Reproduction Flashcards
1
Q
What is the pathway for the production of the female reproductive hormones?
A
hypothalamus makes GnRH –> anterior pituitary makes LH and FSH –> ovaries release oestrogen and progesterone
2
Q
What effect do progesterone and oestrogen have on hormone release?
A
- oestrogen inhibits or encourages GnRh and LH/FSH release
- progesterone always inhibits
3
Q
What replaces LH in pregnancy?
A
hCG
4
Q
What does do LH and FSH do to the follicle?
A
- cause it to increase in size and release the hormones
- LH changes the follicle into corpus luteum so progesterone increases
5
Q
What is the pathway for reproductive hormone release in males?
A
hypothalamus releases GnRH –> anterior pituitary releases FSH and LH –> testes produce testosterone
6
Q
What effect does testosterone have on the levels of other hormones?
A
negative feedback on the hypothalamus and the anterior pituitary
7
Q
What does FSH do in women?
A
growth of ovarian follicles and ovary secretes oestrogen
8
Q
What does LH do in women?
A
ovulation and progesterone production by corpus luteum
9
Q
What does FSH do in males?
A
causes spermatogenesis
10
Q
What does LH do in males?
A
causes testosterone secretion in testes
11
Q
How is secretion of TSH and LH controlled in males?
A
GnRH is released from the hypothalamus in a pulsatile manner which is constant
12
Q
How is secretion of TSH and LH controlled in females?
A
- a high frequency is LH and a low frequency is FSH
- oestrogen increases frequency so FSH levels fall
13
Q
How is the release of GnRH controlled?
A
regulates by oestrogen and progesterone at the Kisspeptins
14
Q
How long is the menstrual cycle?
A
28 days
15
Q
What are the phases of the menstrual cycle?
A
- Phase 1= follicular phase is variable
- Phase 2= luteal phase is fixed at 14 days
16
Q
What does the FSH increase in the cycle cause?
A
appearance of LH receptors on the follicle which causes an LH surge (ovulation) then increased progesterone
17
Q
What follicle is used in each cycle?
A
- many follicles grow but only one contributes to ovulation
- FSH decreases and the dominant follicle survives
18
Q
How do the LH surge and ovulation correspond?
A
LH surge preceeds ovulation by 34-36 hours
19
Q
How does follicular growth occur?
A
- cells increase in number so increase fluid
- LH stops progesterone so turns on enzymes for follicle breakdown
- androgen is needed so LH causes cholesterol –> androgen
- granulosa and theca cells become luteal cells
- LH increases SER and mitochondria so androgen in made
20
Q
What does androgen do?
A
needed for oogenesis
21
Q
What is increased androgen suggestive of?
A
PCOS
22
Q
What are the roles of oestrogen?
A
- regulate LH surge
- decrease vaginal pH through increased lactic acid (reduces infection risk)
- increase vaginal wall thickness
- decrease viscosity of cervical mucous (more fertile) and therefore sperm production
- increased levels inhibit FSH and prolactin
23
Q
What are the roles of progesterone?
A
- thick infertile mucous so decreased infection
- if removed, there is birth
- maintains endometrial thickness
- relaxes smooth muscle
- inhibits LH secretion
24
Q
How long is a sperm cycle?
A
40 days
25
What is the hormone role of testosterone?
- taken up by Sertoli cells
| - helps by producing factors for sperm development
26
What is infertility?
failure to get pregnant after 12 months
27
What are the types of infertility?
- primary = never conceived
| - secondary = have conceived before but may have been an unsuccessful pregnancy
28
What increases chance of conception?
- over 30y
- previous pregnancy
- less than 3y trying
- intercourse during ovulation
- BMI between 18.5-30
- non-smoker
- no caffeine
- no drugs
29
What can cause anovulation?
- hypothalamic= anorexia, excessive exercise
- pituitary= increased prolactin, tumours, Sheean
- ovary= PCOS, premature ovary failure
30
What are the hormone levels in anorexia?
low FSH, LH and estradiol
31
What are the hormone levels in PCOS?
increased androgen, increased LH, impaired glucose tolerance
32
What are the risk factors for PCOS?
- obesity
- hirsutism
- cycle abnormalities
- infertility
33
What are the hormone levels for premature ovarian failure?
high FSH, high LH and low estradiol
34
What are the associations for premature ovarian failure?
associated with Turner's and fragile X
35
What are the types of infective tubal disease?
- STI
- post-procedure
- abdominal infection spread
36
What are the types of non-infective tubal disease?
- polyps
- congenital
- surgery
- endometriosis
37
What is endometriosis?
- endometrial glands outside the uterine cavity
- pelvic pain before menstruation
- painful defaecation
- pain on sex
38
What are the investigations for endometriosis?
laparoscopy
| MRI
39
What are the causes of male infertility?
- low LH and FSH
- low sperm count
- torsion
- obstruction eg CF no vas deferens
40
What are the hormone levels in non-obstructive male infertility?
high FSH and LH and low testosterone
41
What are the hormone levels in obstructive male infertility?
normal LH, FSH and testosterone
42
What are the part of the examination for female infertility?
- menstrual history
- ovulation assessment
- chlamydia
- smear
- laparoscopy
43
What is the examination for male infertility?
semen analysis
44
What length is a regular menstrual cycle?
28-35
45
What are the two types of amenorrhea?
- primary is never had periods
| - secondary is had them and they stopped
46
What does FSH do?
stimulates follicular development and thickens endometrium
47
What does LH do?
- surge causes ovulation
- stimulates corpus luteum development
- thickens endometrium
48
When do oestrogen and progesterone peak?
oestradiol peaks before ovulation
| progesterone peaks after
49
Where does oestrogen get secreted from?
ovaries and adrenal cortex
50
What secretes progesterone in pregnancy?
corpus luteum to maintain early pregnancy
51
What hormone is used to assess ovulation?
progesterone peak which is after ovulation
52
What is hypothalamic pituitary failure?
no/less GnRH is made so low FSH and LH which causes amenorrhoea
53
What are the causes of hypothalamic pituitary failure?
- stress
- excessive exercise
- anorexia/low BMI
- brain/pituitary tumours
- Kallman's
- drugs (steroid/opiate)
54
What is the treatment for hypothalamic pituitary failure?
replace GnRH in a pulsatile way and daily injections of LH and FSH
55
What must be done before treatment of hypothalamic pituitary failure?
- stabilise weight
- give folic acid
- lifestyle
- check semen, rubella and drugs
56
What is hypothalamic pituitary dysfunction?
- normal hypothalamus and pituitary but ovary doesn't recognise this
- nearly always this is PCOS
57
What is PCOS diagnosed with?
- oligo/amenorrhoea
- polycystic on scan
- clinical or biochemical androgenism
58
What are the hormone changes in PCOS?
- hyperinsulinaemia as insulin resistance but normal pancreas
- high LH
- high free testosterone as insulin lowers SHBG levels
59
What is the management of PCOS?
- lifestyle
- loss of weight
- Clomifene (or daily FSH)
- laparoscopic daily ovarian diathermy (drilling under GA)
60
What are the risks of ovulation induction?
- ovarian hyperstimulation (don't have sex)
- multiple pregnancies- GDM, miscarriage, twin issues, prematurity
- risk of ovarian cancer
61
What does hyperprolactinaemia do?
- causes amenorrhoea and galactorrhea
- high serum prolactin but normal FSH and LH
- give Cabergoline but stop when pregnant
62
What are the features of ovarian failure?
- no more eggs
- uncommon <40y
- causes are genetic so Turners, fragile X or autoimmune
63
What is the treatment for ovarian failure?
HRT (combined pill)
64
What is the investigation for ovarian failure?
progesterone challenge: menstrual bleed after 5 day progesterone so the oestrogen levels are normal
65
What does increased weight do in terms of infertility?
- increased risk of miscarriage
- decreased fertility
- decreased success of fertility treatments
66
What are the medications that should be given in pregnancy?
- folic acid 400micrograms during and before the 1st trimester
- supplement 10micrograms vit D
67
What should be screened for in those trying to conceive that seem infertile?
Rubella and Chlamydia
68
What is hydrosalphinx?
water/fluid in the tube to blockage and distention of the tube so removal or undo the blockage with a coil
69
What effect does hydrosalphinx have?
decreases IVF ability and increases miscarriage risk
70
What surgery is done for endometriotic costs or polyps?
endometriotic cyst- laparoscopic surgery
| polyp- myosure surgery
71
What is the process of IVF?
- ovarian stimulation and retrieval
- sperm retrieval by epididymus extraction
- IVF
- embryo transport
72
What is the function of the gonads?
to make sperm and release testosterone which is unbound
73
Where is testosterone produced from?
by Leydig cells under the control of LH and most of it is bound to SHBG or albumin
74
What can testosterone be converted to?
dihydrotestosterone and oestradiol (cardio protective)
75
What is male hypogonadism?
low/reduced testicular function with testosterone deficiency
- common with age
- primary is a testes problem
- secondary is a hypothalamus or pituitary problem
76
What are the features of primary hypogonadism?
- high LH and FSH but low testosterone production
- so there is negative feedback
- spermatogenesis is the most affected
- is hypergonadotrophic hypogonadism
77
What are the causes of primary hypogonadism?
- Klienfelter's syndrome
- undescended testes
- torsion
- trauma
- chemo
- varicoele (enlarged testicular vein
- haemochromatosis
78
What are the features of Klienfelter's syndrome?
- non-inherited, caused by nondisjunction
- presentation is variable
- diagnosis is by karyotyping
- increases risk of learning difficulties
79
What are the symptoms of Klienfelter's syndrome?
- men are infertile due to tubular damage
- small, firm testes
- frontal baldness abscent
- poor beard growth
- wide hips and narrow shoulders
- long arms and legs
- female pubic hair distribution
80
What are the features of secondary hypogonadism?
- testes are capable of normal function but there is under stimulation as the hypothalamus and pituitary are affected
- LH/FSH will be low or inappropriately normal despite low testosterone so not much negative feedback
- hypogonadotrophic hypogonadism
- spermatogenesis and testosterone production are affected equally
81
What are the causes of secondary hypogonadism?
- Kallmann's syndrome
- pituitary damage
- hyperprolactinaemia
- obesity and diabetes
- medications
82
What are the features of Kallmann's syndrome?
isolated GnRH deficiency and reduced/no sense of smell
83
What are the pre-pubertal symptoms of hypogonadism?
- small male sex organs
- decreased body hair, high voice, low libido
- gynaecomastia
- tall, slim, long arms and legs
- decreased bone and muscle mass
84
What are the post-pubertal symptoms of hypogonadism?
- normal appearance
- decreased erections and libido
- decreased axillary hair
- decreased testicular volume
- increased boobs
- decreased muscle and bone mass
85
What are the biochemical tests for hypogonadism?
- morning testosterone if symptomatic
- if low, repeat
- measure LH and FSH to check if it is primary or secondary
- if high, primary
- if low/inappropriately normal it is secondary
86
What is the management of hypogonadism?
- maintain sexual function
- maintain secondary sexual characteristics
- increase fertility
- increased QoL
87
How can testosterone replacement be given?
- IM= Nebido which is long-acting or Sustain which is short-acting
- TD= transfer
- PO= need to be complient
88
What are the contraindications for testosterone therapy?
- cancer (hormone positive)
- prostate cancer investigation
- haemocrit >50%
- sleep apnoea
- HF
