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Y2S2- Genetics, Renal, Endocrine > Repro > Flashcards

Repro Flashcards

1
Q

subfertility and infertility definitions

A

inability to conceive after 6months or 1year of unprotected sex

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2
Q

sperm and egg fertility comparison

A

sperm- constant fertility from puberty, gradual decline with age
egg- cyclical fertility, 7M follicles in utero declines to 0 at menopause

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3
Q

formation of ovarian reserve of follicles

A
  1. primordial germ cells colonise the gonad and numbers expand by meiosis
  2. germ cells enter and then arrest in, meiosis which begins again at ovulation
  3. primordial follicles form
  4. folliculogenesis
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4
Q

stages of follicle development

A
  1. primordial follicle- oocyte with squamous granulosa cells
  2. primary follicle- oocyte with stratified cuboidal granulosa cells
  3. secondary follicle- stroma and theca cells
  4. early antral follicle- theca external and interna with blood vessels
  5. graafian follicle ready to be ovulated
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5
Q

feedback loop of FSH LH

A
  1. hypothalamus secretes GnRH
  2. stimulates anterior pituitary to secrete FSH and LH
  3. oestrogen, progesterones negatively feedback from follicle to inhibit AP and hypothalamus
    inhibins negatively feedback on FSH only
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6
Q

oxytocin effects

A

smooth muscle contraction:
- milk ejection
- contraction of uterus during childbirth: used to induce labour
- during orgasm
Secretion stimulated in response to stimulation of nipples or uterine distension

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7
Q

why does GnRH have a pulsatile release?

A

prevent receptor desensitisation and downregulation

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8
Q

kisspeptin

A

neuropeptide that feeds back on GnRH neurons and regulate secretion

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9
Q

water soluble hormones

A

GnRH, FSH, LH

travel through blood freely and bind to cell surface receptor

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10
Q

lipid soluble hormones

A

oestrogen, progesterone

travel attached to transport protein and freely diffuse into cell

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11
Q

gonadotrophin regulated growth phase

A

from preantral follicle to preovulatory follicle
FSH- astral granulosa cell differentiation, proliferation & function, can make oestrogen
LH- theca cell androgen production, ovulation

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12
Q

AMH

A

anti-mullerian hormone
made by granulosa cells, absent in primordial follicle but present at later stages

has an inhibitory effect on follicle development- neg feedback on small follicles from more developed follicle
unaffected by GnRH/steroid hormones
reliable reflection of growing follicles- decreases over age

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13
Q

which follicles are selected to be ovulated?

A

estrogen and LH induce expression of LH receptor on theca cells
↳ follicle with largest #of LH receptors is ovulated and others die

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14
Q

hormones when follicle begins growth

A

FSH increase, oestrogen increase

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15
Q

When do FSH levels drop during follicle growth?

A

when oestrogen levels are high due to negative feedback causing endometrial thickening

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16
Q

what does the oestrogen peak cause?

A

LH release from the pituitary and suddenly has stimulatory effect on FSH secretion
oestrogen and FSH stimulate LH binding sites on granulosa cells

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17
Q

LH surge on day 14

A

ovulation

oestrogen drops as follicle is gone, corpus luteum produces some

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18
Q

hormones in luteal phase of menstruation

A

drop on FSH/LH as progesterone levels rise completing the endometrium

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19
Q

corpus luteum

A

made fo granulosa and theca cells, lutein cells contain lipid droplets and pigment lutein which give yellow colour, secrete progesterone

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20
Q

hormones when no pregnancy is detected in menstrual cycle

A

CL regresses, FSH rise, progesterone and oestrogen drop as endometrium shed

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21
Q

hCG

A

produced by blastocysts which bind to LH receptors and maintain progesterone if preggo and surpasses maternal immune rejection of placenta

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22
Q

how does hormonal contraception work?

A

suppresses ovulation via negative feedback of progesterone- secondary effects on female genital tract
HPG axis can be awakened in off period

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23
Q

combined pill mechanism

A

oestrogen provides additional feedback and promotes progesterone receptor expression

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24
Q

when can the breast produce milk?

A

once the placenta is delivered

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25
myoepithelial cells in breast
contract on signal from oxytocin and expel milk from ducts
26
milk ejection reflex
suckling breast stimualtes prolactin release and oxytocin synthesis and secretion myoepithelial cell contraction -> milk expulsion
27
why is fertility reducing during lactation?
negative feedback fo prolactin on FSH/LH
28
difference between early and premature menopause
early- <45 | premature- <40 (premature ovarian insufficiency)
29
causes of premature menopause
- idiopathic - autoimmune- Addisons, thyroid - surgery/ chemo/ radiotherapy - chromosomal/infecitons/ metabolic
30
management of early menopause
treat with oestrogen replacement
31
Biochemical profile of post-menopausal women
low estradiol high FSH (main marker) high LH
32
predictors of menopause
FSH – day 3 raised level •AMH – anti-Mullerian hormone: declines with age and useful marker of ovarian reserve •Inhibin B - declines with age and protein hormone marker of ovarian reserve •Ovarian antral follicle count by ultrasound
33
vasomotor symptoms of lack of oestrogen
Hot flushes and night sweats • Palpitations, faintness | • Severe sleep deprivation
34
Urogenital ageing
Vaginal dryness and dyspareunia | • Bladder neck symptoms: urgency, urge incontinence, nocturia, recurrent urinary infections
35
HRT hormones that can be given
• Estrogen- improve symptoms but don't restore fertility • Progestogen - for endometrial protection • Testosterone oral, skin (transdermal) patches and gels, subdermal implant, intra-uterine progestogen Prescribed for menopausal symptom
36
benefits of HRT
improve QOL, protection against osteoporosis (provided HRT is taken long enough) and bowel cancer
37
risks of HRT
• Small extra risk of breast cancer with prolonged duration of use • Increased risk of venous thromboembolism: x2 fold increase • Small excess risk of stroke (last 2 for tablets not transdermal patches)
38
erectile dysfunction marker of cardiovascular disease
especially predictive of CV in men younger than 60 and in those with diabetes
39
Testicular dysgenesis syndrome
condition characterised by: - cryptorchism, hypospadias - testis GC cancer, low sperm count, low-norm testosterone levels (penis may be reduced in size)
40
what can cause cryptoorchism and hypospadias?
deficiencies in fetal androgens
41
what is cryptorchidism
A congenital undescended testis is one that has failed to reach the bottom of the scrotum by 3 months of age- dependant on there being enough androgens
42
Reasons for correction of cryptorchidism
Reduce risk of infertility Allows the testes to be examined for testicular cancer Avoid testicular torsion Cosmetic appearance
43
cryptorchidism link to cancer
Males with undescended testis are 40 times as likely to develop testicular cancer (seminoma) as males without undescended testis After the age of 2 years in untreated individuals the Sertoli cells will degrade
44
assisted reproduction effectiveness with age
increasingly ineffective with age
45
why do Sertoli cells have an impact on sperm count?
each Sertoli cell can only support a fixed number of germ cells during their 10 week development into sperm, mainly determined during fetal/early postnatal life
46
AGD
anogenital distance, between anal opening and base of penis/vaginal opening determined by fetal androgen exposure
47
male AGD is
twice that of female
48
masculinisation programming window
male- female difference in AGD was induced by androgen exposure specifically in the MPW, TDS orginate in 1st trimester MPW (8-12w)
49
factors via mother in TDS
smoking, medications, lifestyle, diet
50
hypospadias is characterised by:
Hypospadias is characterised by - a ventral urethral meatus - a hooded prepuce - chordee (ventral curvature of the penis) in more severe forms - the urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.
51
Turner’s syndrome (45 XO)
Women with Turner’s syndrome run out of eggs as a neonate and therefore have streak ovaries in adult life. cannot produce ovarian oestrogen in response to the increasing LH and FSH during puberty- puberty induced at appropriate time
52
hypogonadotropic hypogonadal anovulation
LH and FSH are low because there is not enough GnRH being secreted from the hypothalamus- low test and oestrogen notably hypothalamic amenorrhoea- excessive exercise, anorexia
53
hyperprolactinemia
Prolactin inbibits gonadotrophin secretin locally. This results in low LH, low FSH and low oestradiol symptoms: galactorrhea
54
visual defect caused by pituitary tumour
bitemporal hemianopia
55
oligomenorrhoea
fewer than six to eight periods per year
56
hypergonadotropic hypoestrogenic anovulation
hypogonadism due to an impaired response of the gonads to the GnRH, FSH and LH, and in turn a lack of sex steroid hormone production
57
normogonadotropic normoestrogenic anovulation
PCOS- high LH and androgens with normal/low FSH and estradiol hyperinsulinaemia also seen
58
PCOS symptoms
hisuitism, acne, oily skin, menstrual disturbances: oligomenorrhea and amenorrhoea, obesity, acanthosis nigricans (due to insulin resistance)
59
PCOS physiology
normal FSH and oestrogen stimulates growth of follicles but high androgens pause growth and inability to ovulate high LH stimulates androgen production- ovary has many arrested follicles looking polycystic overlap with metabolic syndrome
60
treatment of PCOS
COCP- suppresses hormones weight control additional testosterone blocking drugs- cyproterone acetate
61
diagnosis of PCOS
transvaginal USS
62
finding on examination of premature menopause
atrophic vaginitis
63
Which hormone is required to maintain progesterone production during the menstrual cycle?
LH
64
What problem limited the development of IVF as we know it now?
premature LH surge
65
_ increase bleeding at menstruation
prostaglandins
66
When is the best time in an average 28-day menstrual cycle to do a blood test for ovulation?
Day 21- progesterone from CL is measured to confirm ovulation
67
estrogen agonists uses
- HRT: treat post-menopausal atrophic vaginitis, after hysterectomy or induction of puberty - COCP
68
Continuous combined HRT
estrogen and progestagen are taken continually. It is used two years after the menopause and does not cause vaginal bleeding.
69
sequential HRT
estrogen is given followed by two weeks of progestogen. This causes regular periods (after progestogen withdrawal). - used for younger women with hypogonadotrophic hypogonadism or in the climacteric. - not contraceptive but will have less side effects than the oral contraceptive pill
70
oestrogen side effects
nausea, headaches and breast tenderness
71
COCP side effects
headaches, nausea, weight gain, reduce libido, prevent lactation, associated with thromboembolism
72
why can't women with a uterus be given oestrogen alone?
cause continued proliferation of the endometrium and this can cause heavy irregular bleeding or pathologies such as endometrial hyperplasia and endometrial cancer
73
oestrogen antagonist
- ovulation induction (clomifene)- Anti-estrogens for ovulation induction in PCOS are only used for 5 days each month at the beginning of the cycle to allow the endometrium and potential for the LH surge to recover. - breast cancer (tamoxifen)
74
progesterone agonist
- menstrual induction- PCOS - heavy menstrual bleeding- reduce endometrial thickness - progesterone replacement in IVF
75
types of progesterone contraception
- progestagen only contraception - depo contraception- IM, inhibits gonadotrophins - implant contraception - intrauterine system- coil causes endometrial atrophy - post coital contraception- makes endometrium less receptive
76
progesterone vs oestrogen contraception
most of the serious side effect of the combined contraceptive pill are because of the estrogen, progesterone alone is a safer contraceptive and used in higher risk women. However, unlike the combined pill which gives a regular cycle, progesterone only contraception causes irregular bleeding which can be frequent
77
progesterone antagonist
- termination of pregnancy - post coital contraception - shrink fibroid growth
78
androgen agonist
HRT- increase energy & libido
79
androgen antagonist
treatment of hirsuitism (cyproterone acetate, finasteride)- need effective contraception also
80
cyproterone acetate
androgen antagonist and progesterone agonist
81
which 2 drugs are used for termination of pregnancy?
progesterone antagonist (mifepristone) and second stage prostaglandin E (agonist)
82
FSH agonist
- ovulation induction | - superovulation- collect multiple eggs in IVF treatment
83
FSH antagonist
gonadotrophin suppression
84
LH agonist
- superovulation | - ovulation
85
LH antagonist
- IVF- prevent a premature LH surge
86
oxytocin antagonist
prevention fo preterm labour (atosiban)- stop uterine contractions
87
oxytocin agonist
- augmentation fo labour | - post-partum haemorrhage- solve uterine atony
88
prostaglandin agonist in inducing labour
Vaginal prostaglandin E2 gel- cervical ripening and myometrium contractions
89
prostaglandin antagonist
- treatment of heavy menstrual bleeding (mefenamic acid) | - premature labour (indomethacin)- SE: premature closure of the fetal ductus
90
``` Which peptide hormones are produced from: arcuate nucleus preoptic nucleus supraoptic nucleus paraventricular nucleus periventricular nucleus ```
``` GHRH, dopamine GnRH AVP, oxytocin AVP, oxytocin, CRH, TRH somatostatin ```
91
Kallman syndrome
50% of hypogonadotropic hypogonadism cases defined by a delay or absence in onset of puberty and an impaired or absent sense of smell presentation in males is characterised by low gonadotrophins & testosterone and small external genitalia, with small or undescended testis

Y2S2- Genetics, Renal, Endocrine (6 decks)

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