Reproductive System, IVF And Endometriosis

Question 1

Functions of the reproductive system

Answer 1

• The reproductive system provides a mechanism for the survival of the species by producing offspring through the combination of eggs and sperm.
• Female reproductive system has 2 functions – to produce egg cells and to protect and nourish an offspring until birth.
• Male reproductive system has one function - to produce and deposit sperm

Question 2

Technical terms

Answer 2

• Hypothalamic–pituitary–gonadal (HPG) axis

• The hypothalamic–pituitary–gonadal axis (HPG axis) refers to the:
• hypothalamus,
• pituitary gland
• gonadal glands (ovaries and testes)

• as if these individual endocrine glands were a single entity, because these glands often act in together so its easier to refer to them as a group (axis)

Question 3

Hormones and locations

Answer 3

• The axis controls development, reimals tid are main sites each produce hormones that interact.
• Gonadotropin-releasing hormone (GnRH) is secreted from the hypothalamus
• The anterior portion of the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH) (these are known and Gonadotropins)
• Cells in the gonads respond and produce ostrogen and testosterone.

Question 4

Puberty

Answer 4

1. The hypothalamus releases Gonadotropin Releasing Hormone (GnRH), which stimulates the release of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) from the anterior pituitary gland.
2. FSH and LH act on the gonads (ovaries/testicles) to stimulate the synthesis and release of the sex steroid hormones (oestrogen/progesterone and testosterone)
3. These sex steroids exert many effects on the reproductive system and feedback negatively on the hypothalamus and the pituitary gland to ensure that circulating levels remain stable.
4. The rise in FSH stimulates an increase in oestrogen synthesis and oogenesis in females and the onset of sperm production in males.
5. The rise in LH stimulates an increase in production of progesterone in females and an increase in testosterone production in males. As a result of these hormonal changes the physical changes associated with puberty begin to develop

Question 5

Menopause

Answer 5

• Menopause is the cessation of a woman’s menstrual cycle.
• The typical age of menopause in the UK is 51 years, and most women become menopausal between the ages of 45–55 years.
• Menopause is defined as the cessation of periods for 1 year.
• Before periods come to a complete stop they often change, as the ovaries struggle to work as regularly and reliably as they did in the past.
• Hormone levels fluctuate during this transition, and in particular there is a reduction in the amount of circulating oestrogen (produced by the tiring ovaries).
• Periods themselves may become lighter, heavier, or variable in volume and occur at different intervals of time.
• Hormone levels fluctuate in a way that the body is not used to and this, in combination with a declining level of oestrogen, can cause a variety of symptoms.
• The time interval in which women experience symptoms before their periods stop is called the perimenopause and can last months to years

Question 6

Hormone Replacement Therapy (HRT)

Answer 6

• Hormone replacement therapy (HRT) is a treatment used to help menopause symptoms. It replaces the hormones oestrogen and progesterone, which fall to low levels as you approach the menopause.

Menopause symptoms HRT can help to treat include:
• hot flushes
• night sweats
• sleep problems
• mood swings
• anxiety and low mood
• vaginal dryness

• To replace these hormones, you’ll usually take a combination ofoestrogen and progestogen

Question 7

male system and female system

Answer 7

Male:
Prostate Gland, Sperm, Testes, Scrotum, Epididymis, Penis, Seminal Vesicle, Vas Deferens, Urethra

Female:
Vulva , Uterus , Fallopian Tube, Vagina, Ovary, Cervix, Ovum, Urethra

Question 8

Female

Answer 8

Fallopian tube or Oviduct-The fallopian tubes are passageways that carry eggs toward the uterus. Contain cilia that help the ovum to move.

Ovary-Key roles are producing hormones and storing and releasing eggs during the period of life between
puberty to menopause

Cervix-Producing mucus to prevent entry to the uterus, protecting against bacteria entering the uterus and
allowing fluids to drain from the uterus.

Vulva-The external parts of the female reproductive system. Bartholin glands in the entrance to the vagina
produce fluids that provide lubrication.

Vagina- The vagina allows fluids, such as menstrual blood and discharge, to leave the body. It also allows semen, which contains sperm, to enter the body

Uterus- It consists of muscular walls and a lining (endometrium) that grows and diminishes with each
menstrual cycle (menstruation). When it is time for the foetus to be born, the uterus begins strong muscle contractions that dilate the cervix and push the foetus out

Question 9

Male

Answer 9

Prostate Gland- Secretes an alkaline fluid that thickens the semen so that sperm can remain for
longer in the female reproductive tract and enhances sperm motility.

Penis- In addition to aiding in urination, assists with reproduction by transporting sperm to
the female reproductive system.

Urethra-Allows urine and sperm to pass out of the body.

Scrotum- A pouch of skin that houses and protects the testes, the epididymis, and part of the spermatic cord. It is present behind the penis. Sperm production requires a lower temperature than normal body temperature so it takes place outside the core of the body.

Testes- The site of production of hormones and sperm

Epididymis- A 6m network of coiled tubes that hold sperm whilst they mature after being
constructed before they are ejaculated by contraction of smooth muscle.

Vas deferens- A tube fibrous and muscular that connects the epididymis to the urethra. Sperm
travel along this tube during ejaculation.

Seminal vesicles- Release thick fluid which contains fructose (a type of sugar), proteins, and other enzymes. These act as a source of energy and nutrition for sperm

Question 10

Hormones in menstrual cycle

Answer 10

• The pituitary gland releases FSH to develop an ovarian follicle
• The follicle produces an egg and oestrogen
• Oestrogen stimulates uterine lining growth and inhibits FSH production
• High ostrogen levels trigger LH release from the pituitary, causing ovulation (around day 14)
• The follicle becomes the corpus luteum, producing progesterone
• Progesterone maintains the uterine lining
• If the egg isn’t fertilised, the corpus luteum breaks down, progesterone levels drop, and menstruation
occurs
• If pregnant, the corpus luteum continues producing progesterone until the placenta develops, which then maintains progesterone production throughout pregnancy

Question 11

What is endometriosis?

Answer 11

• “Endometriosis is a disease in which cells similar to the lining of the uterus grows outside the uterus”.
• These cells attach themselves to the lining of the pelvis and undergo cyclical changes (related to the menstrual cycle), where patches of endometriosis thicken and are shed but there is no way for them to leave the body. This causes inflammation and can cause scar tissue to form.
• The body’s responses to the inflammation and scar tissue are pain and discomfort
• Recall - hormones only interact with cells that have receptors for that hormone - specificity

Question 12

Two types

Answer 12

• Superficial endometriosis – meaning endometriosis is on the surface of the organ
• Deep endometriosis – meaning the endometriosis is invading into the muscle of the organ

• Endometriosis can affect women at any age from puberty to menopause. It is a long-term condition that can have an impact on general physical health, emotional wellbeing and daily routine

Question 13

Statistics

Answer 13

• Endometriosis is one of the most common gynaecological disorders in women of reproductive age.
• Endometriosis is estimated to affect approximately 10% of women of reproductive age, translating to around 190 million women and girls globally
• True prevalence is difficult to determine because a definitive diagnosis requires direct visualization at laparoscopy. In addition, its presentation is variable and delayed diagnosis common, and prevalence varies with the population studied
• It is most commonly diagnosed between the ages of 18 and 29 years, although it can present before menarche and in menopause
• Women with a first-degree relative with endometriosis have a 7 to 10-fold increased risk of developing the condition

Question 14

Prognosis

Answer 14

• The prognosis of endometriosis is variable
• Endometriosis is usually a chronic disease, and in most affected people symptoms begin in adolescence and improve after menopause, although some continue to have pain after menopause.
• It is not inevitably progressive, with studies showing regression of endometriotic lesions in up to a third of cases. Others remain stable or progress with time.
• Medical and surgical treatments can often provide symptomatic relief but are not curative.
• Reported recurrence rates after surgery vary widely, between 6 and 67%

Question 15

In Vitro fertilisation (IVF)

Answer 15

• In vitro fertilisation (IVF) is one of several techniques available to help people with fertility problems have a baby.
• During IVF, an egg is removed from the woman’s ovaries and placed with sperm to be fertilised. Sometimes a single sperm may need to be injected into the egg but this is called intracytoplasmic sperm injection (ICSI).
• The fertilised egg, called an embryo, is then returned to the woman’s womb to grow and develop.
• It can be carried out using the persons own eggs and their partner’s sperm, or eggs and sperm from donors

Question 16

Statistics

Answer 16

• The most common reasons for IVF treatment cycles being carried out are male infertility (37% of recorded reasons), unexplained (32%), an ovulatory disorder (13%), tubal disease (12%) and endometriosis (6%).
• In 2019, the percentage of IVF treatments that resulted in a live birth was:
• 32% for women under 35
• 25% for women aged 35 to 37
• 19% for women aged 38 to 39
• 11% for women aged 40 to 42
• 5% for women aged 43 to 44
• 4% for women aged over 44

Question 17

Why might IVF be needed?

Answer 17

• NICE guidelines recommend that IVF should be offered to women under the age of 43 who have been trying to get pregnant through regular unprotected sex for ___years. Or who have had 12 cycles of artificial
insemination, with at least 6 of these cycles using a method called intrauterine insemination (IUI – injection of sperm directly into the womb)
• This varies by county so Somerset’s age range is 23-39 with some other
conditions set by the local integrated care boards (ICB)

Question 18

A ‘cycle’ of IVF

Answer 18

• IVF involves 6 main stages – this is known as a ‘cycle’.

1. suppressing the natural cycle
2. helping ovaries produce extra eggs
3. monitoring progress and maturing eggs
4. collecting the eggs
5. fertilising the eggs
6. transferring the embryo(s) to the uterus

Question 19

Factor effecting embryo transfer

Answer 19

• Research in the UK has shown the age of the woman is a factor with older women having more success with two embryos implanted but transfer of three or more embryos at any age should be avoided.
• However other research shows that five or more is the optimum number for transfer for women over 40. It appears to vary based on country somewhat.
• In the UK, for women under 40, single embryo transfer is the norm with remaining fertilised and viable embryos frozen or donated
• The number of IVF cycles can also impact success although this is contested in different studies.
• The French National IVF Registry reported that the pregnancy rate of IVF in the first, second, third, fourth, and fifth cycle and in additional subsequent cycles were 18.3%, 17.1%, 17.8%, 16.8%, 16.2% respectively.
• However, there are also a number of studies reporting that the clinical pregnancy rate in women with repeated ET failure is reduced with each cycle to a significant effect
• The ‘quality of the embryo’ is also a factor in the number of embryos transferred. Normal practice in women under 40 is to transfer one high quality embryo in each cycle but only if that embryo is ‘high quality’ otherwise two ‘lower quality’ may be transferred
• ‘Quality’ is defined by the number of cells, the speed of division and the presence of the tissue that will become the placenta and the foetus

Question 20

NHS guidance

Answer 20

• Women under 37 in their 1st IVF cycle should only have a single embryo transfer. In their 2nd IVF cycle, they should have a single embryo transfer if 1 or more top-quality embryos are available. Doctors should only consider using 2 embryos if no top-quality embryos are available. In the 3rd IVF cycle, no more than 2 embryos should be transferred.
• Women aged 37 to 39 years in their 1st and 2nd full IVF cycles should also have a single embryo transferred if there are 1 or more top-quality embryos. Double embryo transfer should only be considered if there are no top-quality embryos. In the 3rd cycle, no more than 2 embryos should be transferred.
• Women aged 40 to 42 years may have a double embryo transfer