Flashcards in Female Fertility/Implant/Infertility/Contraception Deck (34):
How does the PS system effect female reproductive organs during orgasm
discharge from perineum and vagina->dilation of arterioles and constriction of venules in clitoris and introitus->clitoral erection and tightening of vagina around shaft of penis->massaging action to assist in male orgasm
What gland is responsible for the vaginal secretions during coitus?
What are spinal reflexes responsible for during orgasm?
vigorous upward contraction of muscles of perineum, vagina, cervix, uterus and oviducts
After orgasm how long does the cervix remain open? Why?
20-30 min, sperm entry
Hwo are sperm transported inside the female?
200-300mil deposited near cervix, sperm swim through open cervix and uterus to oviducts, uterine contractions and oviductal ciliary movements generate upward current to aid sperm, ~200 reach ampulla; viable 48-72 hrs after ejaculation; egg only 24-48hrs
What is capacitation and where does it occur?
shed cholesterol deposit from head of spermatozoa, Ca influx occurs and flagellar beating increases and epididymal glycoproteins are removed from sperm surface unmasking binding proteins; fallopian tube; reason sperm is washed in IVF
What is the acrosome reaction?
release of hyaluronidase and acrosin from acrosome (sac opens)
What changes occur in the oocyte resulting in fertilization?
hyalronidase disperses cumulus cell, spermatozoa reaches zona pellucida and bind to ZP3 receptor->acrosin perforates zona->spermatozoon enters perivitelline space-> cortical granules make the zona protease resistant to further sperm penetration (polyspermy)-> swelling of egg and sperm nuclei to form femal and male pronuclei which fuse making the zygote
What causes polyspermy?
abnormality in zona pelucida; especially in older eggs
What are some chromosomal abnormalities?
absence of one X (Turner syndrome), superneumerary chromosome (Klinefelter syndrome or fatal), increased postanatal aging can cause trisomy of various types (trisomy 21- downs)
What are the steps of implantation?
6-7 days, in uterus morula transform into blastocyst containing inner cell mass and outer trophectoderm, before implanation blastocyst sheds zona (hatching), blastocysts attches on endometrial surface, trophoblast cells phagocytose and penetrate endometrium (Luteal Phase)
After implantation what leas to secretion of hCG?
inner cytotrophoblast layer is composed of mitotic cells, outer syncytiotrophoblast layer (post mitotic surface layer derived by fusion of plasma membrane of cytrophoblast ->multinuclear syncytium are highly differentiated and secrete CG
What does CG do?
rescues CL from demise=maternal recognition of pregnancy
What prevents the endomtetiurm from having an immune response to the blastocyst?
syncytiotrophoblast or cytotrophoblasr do not express functional MHC antigens; if infection present at same time can result in loss of embryo
What is decidualization?
growth factors secreted by syncytial induce endometrial differentiation into cobble stome like decidual cells; begins in endometrium closely apposed to the implanting embryo, spreads with progress of implantation and placentation
What do decidual cells secrete?
pregnancy associated protein A, CA125 (glycoprotein), prolactin, B-endorphin, plasminogen activator (protease participating in trophoblast penetration, and diamine oxidase (forms spermidine-strong immunosuppressant)
What are the four main causes of infertility?
tubal patency, endometriosis, luteal phase defect, problems with male counterpart
What causes tubal patency issues?
PID, septic abortion, long-term IUD use, tubal damage from previous ectopic pregnancy
Why does endometriosis cause infertility?
hampers tubal movement and induces breakthrough bleeding
What causes luteal phase defect?
retarded follicular growth, anovulation, inadequate progesterone support of endometrium- breakthrough bleeding
What problems can IVF address?
tubal defects (surgery or disease), endometriosis (refractory to surgical or medical treatments), idiopathic infertility, oligospermia, antisperm antibodies, and cervical factors
What are the major components of IVF?
ovarian stimulation and induction of ovulation (harvest), preparation of sperm, IVF and embryo development, and embryo transfer
How is ovarian stimulation done during IVF?
follicular recruitment induced by clomiphene citrate or recombinant FSH (rFSH), for favorable recruitment controlled ovarian hyperstimulation needed-> GnRH agonist (Lupron) injected midluteal phase~1 week from ovulation and continued for 10 days or onset of meses(many use GnRH anatgonsit to avoid transient rise in LH-linked to poor eggs), rFSH injected 3rd day of menses for 7-12 days or until 18-20mm follicles seen on ultrasound; CG injected 36hr before retrieval (ensure matrutiy-complete meisosis 1)
How are eggs retrieved?
cumulus cell-enclosed eggs collected into synthetic culture medium using ultrasound guided aspiration needle laparoscopy- 1st polar body should be visible
how is the sperm prepared in IVF?
semen collected, spermatozoa purified by washing, capacitated in insemination medium and motile sperm added to culture containing an egg
What is done differently in IVF for low sperm count/ high percentage abnormal morphology or abnormal motility?
motile sperm concentrated further using density centrifugation
In severe cases of azoospermia, oligospermia or older eggs what is done differently in IVF?
one motile spermatozoon is microinjected into oocyte cytoplasm bypassing ZP- ICSE
What are the criteria for successful fertilization in IVF?
2nd poar body, presence of male and female pronuclei, contracted egg cytoplasm or normal cleavage
At what stage of development does embryo transfer occur?
blastocyst develop by 5th day; either 3 day (8 cell) or 5 day; usually 5 day
How do combo OCs work?
estrogen is ethynyl estradiol or mestranol- breaks down to estradiol- resistant to liver so effective in small doses, progestin is norethindrone, norgestrel, norethindrone acetate, ethynodiol diacetate; 21 day active 7 day hormone free; can be mono, bi or triphasic
How do progestin only OCs work?
minipill, continuous low dose progestin, causes endometrial involution and thickening of cervical mucus, pills must be taken continuously w/o hormone free period for max effectiveness; slightly less effective, often irregular menses because gonadotropins are not consistently suppressed resulting in varied ovarian stimulation
how do postcoital contraception OC work?
ethinyl estradiol with levonorgestrel or high dose levenorgestrel- withnin 72 hrs, functions by altering egg transport through oviduct
What can cause a spontaneous abortion?
luteal phase defect, infection- (B toxins trigger immune cells to secrete cytokines (IL-1 and PG); PG cause uterine contractions, IL-1 causes cervical ripening via collagenase activity and fetus is expelled, or abdominal trauma