The Normal Ovary Flashcards
Normal Ovary
_____ (2)
_____ shape, small
Measure in _____ and _____ planes
___-___cm (L), ____cm (W), ___cm (AP) =size/volume
formula to manually calculate OV volume:
- Vol = ___ x ___ x ___ divided by 2
Lie in a shallow depression - _____ fossa (Adnexa)
OVs are “held” in the ovarian fossa near and lateral UT by several structures:
- Connected bil to UT by the _____
- Connected medially by _____ ligament
- Held post to broad ligament by _____
- Connected to pelvic wall laterally by _____ (suspensory) ligament and NOT surrounded by peritoneum
anterior to _____
Lymphatic drainage from OVs are: _____-_____, _____ iliac, _____ iliac, _____ iliac, _____, _____, _____, _____, inguinal nodes
paired almond sagittal transverse 3 4 2 1 h w l ovarian FTs ovarian mesovarium infundibulopelvic rectum para-aortic internal external common sacral obturator pelvis retroperitoneal
Sonographic Vessel Landmarks:
-Internal Iliac _____
-Internal Iliac _____
-Both lie _____ to the ovaries bilaterally
-Iliac _____ is immediately lateral to ovaries and easier to image
(Iliac Vein is the largest)
The OVs are made up of 2 distinct areas:
1) Cortex:
- _____ portion of ovarian tissue is the cortex area of connective tissue/stroma
- Responds to _____ stimulation
- _____ located within the cortex
2) Medulla:
-_____-middle germinal layer
coats the ovary, made of cuboidal epithelial cells
-area of the _____ vasculature
Artery Vein lateral vein outer hormonal follicles inner ovarian
Each Ovary presents with:
- _____ border - uterine end (closest to UT) surfaces
- _____ border - tubal end (further away from UT)
-_____ and _____
free borders
-_____ and _____ borders
medial lateral anterior posterior superior inferior
Ovarian/Gonad Function
2 Functions: _____ and _____
1) Producing eggs (_____ function)
2) Secreting hormones (_____ function)
The term _____ refer to the ovaries in females and testes in males
Each month, during the menstrual cycle, an ovum (egg) is released form 1 ovary; this process is called _____; repeats the next month on the opposite ovary and so forth. The egg is released when a mature follicle ruptures in response to a hormonal signal. Ovulation occurs around 14-15 days from the 1st day of the woman’s last menstrual cycle. When ovulation occurs, the ovum moves into the FTs and becomes available for fertilization. If fertilization does not occur, the egg is “spilled out” through the endometrial cavity.
exocrine endocrine exocrine endocrine gonads ovulation
Women are born with a limited reserve of _____ (oocytes are the cells within the ovaries that produce the ovum)
This supply diminishes during a woman’s life, reaching critical low #s of oocytes by age _____
A fetal ovary contains ___-___ million oocytes by the 20th week of gestation.
At approx. 50 years old, the number of oocytes left is exhausted and enter the _____ phase, making pregnancy almost impossible
oocytes 40 6 7 menopause
Hormones Secreted
_____ is produced by the follicle and responsible for the appearance of secondary sex characteristics of anatomically female people at puberty and for the maturation and maintenance of the reproductive organs in their mature functional state.
_____ is produced by the CL and functions with estrogen by promoting menstrual cycle changes in the endometrium.
Levels of both change through out the menstrual cycle and directly correspond with menstrual cycle each moth
estrogen
progesterone
Ovarian Follicle stages
The UT and OV are driven largely by 4 hormones:
- _____-stimulating hormone (FSH)
- _____ hormone (LH)
- _____
- _____
An ovarian _____ progresses through several distinct phases before it finally matures and releases it’s ovum
follicle leutenizing estrogen progesterone follicle
Stages of an Ovarian Follicle
Stage 1: \_\_\_\_\_ Follicle Stage 2: \_\_\_\_\_ Follicle Stage 3: \_\_\_\_\_ Follicle Stage 4: \_\_\_\_\_ Follicle Stage 5: Corpus \_\_\_\_\_ Stage 6: Corpus \_\_\_\_\_
Primordial primary secondary vesicular luteum albicans
Stage 1 : Primordial Follicle
During the first 5 month of development, a finite number of primordial follicles form in the fetal _____
These follicles consist of _____ surrounded by a single layer if squamous follicular cells.
These primordial follicles remain in the process of the _____ meiotic divison
At puberty, begin to develop further and become _____ follicles
ovary
oocytes
1st
primary
Stage 2 : Primary Follicle
At the start of each menstrual cycle a limited number of _____ follicles are triggered to develop.
1st apparent histological stage is the early _____ follicle: that consists of a central oocyte surrounded by a single layer of follicular cells which have become cuboidal (granulosa) cells.
The zona _____ is a thin band of glycoproteins that separates the oocyte and follicular cells.
Tiny _____ may/may not be imaged on US
As development proceeds, the number of follicular cells _____ by mitosis forming several layers around the primary oocyte.
As these cells enlarge they release steroid hormones called _____ of which estradiol is the dominant one prior to ovulation
During each cycle, a few primary follicles will continue to develop into _____ follicles.
primordial primary pellucida cysts increase estrogens secondary
Stage 3 : Secondary or Late Follicle
Consists of several layers of cuboidal/columnar follicular cells, now collectively called the membrana granulosa which begin to secrete _____ fluid. Antrum begins to form
A thick, amorphous layer, zona _____, forms within it and follicular fluid secreted accumulates, small pockets of fluid between granulosa cells begin to appear and may be imaged on US
Normally, this is the stage in which only _____ of the primary early follicle will continue and develop into this secondary follicle
follicular
pellucida
one
Stage 4 : Graafian Follicle
is the stage after the meiotic division has completed but before \_\_\_\_\_. The follicle is characterized by a large follicular antrum that makes up most of the follicle. An oocyte (egg) is now fully developed/matured and located eccentrically, surrounded by the zona pellucida and a layer of several cells. follicle become large; usually extend from the deepest parts of the cortex and protrude from the surface of the ovary. The bigger = the more \_\_\_\_\_
Graafian Follicle will release the _____ (egg) and the remaining cells of GF will form the corpus luteum
ovulation
mature
oocyte
Stage 5 : Corpus Luteum (CL)
Approx. a ___ cm, round lobulated structure with a cystic (anechoic) center, varies in size, shape, located on ovary
is the follicle which matured (_____) and underwent ovulation (pushed the egg out) and produces progesterone and some estrogen in case the egg gets fertilized
If fertilization occurs, the _____ produces the required progesterone needed to sustain the pregnancy until the placenta is formed near the end of 1st trimester and will then sustain the pregnancy.
Because of fertilization and during the 1st trimester pregnancy, the CL “cyst” of pregnancy may become large before it finally _____ and diminishes near the end of 1st trimester when the placenta finally forms
CL “cyst” should disappear by then end of _____ trimester
In the absence of fertilization, the life span of the CL “cyst” is approx _____ days.
Once the CL “cyst” ruptures, there may be a small amount of free fluid imaged in the _____
2 graffian CL ruptures 1st 14 PCDS
Stage 6: Corpus Albicans
Degenerated corpus _____ (CL)
Pregnancy did not occur; _____ degenerates
luteum
follicle
Sonographer needs to know ovarian sono appearances of the different stages of a _____ to know normal vs pathology at a particular time in the ovarian cycle
follicle
When pregnancy doesn’t occur, the cycle begins all over again on the opposite _____.
So every other month, a person _____ on the same side.
ovary
ovulates
Ovary Variants
Agenesis
- Rare; usually associated with FT (fallopian tube) _____
- _____ = without an opening
- _____ = small
Malposition
-Most frequent above _____ vessels in patients with congenital anomalies
Supernumerary
- Extra _____ at remote site
- May develop benign teratomes and dermoid _____
Ectopic / Accessory Ovarian Tissue
- Usually less than ____ cm in diameter; in _____ ligament near ovary
- Ectopis also near _____ or in retroperitoneal space
Paraovarian Cysts
-may infarct and cause _____ when twist upon itself
atresia atresia agenesis vessels ovary cysts 1 broad kidney pain
Reproductive Medicine and Ultrasound
Over the last 25 years, the advances in US have paralleled advances in Assisted _____ Technology (ART)
_____ has become the most important and widely used tool in the diagnosis and treatment of infertility. Ultrasound evaluation is one of the first steps to assess the cause of infertility; the three areas of evaluation are the _____, _____, and _____ tubes. Ultrasound allows physicians to diagnose ovarian reserve but also pathologies such as polycystic ovarian syndrome, endometriosis, or other ovarian cysts that can impact fertility. The results of this initial exam immediately affect the decisions in the management of the patient’s condition. When fertility treatments begin, ultrasound is used in almost any interaction with the patient in order to monitor follicular development and endometrial response; ultrasound guidance is also vital for embryo retrieval and transfer (ET).
reproductive ultrasound ovaries uterus fallopian
Reproductive Medicine
There are many causes for infertility. Approx. 40% are due to _____ factors, 40% to _____ factors, 5-10% are related to both partners, and 5-10% remain unexplained, Female factors include:
- Anovulation and abnormal _____
- _____ and Transport factors
- _____
- _____ Factors
- _____ Ovary Disease
- Others
female male ovulation tubal endometriosis uterine polycystic
Management Options of Infertility
“Artificial Insemination and Ovulation”
_____ _____ Fertilization (IVF): a variety of technique exist for the in vitro
-assistance of fertilization including oocyte retrieval/harvesting and deposition of gametes or zygotes into the uterus
_____ Intrafallopian Tube Transfer (GIFT): Sperm and ova are placed
-into fallopian tube via EV guided cannulization
_____ Intrafallopian Tube Transfer (ZIFT): embryo (or zygote) is placed
-into fallopian tube via EV guided
In vitro
Gamete
Zygote
Ovulation Induction
Several pharmacologic agents can be used to induce superovulation and _____ the chances of fertilization.
–Clomid (clomiphene citrate, CC) _____ FSH secretion which stimulates more primary follicles. hCG is given to induce final follicular and oocyte maturation.
–Pergonal (human menstrual gonadotropin, hMG) contains equal parts of _____ and _____. Since more complications are encountered with this agent it is used only in selected patients.
Since these agents stimulate follicular growth and development, multiple _____ follicles may be seen bilaterally with ultrasound.
increase increases FSH LH cystic
Sonography
Sonography is used in in vitro fertilization programs to:
- Establish normal uterine anatomy and expected physiologic changes during the _____ cycle
- Monitor the development of the growing _____
- Confirm ovarian response to various drugs (Clomid, Pergonal) to induce _____.
- Identify hyperstimulated _____
Ovulation Monitoring
- _____ sonography (EVS) is the method of choice
- for monitoring follicular development. Follicles are typically
- aspirated for IVF when they measure ___-___mm.
IVF Sonographic Protocol
- Baseline _____ sonogram.
- Preliminary EV evaluation of _____.
- Daily EV to monitor dominant _____
menstrual follicles ovulation ovaries endovaginal 18 24 transabdominal follicles follicle
Complications Imaged with Ultrasound
_____ Hyperstimulation Syndrome (OHS) =
A condition resulting from the excessive stimulation of the ovaries, OHS most commonly occurs in women taking infertility drugs. Mild cases usually resolve spontaneously following the next menstrual cycle. More severe cases are associated with a high mortality rate (50%) and require hospitalization for correction of fluid an electrolyte imbalances.
Sono appearance:
- Large simple _____ bilateral.
- Resemble theca _____ cysts.
Multiple Gestations
Incidence of multiple gestations is increasing with more prevalent and more successful infertility treatment. Multiple gestations can complicate pregnancy by impacting maternal health and wellbeing, fetal outcome (including prematurity).
Ovarian
cysts
lutein
