Reproductive Function and Regulation Flashcards

1
Q

Provide a brief description of the menstrual cycle

A

The menstrual cycle incorporates a cyclic series of event designed to prepare the female reproductive system for sexual reproduction

**It begins at puberty **

The cycle is **interupted by pregnancy **and terminated by menopause

Although variable between individuals; the average cycle is 28 days duration

There are three phases of the menstrual cycle:

  1. Follicular / Proliferative phase
  2. Ovulation phase
  3. Luteal Phase
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2
Q

Describe the **Follicular / Proliferative Phase **of the menstrual cycle

Include references to the state of hormones, follicles and uterus

A

Follicular / Proliferative Phase = Day 0-14

Hormones:

FSH stimulates follicular development

  • maturation to secondary + tertiary follicles
  • stimulate granulosa cells to produce estrogen

Estrogen produced from granulosa cells

  • positive feedback to granulosa cells to further increase estrogen levels
  • long negative feedback loop to decrease FSH and LH

LH stimulates thecal cells to produce androgens

  • androgens are converted by granulosa cells into estrogen

Follicle:

Follicular enlargement and maturation

  • one dominant follicle develops into
  • estrogen negative feedback on LH and FSH prevents the development of additional follicles

Uterus:

Endometrium rebuilds as estrogen levels rise

  • menses occured at the beginning of proliferative phase
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3
Q

Characterise the ovulation phase of the menstrual cycle

A

Ovulation Phase = Day 14

Hormones:

Estrogen levels high

  • elevated concentration changes the effects of estrogen to have positive feedback on GnRH
    • “leads to an LH and FSH surge”
      • FSH surge to a lesser extent because it is inhibited by inhibin and estrogen

LH surge

  • High LH stimulates the first meiotic division to produce the secondary oocyte
  • Promotes follicular rupture and ovulation of egg
  • Promotes luteinising hormone
    • transforms the follicular cell into corpus luteum

**High inhibin **

  • Inhibits FSH to prevent the development of new follicles

Low progesterone

  • Produced by granulosa cells
  • Positive feedback to GnRH and LH
    • contributes to LH surge

Follicle:

Completes 1st meiotic division + ovulates egg + differntiates to corpus luteum

Uterus:

Estrogen readies endometrium for implantation

Cervix:

Mucous secretions abundant

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4
Q

Characterise the **Luteal Phase **of the menstruation cycle

A

Luteal Phase = Day 15-28

Hormones:

Progesterone significantly elevated

  • produced by corpus luteum
  • maintains endometrium
  • inhibits GnRH, LH and FSH
  • increases body temperature
  • thicken cervix mucus

Estrogen increased

  • produced by corpus luteum
  • maintain endometrium
  • inhibits GnRH, LH and FSH

**High Inhibin **

  • Inhibits FSH and follicle development

Corpus Luteum:

Significant progesterone production + increased estrogen & inhibin

Follicle:

No new development

Uterus:

Prepares for pregnancy

Cervix:

Viscous mucus secretion

Body temperature:

Increases

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5
Q

Depending on the outcomes of fertilisation, what happens to the menstrual period?

A

No pregnancy:

  • The corpus luteum dies due to the absence of placental-produced human chorionic gonadotropin (hCG) which is required to maintain it.
  • No hormones produced from corpus luteum
  • **increase in FSH and LH causes menses and new follicular development **

Pregnancy:

  • maintain high hormones via corpus luteum (maitained by hCG) to retain endometrial lining
  • Eventually the corpus luteum will die when the placenta itself can produce the required hormones
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6
Q

Why does menopause lead to infertility?

A

As a female ages, her ovaries cease to respond to FSH and LH which leads to cessation of egg development -> ultimately the death and loss of all eggs

Levels of estrogen and progesterone decrease without ovarian reception of LH and FSH

Leads to symptoms of hot flushes and osteoporosis

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7
Q

Describe the sequence of events occuring during fertilisation

A
  • Sperm swim “upstream” to the ampulla of the fallopian tube
  • Spermal acrosomal reaction releases digestive enzymes which dissolve the zona pellucida and cell junctions of the secondary oocyte
  • Sperm and oocyte membranes fuse allowing the sperm nucleus to enter
  • The secondary oocyte completes final meiotic division and the two nuclei fuse to form a zygote
  • Secondary polar body is ejected
  • Cortical reaction blocks polyspermy
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8
Q

What are the respective life spans of a sperm and secondary oocyte?

A

Sperm = 48 hours

Secondary oocyte = 12-24 hours

The life spans of these two gametes dictate the ‘fertilisation window’

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9
Q

Describe zygote development

A

Day 1 = fertilisation

Day 2-4 = cell divisions

Day 4-5 = blastocyst migrates to uterus

Day 5-9 = blastocyst implants in uterus

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10
Q

Describe the critical periods of human development in utero

A

Early Pregnancy (Week 1-2)

  • Not susceptible to teratogens
  • Susceptible to chromosome abnormalities
  • Environmental disturbances interfere with implantation

Embryonic Period (Week 3-8)

  • Most susceptible to tetratogens
  • All major organ systems develop and are present at week 8

Foetal Period (Week 8 - Term)

  • When all organ system are present = foetus
  • Rapid growth
  • Physiological and functional defects susceptible to developing
  • Minor morphological abnormalities can develop
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11
Q

What are the two central functions of the reproductive organs?

A
  1. Gametogenesis
  • Spermatogenesis in male Sertoli cells
  • Oogenesis produce ova in the ovaries
  1. Secretion of hormones
  • Testosterone from male Leydig cells
  • Estrogen from Granulosa cells

The female reproductive organs are additionally responsible for the reception of sperm, fertilisation, gestation, parturation and lactation

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12
Q

What is gametogenesis?

A

Gametogenesis is production of haploid germ cells within a person’s sex organs.

Males undergo spermatogenesis ; females undergo oogenesis

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13
Q

Characterise spermatogenesis

A

Spermatogenesis begins in puberty

  1. Spermatogonia mitotically divide in the inner surfaces of the seminiferous tubule produceing two daughter spermatogonium cells: one that maintains proliferating germ cell line and the other that moves towards the lumen as a primary spermatocyte destined for meiosis
  2. A diploid primary spermatocyte undergoes the first meiotic division to produce two haploid secondary spermatocytes
  3. Secondary spermatocytes undertake second meiotic division to produce haploid spermatids
  4. These spermatids differentiate into spermatozoa (obtain head and tail etc.)
  5. Spermatozoa are stored in the epididymis where they mature into sperm
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14
Q

Characterise oogenesis

A

Oogenesis begins in utero prior to birth

  1. Mitotic divisions of germ cell oogonium occur to produce primary oocytes prior to birth and this ceases permanently late in foetal life
  2. Females are subsequently born with their full complement of gametes
  3. After the onset of puberty, one primary oocyte reaches maturity and is ovulated each menstrual cycle until menopause
  4. The first meiotic division is completed immediately prior to ovulation in order to ovulate a secondary oocyte and produce a first polar body
  5. The secondary oocyte undergoes the second meiotic division immediately following fertilisation -> giving rise to a mature ovum

Note: many primary oocytes develop in each menstrual cycle but only one reaches the right level of maturity to be ovulated -> other developing oocytes die off

This dying off of primary oocytes over the course of a woman’s life contributes to menopause

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15
Q

Illustrate the hormonal regulation of male sexual development

A
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16
Q

What are the effects of testosterone?

A

Before Birth

  • Masculinises reproductive tract and external genitialia
  • Promotes descent of testes into scrotum

Sex‐specific tissues

  • Promotes growth and maturation of reproductive system
  • Spermatogenesis

Other reproductive effects

  • Sex drive; Control of Gonadotropin secretion

Secondary sexual effects

  • hair growth (beard, chest, pubic), voice to deepen, muscle
  • growth, body configuration

Nonreproductive Actions

  • protein anabolic effects, bone growth, closure of epiphyses, sebaceous gland secretions
17
Q

What are the three different types of oral conntraceptive formulations?

A

1) Combined preparations (COCs)

  • Mixture of oestrogen and progestogen in a fixed ratio of doses

2) Sequential preparations

  • Ratio of dose varies to correspond approximately to endogenous changes in
    oestrogen and progestogen thoughout the cycle

3) Progestogen-only oral preparations (Mini-pill)

  • When oestrogens are contraindicated – least effective of OCs,
    • Tend to be used by lactating women because oestrogen causes the cessation of lactation

Note: it is critical* *that the last two formulations of OCP are taken everyday -> much more susceptible to failure if a course is missed. This is not so important for the combined preparations.

The formulations 1-3 are in descending order of effectiveness

18
Q

How do oral contraceptive pills work?

A

Administration of combined oral contraceptive pills (COCPs) prevents ovulation by inhibiting gonadotropin secretion through the effect of estrogen and progestin on the anterior pituitary and hypothalamus:

  • The progesterone component of the pill primarily suppresses luteinizing hormone secretion
    • also provides a level of progesterone that makes the uterus unaccomodating for implantation + thickens mucus to reduce sperm efficiency
  • The Oestrogen component suppresses follicle-stimulating hormone - don’t get development/ovulation of primary oocyte

Both steroids in COCPs contribute to the suppression of ovulation

Because the contraceptive efficacy of COCPs relies on daily use, failure rates are largely attributable to poor adherence

19
Q

What are the different hormones used in oral contraceptive pills?

A

All hormones contained within the OCP are synthetic oestrogens or progesterones - this is because endogenous forms of the hormone aren’t orally bioavailable

Estrogens

  • Eithinyloestradiol
    • most frequently used estrogen
  • Mestranol

Progesterones

  • Levonorgestrel
    • most frequently used progesterone
    • forms the emergency contraceptive pill
    • involved in hormone replacement therapy
  • Desogestrel
    • Cause increased thromboembolytic events
  • Gestodene
    • Cause increased thromboembolytic events
  • Cyproterone
    • Have anti-andronic effects - Less androgenic than previous OCP
    • Also used in poly cystic ovary disease where hirsutism, acne etc are prevalent
  • Drospirenone
    • Have anti-andronic effects - Less androgenic than previous OCPs
    • Also used in poly cystic ovary disease where hirsutism, acne etc are prevalent
20
Q

What is the risk of COC users developing hypertension?

A

Small risk of developing or exacerbating existing hypertension (reversible).

21
Q

What is the association between COCP usage and thromboembolism events (VTE)

A

Patients on COCP have increased risks of VTE

The risk of VTE depends upon the:

  1. Dose of estrogen component
    * The higher the dose, the greater the incidence
  2. Type of progesterone component
  • Greatest risk = cyproterone
  • Medium Risk = desogestrel, drospirenone or gestodene
  • Lower risk = levonorgestrel or norethisterone
  1. Presence of other risk factors
  • effects are most apparent in women >35 y.o
  • History of DVT, blood disorders etc
22
Q

In terms of per 100,000 patient years, what are the risks of VTE in COCP users?

A
  • 5-10 in non-users
  • 15-20 for COCs containing either levonorgestrel or norethisterone with 35micrograms or less of ethinyloestradiol
  • 25-40 for COCs containing desogestrel, drospirenone or gestodene
  • 30 for COCs containing 50 micrograms or more of ethinyloestradiol
  • 60 for COCs containing cyproterone (some studies suggest incidence is similar to COCs containing desogestrel or gestodene)
  • 60 per 100 000 pregnancies (incidence even higher in first 6 weeks post partum)
23
Q

What is the association of COCP use with cancer?

A

There is a suggestion that oestrogen may increase the risk of breast, cervical and uterine cancer

BUT

Incidence of endometrial carcinoma is diminished when a progestogen is given concurrently to women with an intact uterus - so overall COCs have a protective effect against endometrial cancer.

Decreased incidence of ovarian cancer and ovarian cyst formation

Reduction in risk of colorectal cancer

24
Q

What general side effects can result from COCP use?

A
  • Nausea/vomiting
  • Dizziness
  • Flushing
  • Breast discomfort
  • Headache
    • especially in women who get headaches normally before onset of periods, it can become worse on COCs
  • Weight gain
  • Decreased libido
  • Chloasma
  • Acne
  • Depression
  • Irritability
  • Fatigue
25
Q

What are the off-label benefits of COCPs?

A
  • Decreased risk of endometrial cancer
    • if there is progesterone as part of the contraceptive pill
  • Decreased incidence of ovarian cancer and ovarian cyst formation
  • Reduction in risk of colorectal cancer
  • Protective effect on benign breast tumours
  • Reduction in risk of bone fractures
  • Reduction in dysmenorrhoea and menorrhagia (and therefore protection against iron deficiency anaemia)
26
Q

Other than OCPs, what other forms of oral contraception are available?

A

Vaginal Ring

  • Etonogestrel and ethinyloestradiol – it is inserted into the vagina, left for three weeks and removed for one week. The process is repeated. It is effective with lower doses of hormones as it bypasses the portal circulation unlike the oral contraceptives

Progestogen-Only Contraceptives

  • Medroxyprogesterone – intramuscular injection every 12 weeks
  • Etonorgestrel – subdermal implant (injected just under the skin in the inner upper arm), effective up to three years
  • Levonorgestrel – intrauterine device, effective up to 5 years

Emergency contraceptive pill

  • One tablet of 1500 microgram levonorgestrel, within 72hrs after unprotected intercourse (normally only 150 micrograms in a COCP)
27
Q
A