Reproduction Flashcards
(101 cards)
1
Q
oogenesis arrests in ___ and restarts at ___
A
prophase
puberty
2
Q
1st polar body =
A
formed after the first meiotic division of an oocyte
1 haploid cell gets much less cytoplasm and so is infertile
3
Q
if there are two polar bodies this indicates
A
sperm entry and completion of the 2nd meiotic division
4
Q
__-___ oocytes are ovulated per female
A
300-400
5
Q
GnRH frequencies of pulses to stimulate LH and FSH release
A
LH = high freq FSH = low frequency
6
Q
FSH stimulates __ and ___
A
follicular development and thickens endometrium
7
Q
LH surge stimulates
A
ovulation
8
Q
the type of cervical mucus that oestrogen stimulates the production of
A
fertile - clear stringy, stretchable, slippery, fern patterns when dry
9
Q
increased oestrogen inhibits __+__ and stimulates ___
A
FSH and PRL
stim.s LH
10
Q
oestrogen causes the uterus’ water content to increase by
A
accelerating Na+ and H2O reabs by kidney tubules
11
Q
the type of cervical mucus that progesterone stimulates the production of
A
infertile
opaque, sticky, thick, non stretchy, non-fern like when it dries
12
Q
progesterone affects
A
inhibits LH thermogenic relax SM maintain thick endometrium maintain pregnancy infertile mucus production
13
Q
after LH surge the oocyte resumes ___ it stops at ___ unless it is fertilised
A
meiosis
metaphase II
14
Q
___hrs after LH surge = ovulation and formation of corpus luteum
A
36.5
15
Q
in the menstrual phase there is no __/__ and so __ occurs and __ secretion is stimulated
A
oestrogen/progesterone
mensstruation/endometrial degeneration
FSH
16
Q
lutein is a __
A
yellow carotenoid pigment found in corpus luteum
17
Q
In males LH acts on __ to stimulate
A
Leydig cells
testosterone secretion
18
Q
spermatogenesis occurs in the
A
seminiferous tubules of testes
19
Q
In males FSH acts on ___ to ___
A
Sertoli cells
enhance spermatogenesis and for spermatid remodelling
20
Q
Sertoli cells secrete __+__(inhibits ___ release_
A
ABG
inhibin - inhibits FSH release
21
Q
Testosterone suppresses __ and decreases the sensitivity of ____ to ___
A
GnRH release
LH secreting cells to GnRH
22
Q
it takes ___ days to make a sperm
A
72
23
Q
golgi in a sperm cell =
A
acrosome
24
Q
granulosa cells in female =
A
follicle cells in the ovaries
25
__+___ cells of the ovaries produce oestrogen
theca and granulosa cells
26
granulosa cells are stimulated by __ to produce ___ which diffuses to adjacent theca cells which produce ___ that goes back to the granulosa to be turned into oestrodiol
LH
pregnenolone
androstenedione
27
enzymes present in theca cells that convert pregnenolone to DHEA to androstenidione
17, 20 lyase + 3beta HSD
28
expression of aromatase and 17beta HSD stimulate __
FSH
29
aromatase causes __>___ in extraglandular tissues eg bone and fat
androgens to oestrone
30
pregnenolone is acted on by ___ in _+_+_ to produce progesterone
3beta HSD
| corpus luteum placenta and adrenals
31
<9 periods a year =
oligomenorrhoea
32
primary amennorrhea =
failure of menarche by 16yo
33
2ndry amennorhea definition -
previously menstruated but ceased for >6months
34
congenital causes of primary amennorhea
Turner's
| Kallman's
35
amennorhea + anosmia =
Kallman's
36
Ix for all oligo/amennorhoeic patients
```
LH
FSH
oestradiol
TFT
PRL
```
37
primary hypogonadism in females=
ovarian problem
high LH and FSH
hypergonadotrophic hypogonadism
38
2ndry hypogonadism in females =
low FSH/LH
| hypogonadotrophic hypogonadism
39
causes of Prematur ovarian failure
Turners
Fragile X
FSH/LH receptor mutations
Addisons/AI thyroid
40
POF age =
<40yo
41
diagnosis of POF =
FSH >30 on 2 occasions >1 month apart
42
causes of 2ndry hypogonadism =
```
Kallmans
Idiopathic
functional
prader willi
haemochromatosis
```
43
causes of functional hypogon hypogonadism
```
stress
exercise
wt change
anabolic steroids
systemic illness
head trauma
sarcoid
```
44
Kisspeptin =
stimulates GnRH secretion
| regulates M+F fertility
45
idiopathic hypogon hypogonadism =
inability to activate pulsatile GnRH secretion
absent/delayed sexual development ass with inappropriately low LH/FSH and sex hormone wo anatomical/functional defects of HPG axis
46
In Kallmann's there is absence of ___ which causes ___
mode of inheritance
M:F
no olfactory bulbs so anosmic
auto dom/recessive or sporadic or x linked
M4:1F
47
Rotterdam criteria for PCOS
normal oestrogen and >= 2 of:
oligomenorrhea
hyperandrogenism
polycystic ovaries => insulin resistance, hirsutism
48
non-classical CAH usually presents
in adults as hirsute, menstrual disturbance and anovulation
49
Rx for PCOS hirsutism
oral contraceptive
anti-androgens (cyproterone acetate PO / efflornithine cream)
electrolysis
50
Rx for late onset CAH hirsutism
low dose glucocorticosteroid to suppress aCTH drive
51
45X =
Turner's
52
short webbed neck, shield chest, wide spaced nipples, amennorhea, cubitus valgus =
Turner's
53
XY but androgen insensitive so phenotypically F =
pseudohermaphrodites
| testicular feminisation
54
Primary causes of male hypogonadism
trauma, chemo, haemochromatosis, cirrhosis
| Klinefelter's, SHBG
55
47XXY
Klinefelter's
56
2ndry causes of male hypogonadism
CAH, IHH, Klinefelter's, Prader Willi, hyperPRL, functional
57
infertility definition =
failure to conceive after >= 12months of regular unprotected sex in couples with no kids previously
58
difference between primary and secondary infertility =
```
primary = have never conceived
2ndry = conceived but did not have a live birth
```
59
hot flushes, atrophic vaginitis and night sweats are indicative of
POF
60
non-infective tubal diseases that can cause infertility in Fs
endometriosis, Sx, fiboids, polyps, salpingitis isthmica nodosa
61
endometriosis =
endometrial glands outside theuterine cavity
62
causes of endometriosis
retrograde menstruation
abnormal cellular adhesion molecules
genes
abnormal immune system
63
chocolate ovarian cysts on scan =
endometriosis
64
s+s of endometriosis
```
chocolate ovarian cysts on scan
dysmmenorrhea (prior to menstruation)
dyspareunia
menorrhagia
painful defaecation
chronic pelvic pain
uterus may be retroverted/fixed
```
65
endocrine causes of male infertility
```
hypog hypog
klinefelter
chemo
undescended testicle
hyperPRL
acromegaly
cushings
thyroid high or low
```
66
obstructive causes of male infertility
CF (no vas)
infection
vasectomy
67
results of test if obstructive cause of male fertility
Testosterone LH and FSH normal
normal testicular volume
2ndry sexual characteristics
68
signs that the cause of male infertility is testicular
```
reduced testicular volume
reduced 2ndry sexual characteristics
vas present
FSH and LH up
Testosterone low
```
69
basic Ix for females with infertility
```
BMI
examine
endocervical swab for chlamydia
smear test if due
blood for rubella immunity
midluteal progessterone levels (>30nmol/l = ovulation)
```
70
Hysterosalpingiogram is used to Ix
infertility thought to be a tubal patency problem if no tubal/pelvic pathology
or if laparoscopic is contraindicated
however it misses adhesions and the cause of the block
71
if known or suspected tubal/pelvic pathology the Ix for tubal infertility causes =
laparoscopy
72
if suspect/know endometrial pathology then Ix for tubal infertility =
hysteroscopy
73
if find an abnormality on pelvic exam then next Ix =
Pelvic US
74
Features of semen analysed in fertility clinic
```
volume
pH (7.2-7.8)
concn
motility
morphology
WBC
```
75
if abnormal genital exam on males next Ix =
scrotal Ix
76
regular menstrual cycle = __-__ days
28-35 days
77
menstrual cycle >35days =
oligomenorrhea
78
length of follicular and luteal phases
```
follicular = variable
luteal = 14 days
```
79
if bleed 5 days and the menstruation occurs every 30 days this is annotated as
5/30
80
ovulation predictor kits are 3% unreliable because
not all females secrete LH in urine and it detects LH surge in urine
81
oestradiol+progesterone peak before/after ovulation
```
oest = before
prog = after
```
82
if periods are regular then to assess ovulation use this Ix
midluteal (day21) serum progesterone
2 samples
>30mmol/l = ovulation
83
Rx of anovulation in Group 1 ovulatory dysfunction (hypogon hypogonadism)
stabilise BMI >18.5
pulsatile GnRH S/C or IV
FSH and LH daily injections
84
85% of ovulatory disorders are
Group 2
| normal FSH/LH and oestrogen but oligo/amennorhoea
85
in PCOS __ lowers SHBG and so cause there to be more free ___
insulin
| testosterone => hyperandrogenism
86
first line for ovulation induction in PCOS
```
clomifene citrate
(other anti-oestrogens = tamoxifen
alternative = letrozole
```
87
drug used in PCOS for ovulation induction that increases sensitivity to clomifen and improves insulin resistance
metformin
88
risk of recombinant FSH daily injection for ovualtion induction in PCOS
multiple preg and overstimulation
89
Sx option for PCOS ovulation induction and its risk =
laparoscopic ovarian diathermy
| ovarian destruction
90
TTTS=
| description
twin twin transfusion syndrome
monochorionic - recipient = polyhydramnios
donor = oliguria, oligohydramnios, growth restriction
91
Rx for TTTS
laser division of placental vessels
92
Group 3 ovulatory dysfunction =
ovarian failure
93
Rx for POF
HRT (doesnt restore ovulation - must cryopreserve eggs prior to POF to preserve fertility)
94
scan that is a routine part of infertility consultation
US transvaginally
95
drugs that cause galactorrhea
```
oestrogen containing
opiates
simetadine - older H2 antagonists
metaclopramide
domperidone
phenothiazine, beloperidol
```
96
rubella signs at birth
```
rash
low birth wt
small head size
PDA
visual problems
bulging fontanelle
```
97
Rx for chlamydia
azithromycin 1g stat
| if allergy = doxycyline 100mg bd for 7 days
98
in PCOS usually follicle arrangement =
peripherally arranged around an enlarged hyperechogenic central stroma
99
aromatase inhibitors =
| used in infertility treatment but not licensed in UK
letrozole/ anastrozole
100
___ increases sensitivity to clomifene
metformin
101
Ix for tubal infertility that can cause PID flare, vasovagal attack, palvic pain
hysterosalpingogram
