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Repro > Session 5 - Sexual function/ Fertilisation/ Infertility > Flashcards

Session 5 - Sexual function/ Fertilisation/ Infertility Flashcards

1
Q

Describe process of erection

A

Psychogenic or somatogenic stimuli activates parasympathetic NS (s2,3,4 for pelvic nerve) to inhibit the dominant sympathetic vasoconstriction. Vasodilation occurs (via ACh, binds to M3 Rs, NO released, vasodil) of arteries and corpus cavernosum and spongiosum fill with blood. Tunica albuginea is a tough membrane for them to fill against (resists so compresses venous drainage)
Also somatic involvement- ischiocavernosus and bulbospongiosus contract in final phase of erection to force more blood in

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2
Q

Describe process of ejaculation

A

Sympathetic mediated. Vas deferens and seminal vesicle and prostate peristaltic contractions. Also internal urethral sphincter contracts to prevent retrograde emission
Rhythmic contraction of striated muscle (pelvic floor, ischiocavernosus, bulbospongiosus)

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3
Q

What are the 3 nerves involved in ejaculation/erection

A

Parasympathetic pelvic nerve
Sympathetic hypogastric nerve
Somatic pudendal nerve

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4
Q

Causes of erectile dysfunction

A

Psychogenic, ruptured tunica albuginea, vascular problems, antidepressants, antihypertensives

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5
Q

How does viagra work

A

slows rate of cGMP degradation so that action of NO to vasodilate lasts for longer

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6
Q

How do sperm mature in the epididymis

A

Nuclear condensation, acrosomal shaping, add a glycoprotein coat, flagellum become more rigid with a stronger beat

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7
Q

Give me some facts about sperm

A

Only 50% motile, 60% morphologically normal, >20mil/ml

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8
Q

Normal ejaculate volume

A

2-6ml

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9
Q

Semen =

A

spermatozoa + seminal plasma

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10
Q

Describe cervical mucus changes

A

With oestrogen only, thin and stretchy

With oestrogen and progesterone, thick, sticky, plug

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11
Q

What is the fern test

A

What mucus looks like at ovulation

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12
Q

Describe process of capacitation

A

Final stage of sperm maturation in F genital tract.

Cell membrane changes to allow fusion with oocyte, whiplash beats begin and acrosome reaction now possible

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13
Q

How long does capacitation take

A

6-8hours

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14
Q

When is the fertile period

A

Up to 3 days prior to ovulation (sperm can survive 48-72 hours but eggs only 6-24hours)

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15
Q

What is the acrosome reaction

A
  1. Sperm pushes through corona radiata (clump of granulosa cells)
  2. Sperm binds to ZP3 of the zona pellucida
  3. Acrosome reaction is triggered
  4. Zona pellucida is digested
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16
Q

Many sperm push through corona radiata, but only one penetrates the zona pellucida

A

Okay cool

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17
Q

What is the cortical reaction

A

Blocks polyspermy by egg releasing granules

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18
Q

What happens after an egg penetrates the zona pellucida?

A

Egg and sperm fuse, calcium waves are activated, egg resumes Meiosis II and forms a pronucleus, joins with sperm pronucleus

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19
Q

Which cell provides the mitochondria and which provides the centriole?

A

Sperm has centriole, egg has mitochondria

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20
Q

What is a morula

A

What is formed by the combined egg and sperm pronuclei, it is totipotent cells

21
Q

At what stage in IVF is the baby put into the uterus

A

When its a morula (can also take a morula cell and test it for problems before implanting, called pre-implantation genetic diagnosis)

22
Q

What must the blastocyst do before implantation

A

Hatch from the zona pellucida

23
Q

blastocyst =

A

trophoblast + embryoblast

24
Q

What controls the degree of invasion of the trophoblast

A

The endometrium

25
Why can ectopic pregnancies invade
The endometrium isn't there to control the invasion
26
Implantation in lower uterine segment can cause...
placenta praevia
27
Name four contraceptives using progesterone
Progesterone-only pill, progesterone implant, progesterone injection (Depo-provera), Mirena
28
Which contraceptives can make bleeding worse
Progesterone implant and progesterone-only pill , IUCD
29
Which contraceptives have a delay in fertility returning
Depo provera
30
Downsides of depo provera
Delay in ferility return and osteoporosis
31
How long do the IUD and IUCD work for
Mirena 3-5yrs, IUCD 5-10yrs
32
Name three emergency contraceptives
Emergency IUD Pill with levonorgestrel Pill with ulipristal acetate
33
Define subfertility
no pregnancy in couple having regular sex (2-3days) for one year
34
When do you get early referral for subfertility
If F >36yo or known reason for infertility
35
What % of infertility is both M and F
40% both
36
Name reasons for M infertility
ED, torsion, chylamydia, diabetes, prolactinemia, hypothyroidism
37
Name reasons for F infertility
PID, chylamydia, ectopic pregnancies, tubo-ovarian abscess, endometrial cancer, endometriosis, fibroids (leimyomas), cervical stenosis, Mullerian agenesis, PCOS
38
How can you test ovulation has occured
Test progesterone at day 21 from blood
39
What's the problem with hyperprolactinemia?
Inhibits GnRH
40
How do you treat hyperprolactinemia?
Dopamine agonists (Bromocriptine)
41
When does physiological secondary amenorrhea occur?
Pregnancy and menopause
42
How can you diagnose blocked uterine tubes
Contrast ultrasound- hysterosalpingogram
43
What can cause blocked uterine tubes
Endometriosis and PID
44
What do you give clomiphene for and how does it work
For anovulation So clomiphene binds to oestrogen receptors in hypothalamus This means the hypothalamus doesn't get any negative feedback from oestrogen so it thinks there is very low oestrogen This means it releases more GnRH More FSH and LH from anterior pituitary LH surge for ovulation
45
How does PCOS work
Abnormal GnRH secretion Many follicles develop but none selected as dominant Strange GnRH secretion means more LH and less FSH produced Means theca cells make androgens and follicles arrest in antral stage, so no corpus luteum, not much progesterone, plus unopposed oestrogen (no progesterone) and endometrial hyperplasia but no shedding so endometrial cancer risk
46
What is the difference in action between the progesterone only pill and the depo provera/progest implant
The depo provera and progest implant are high progesterone doses therefore primary action is to prevent ovulation via negative feedback on the hypothalamus. The POP is low progesterone so works via increasing cervical mucus only
47
Most common cause of female infertility?
Anovulation
48
Most common cause of irregular upper tract bleeding?
Anovulation
49
Mumps orchitis can result in
Testicular atrophy

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