug
What are high hCG levels associated with?
Vomiting
What are the reproductive hormones?
GnRH
LH
FSH
Oestrogen
Progesterone
Testosterone
What is the role of FSH in males?
Causes spermatogenesis in the testes.
What is the role of FSH in females?
Causes the growth of ovarian follicles, and also plays a role in the ovary secreting oestrogen.
What is the role of LH in males?
Causes testosterone production at the testes (and then helps FSH to stimulate spermatogenesis).
What is the role of LH in females?
Causes ovulation, and progesterone production from the corpus luteum.
What is the corpus luteum?
The ovulated follicle.
Where is GnRH produced?
Hypothalamus
Where are LH/FSH produced?
Anterior pituitary
What is the role of progesterone?
It is a pro-gestation hormone, that increases the likelihood of implantation.
What are the 2 phases of the menstrual cycle?
Follicular phase
Luteal phase
What occurs in the follicular phase?
The follicle starts to grow.
Oestrogen can pass into the hypothalamus, which can pass into the hypothalamus to increase GnRH pulsation.
Only one follicle usually ovulates.
What occurs in the luteal phase?
Follicle will form the corpus luteum.
How long following the LH surge will it take until ovulation begins?
34-36 hours.
Does male fertility decrease with age?
Yes, it is equal to the depreciation observed in female fertility.
In which cells are testosterone produced?
Leydig cells
What is produced in sertoli cells?
Androgen-binding globulin, that carries testosterone into the testes.
What is primary hypogonadism?
A reduction in testosterone production, resulting from an issue at the testes. Will produce GnRH/LH/FSH in response (hypergonadotrophic hypogonadism).
Is spermatogenesis, or testosterone production more affected in primary hypogonadism?
Spermatogenesis
Where is affected in secondary hypogonadism?
Hypothalamus/Pituitary gland (the testes are capable of normal function).
What is the most common genetic cause of primary hypogonadism?
Klinefelter’s syndrome
Genotype is 47XXY
What lifestyle changes may be suggested in those with fertility issues?
Smoking cessation
Stop recreational drugs/methadone
Reduce alcohol intake
Moderate caffeine intake
Reduce BMI to 18.5-30
How does obesity affect women attempting to conceive?
2.5x less likely to conceive
More likely to miscarry
Decreased chance of fertility treatment success
How does obesity affect men attempting to conceive?
2x less likely to conceive
3x less likely to suffer erectile dysfunction
What should all women attempting to conceive take?
400ug of folic acid daily (continue this through the first 12 weeks of pregnancy.
What women should be advised to take 5mg of folic acid?
Previous baby with neural tube defect
Family history of neural tube defect
Diabetic mothers
Obese mothers
How does rubella affect a developing neonate?
Microcephaly
Patent ductus arteriosus
Visual abnormalities
Prevent risk by giving mothers MMR booster - should be atleast 4 weeks before conception.
How should pregnant women with chlamydia be treated?
100mg of doxycycline twice daily for 7 days.
Treat both partners.
How common are anovulatory cycles?
Very common - around 10% of all cycles.
How does ovarian failure present in blood tests?
Raised FSH and LH
Low oestrogen levels
What are group 1 ovulatory disorders?
Those that affect the hypothalamus, causes include:
Excessive exercise
Anorexia
Kallmann’s syndrome
Isolated gonadotrophin deficiency
What are group 2 ovulatory disorders?
Those caused by hypothalamic-pituitary axis dysfunction.
Most cases are due to PCOS or anovulation.
How are bloods affected in group 1 ovulatory disorders?
Low LH
Low FSH
Low oestrogen
What are group 3 ovulatory disorders?
Those with ovarian failure.
May also be due to hypothyroidism and hyperprolactinaemia.
What medication can be used to induce ovulation in PCOS?
Clomifene citrate (50mg/day) - taken on days 2-6 of the cycle.
Confirm with USS that follicle has grown.
If clomifene citrate is unsuccessful, what should be given?
Gonadotrophin injections
Risk of multiple pregnancies when taking this therapy.
What is third-line in PCOS infertility management?
Surgery - laparoscopic ovarian diathermy.
What is a hydrosalpinx?
When a fallopian tube is blocked with fluid.
May be due to a pelvic infection, or an STI.
What form of fibroid impact fertility?
Submucosal fibroids
These bulge into the endometrial cavity.
Can a vasectomy be reversible?
Yes - 50% success rate of unlocking vas deferens.
What should be given to supplement an IVF pregnancy?
Progesterone to keep the endometrial lining thick and healthy.
What is oligomenorrhoea?
A menstrual cycle lasting more than 42 days.
What criteria is used to diagnose PCOS?
Rotterdam criteria
Patients require any 2 of the following:
- Oligomenorrhoea/Amenorrhoea
- Polycystic ovaries on a USS
- 12 or more follicles of <9mm
- Increased ovarian volume (>10ml)
If not keen on clomifene citrate as an ovulation-inducer, what may be given?
Tamoxifen, or letrozole.
How can it be ascertained whether ovulation has occurred or not?
21 day mid-luteal progesterone level
What is premature ovarian failure?
Menopause occurring before the age of 40.
What are potential causes of premature ovarian failure?
Turner’s syndrome
Fragile X
Autoimmune disease
How is premature ovarian failure treated?
Give HRT
Consider egg conservation.
