Repro - 1-28 - Female Fertility

Front 1

When do oogonia begin to form primary oocytes?

Back 1

at 15 weeks it starts, peaks at 20-28

Front 2

Does removing an ovary effect prepubertal development?

Back 2

no

Front 3

Function of ovary after puberty

Back 3

prod of haploid oocytes, prod of estrogens and progesterone.

Front 4

How adult ovarian func differs from testic (3):

Back 4

total num of oocytes/primordial follicles declines from intrauterine life onward, relatively few oocytes are released, and release is not continuous but occurs in a cyclic manner.

Front 5

by 6 months, are there any oogonia?

Back 5

not typically, they havce all been converted to primary oocytes.

Front 6

Primordial follicle

Back 6

single layer of granulosa cells enclosing an immature oocyte

this follicle is separated from surrounding cells by a thin BM

Front 7

primary follicle

Back 7

multilayered granulosa layer and zone pellucida

cuboidal differentiation of spindle-shaped cells. oocyte secretes a glycoprotein substance (ZPellucida) that is btwn oocyte and granulosa cells

Front 8

secondary follicle

Back 8

granulosa and thecal layer

theca next to basal lamina is the theca interna, the cells merging with surrounding stroma is theca externa.

Front 9

tertiary follicle

Back 9

antral follicle

fluid-space

this follicle rapidly expands in size due to gonadotropins to form the mature graafian follicle eventually.

Front 10

graafian follicle

Back 10

mature - still devoid of vascularization

Front 11

When does follicle become vascularized?

Back 11

just before ovulation.

Front 12

Why can women treated with PG synthase inhibitors (e.g. NSAIDS) fail to ovulate?

Back 12

PG is involved in rupture of the follicle. So these women have "luteinized unruptured follicle."

Note - so are proteolytic enzymes which digest teh collagen in the follicular wall.

Front 13

In corpus luteum, which cells secrete porgesterone?

Back 13

granulosa cells.

Front 14

Where does fertilization usually take place?

Back 14

The ampulla (widest and most distal portion of the fallopian tube) - within 24 hours of fertilization

Front 15

Optimal time for intercourse

Back 15

days imm preceding ovulation - the best is the day of ovulation

Front 16

Sperm interact with which zona pellucida protein?

Back 16

ZP3

Front 17

Which reaction is it that makes the ZP impenetrable

Back 17

cortical reaction

Front 18

Components of a blastocyst

Back 18

outer layer of cells whcih differentiate into trophoblasts, a fluid filled cavity, and an inner cell mass that will give rise to a fetus.

Front 19

When does human implantation take place?

Back 19

6-7 days after fertilization - around day 20 of a 28 day menstrual period

Front 20

Pinopodes

Back 20

microprotusions on surface epithelium of endometrium that allow initial apposition of embryo to uterine wall.

Front 21

Whata adhesion of embryo to endometrial wall usually occurs

Back 21

upper posterior area of the uterine fundus.

Front 22

Integrin alpha v beta 3

Back 22

expressed by trophoblasts and endometrial epithelial cells at time of implantation.

Front 23

LIF and HOXA10/A11 knock outs

Back 23

infertile due to implantation defects (these genes are necc for adhesion of embryo to endometrial wall).

Front 24

LIF

Back 24

contributes to trophoblast differentiation and embryonic gene activity.

Front 25

Expression of LIF, HOXA10 and A11

Back 25

menstrual cycle dependent manner.

Front 26

After blastocyst attaches to endometrum...

Back 26

trpohoblasts diff into cytotrophoblasts (inner) and syncytiotrophoblasts (outer - secretes hCG)

Front 27

Definition of infertility

Back 27

one year of unprotected intercourse with failure to conceive.

Incidence of this increases dramatically after age 35.

Front 28

Common causes of infertility

Back 28

anovulation, tubal occlusion, male factors.

Front 29

Tests to eval infertile couples

Back 29

semen analysis
hysterosalpingogram
confirmation of ovulation
laparoscopy and/or hysteroscopy
testing of ovarian reserve.

Front 30

Ways to determine ovarian reserves

Back 30

US to measure resting antral follicle count and total ovarian volume

cycle day 3 FSH, estradiol and inhibin B levels

clomid challenge test
FSH and estradiol on cycle day 3
clomiphene citrate 100mg given cycle day 5-9
FSH on cycle day 10

Front 31

FSH levels in relation to ovarian reserves declining

Back 31

They rise by day 3 because inhibin B release from granulose cells goes down. so there is less negative feedback.

Front 32

successful preg very rare when day 3 FSH levels are greater than

Back 32

15 mIU/ML

Front 33

IVF

Back 33

bypass fallopian tubes.

fertilize oocytes (from ovary) in the lab and then reimplant into endometrial cavity through the cervix.

for tubal occlusion and all other causes of infertility that don't respond to more conservative approaches

Front 34

ICSI - intracytoplasmic sperm injection

Back 34

for severe male factor infertility or prior poor/failed fertilization

Front 35

pre-implantation genetic diagnosis

Back 35

FISH or PCR the polar body or blastomere.

if blastomere, do it at 6-8 cell stage (day 3 after oocyte retrieval)

for couples with known defects or women over age 35.