Integration of Female Reproduction

Question 1

What is primary amenorrhea?

Answer 1

Absence of menses in female by age 17

Question 2

What is secondary amenorrhea?

Answer 2

Cessation of menses longer than 6 months

Question 3

What are the most common causes of secondary amenorrhea?

Answer 3

Pregnancy
Menopause
Hyperprolactinemia with excessive PRL

Question 4

What is oligomenorrhea?

Answer 4

Infrequent periods with length >35 days between menses

Question 5

What is dysmenorrhea?

Answer 5

Painful menses related to uterine contractions

Question 6

What is hirsutism?

Answer 6

Inappropriate hair growth in androgen sensitive areas

Question 7

What is virilization?

Answer 7

Androgen stimulation with deep voice/balding/male features

Question 8

What is a possible cause of oligomenorrhea?

Answer 8

Intense exercise

Question 9

When does PMS occur?

Answer 9

Late luteal phase

Question 10

What are the causes of polycystic ovarian syndrome?

Answer 10

The main cause of PCOS is insulin resistance and obesity, both which are also effects of the condition. PCOS also leads to infertility.

Question 11

How does insulin resistance lead to PCOS?

Answer 11

High insulin stimulates androgen production (causing infertility), increased conversion to estrogens (weight gain).

Question 12

What causes the cysts in PCOS?

Answer 12

Follicle development is impaired and ovulation isn’t completed so follicles degenerate into cysts.

Question 13

What are the treatments for PCOS?

Answer 13

Weight Loss
Smoking Cessation
Metformin (for insulin resistance)

Question 14

What must occur to have fertilization?

Answer 14

Sperm must penetrate the zona pellucida of the egg.

Question 15

What are the steps that lead to fertilization?

Answer 15

Sperm Capacitation
Acrosomal Reaction
Zona Reaction

Question 16

What occurs with sperm capacitation and what is the purpose of it?

Answer 16

Changes occur in properties of the sperm as they traverse the female tract and these changes allow for the penetration of the egg.

Question 17

What occurs with acrosomal reaction and what is the purpose of it?

Answer 17

Release of the proteolytic enzymes and the sperm binds ZP3 which leads to increased [Ca2+] in the cell that will lead to the fusion of the sperm and egg and the exocytosis of the sperm contents.

Question 18

What occurs with zona reaction and what is the purpose of it?

Answer 18

Prevents polyspermy with sperm penetration leading to the exocytosis of oocyte internal cortical vesicles that will harden the glycoproteins of the zona pellucida and prevent successive sperm penetration.

Question 19

What are the essential steps of fertilization?

Answer 19

1. Exocytosis of sperm contents

2. Exocytosis of oocyte vesicles

Question 20

When does the second meiotic division of the oocyte occur?

Answer 20

Same increase in [Ca2+] that triggers the cortical reaction also triggers completion of the second meiotic division and the second polar body is released leaving oocyte with haploid, unduplicated chromasomes.

This occurs during fertilization.

Question 21

What is the function of E2 in sperm transport?

Answer 21

E2 primes the female tract to aid sperm transport to the oviduct

Question 22

What is the function of cGMP in sperm transport?

Answer 22

cGMP increases velocity and direction of sperm

Question 23

What is the function of decreased [H+] in sperm transport?

Answer 23

Decreased [H+] of vagina facilitates sperm motility

Question 24

What change in the cervical mucus occurs and why?

Answer 24

Decreased viscosity of cervical mucus increases sperm access to uterine cavity

Question 25

Describe oocyte transport.

Answer 25

After its release it is taken into the oviduct by the fimbriae and then the ampulla will churn to promote random egg/sperm interactions.

Question 26

How does blastocyst transport occur?

Answer 26

E2 will cause isthmus contraction in the oviduct and delay the transport of the blastocyst and an increase in progesterone will relax the myometrium to allow passage.

Question 27

What are the steps of implantation?

Answer 27

Adhesion
Penetration
Invasion

Question 28

What occurs in adhesion?

Answer 28

Zona pellucida dissolves (egg hatches) under the control of progesterone

Question 29

What causes the bonding of endometrial and blastocyst cells to themselves?

Answer 29

IL-1 from the blastocyst triggers increase in integrins which bond these cells to like cells

Question 30

What is the function of osteopontin?

Answer 30

Binds integrins of endometrium and blastocysts together as a bridge

Question 31

What occurs in penetration?

Answer 31

Progesterone promotes fibroblast-type stromal cells enlarging and forming the decidua, which serves as the source of nutrients for the embryo until vascular connections are established and as a barrier.

Question 32

What occurs in invasion?

Answer 32

Balance between the defensive decidua and offensive trophoblast cell migration.

Trophoblast MMPs and IGF-2 VS Anti-MMP and IGF-binding proteins

Question 33

What is the function of syncytiotrophoblasts?

Answer 33

Responsible for most endocrine functions (hCG/hPL)

Question 34

What is the function of cytotrophoblasts?

Answer 34

Secrete CRH/TRH/Somatostatin

Question 35

What are the functions of the placenta?

Answer 35

• Transports nutrients (glucose/O2)
• Transports waste (urea/CO2)
• Endocrine function secreting hormones

Question 36

What are the functions of hCG?

Answer 36

Similar to LH.

It rescues the corpus luteum and is made by the syncytiotrophoblasts under cytotrophoblast GnRH control.

It is also what leads to maternal recognition of the pregnancy.

Question 37

What are the functions of hPL?

Answer 37

Similar to GH.
AKA human chorionic somatomammotropin

It is produced by syncytiotrophoblasts and acts in response to hypoglycemia. HPL stimulates lipolysis and has anti-insulin actions on maternal carbohydrate metabolism which leads to an increase in plasma glucose and free fatty acids to maintain continuous flow of nutrients to the fetus.