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129 Cards in this Set
- Front
- Back
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Which component of Meiosis is most important to reproduction?
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Meiosis 1
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What accounts for the genetic diversification achieved in meiosis?
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Crossing over events between homologous chromosomes.
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Where on a chromosome does crossing over occur?
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At the chiasmata. Too few chiasmata are associated with chromosomal non-disjunction.
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When do female primate oocytes enter Meiosis?
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Close to birth.
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What happens to female eggs after Meiosis 1 begins?
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Meiosis 1 ARRESTS prior to cell division.
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When does Meiosis 1 resume in a female oocyte?
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After its arrest near birth, Meiosis 1 does not resume until shortly before ovulation.
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When does Meiosis 2 complete?
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The egg is held in Meiosis 2 until sperm penetrate the egg.
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How many eggs derive from a single oogonia once its been committed to Meiosis?
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1 gamete, and 2 polar bodies
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In what cell division stage do most aneuploidy abnormalities arise?
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During maternal meiosis 1.
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What cytogenetic dysfunction portends advanced maternal age?
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Poor chromosomal alignment at the metaphase plate.
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Which allele has been damage in Prader-Willi
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The father's.
Prader-Willi: Problem with the Paternal copy. (Paternal was deleted/mutated or two maternal were inherited.) |
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Which allele has been damaged in Angelman's?
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The mother's.
(Maternal was deleted/mutated or two paternal alleles were inherited.) |
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Which testicular cells make Testosterone?
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The Leydig Cells make testosterone.
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What stimulates the production of testosterone?
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LH, binding to LH Receptors on the Leydig cells, stimulates the production of Testosterone.
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Testosterone stimulates what support cell in the production of sperm?
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Testosterone stimulates Sertoli cell support of developing sperm. Other testicular support cells exist.
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What happens during seminal emission?
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Smooth mm w/in the epididymis slowly contracts, moving sperm toward the vas Deferens. Ciliary motion occurs as well.
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In what structure do sperm undergo the last steps of maturation?
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In the epididymis.
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How does the epididymis put a hold on sperm maturation?
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Proteins secreted in the epididymis, which must be removed in the female repro. tract, put a hold on sperm capacitation to avoid "early sperm burnout."
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What gland contributes fructose to the ejaculate?
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The Seminal Vesicles contribute approx. 60% of ejaculate volume, including fructose.
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How do sperm swim at ejaculation? After capacitation?
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Sperm are 'active' at ejaculation, and swim straight.
Sperm become 'hyperactive' within the female reproductive tract and start to swim in circles. |
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What is the "hallmark" of sperm capacitation?
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The Acrosome Reaction is considered to be the hallmark of sperm capacitation.
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Following ovulation, how is the oocyte-cumulus complex transported?
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Via ciliary action and smooth mm contraction.
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Where does oocyte fertilization most often occur?
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Most often w/in the Fallopian Tube.
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Why does only one sperm fertilize an oocyte?
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Cortical Granulation
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What controls the development of the fetal testis?
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The presence of a functional SRY gene is required direct the development of testes. (XY females are possible when the SRY gene is mutated.)
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What hormone is responsible for the regression of the Mullerian derivatives in a normal male?
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Mullerian Inhibiting Substance, produced by the Sertoli Cells
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Are active ovaries necessary for the development of a female genital tract?
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No. The female genital tract will develop in the absence of ovaries.
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What two roles do the fetal testes play in developing normal male reproductive anatomy?
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1) Masculinizing the Wolffian derivatives.
2) Repressing the Mullerian derivatives. |
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What internal structures derive from the Wolffian duct?
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1) Epididymis
2) Seminal Vesicles 3) Ejaculatory Duct |
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What structures derive from the Mullerian duct?
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1) Fallopian Tubes
2) Uterus 3) Upper 1/3 of the Vagina |
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What hormone stimulates Wolffian development?
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Testicular androgens, especially Testosterone.
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What hormone is responsible for the development of male external genitalia?
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DHT, or Dihydrotestosterone.
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What enzyme converts testosterone into DHT?
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5-alpha Reductase
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Without 5-alpha Reductase, what will happen to male external genetalia during development?
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Female external genitalia (clitoris, & labia) will develop, regardless of genetic or gonadal sex.
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What are the SXS of Turner's Syndrome?
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* Female external and internal genitalia
* Short, webbed neck * Risk of cardiac defects * Infertility |
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What's the result of a mutated, non-functional testosterone receptor?
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* Female phenotype due to unopposed estrogen
* Cryptorchidism - higher risk of testicular cancer * Blind vaginal pouch - Mullerian regression intact due to okay MIS |
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What would be the result of a 5-alpha-Reductase deficiency?
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No conversion of Testosterone -> DHT
* Hueves a Doce * Internal male anatomy intact (except prostate) * External male anatomy develops with testosterone surge at puberty |
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Which type of Congenital Adrenal Hyperplasia is SALT-WASTING?
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C-21 Deficient CAH
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What are the two big SXS of Kallman's Syndrome?
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* Anosmia
* Failure to initiate puberty |
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Is the presence GnRH enough to stimulate gonadotrope secretion?
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No - GnRH must be present in a PULSATILE fashion. Constant, tonic GnRH will actually INHIBIT LH/FSH release.
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What is the average periodicity of menses?
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28 Days
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At what ages are menses most IRREGULAR?
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For the young and the perimenopausal.
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How do estrogen levels affect the timing of the LH surge?
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* Tonically low estrogen levels SUPPRESS the LH surge
* Rising/Higher estrogen levels PROMOTE the LH surge |
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Which phase of the menstrual cycle is the most variable?
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The FOLLICULAR phase has the most variable phase length.
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Does a menstrual cycle guarantee ovulation?
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No.
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LH affects which cell type in follicular development?
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LH stimulates the Theca Cells to produce androgen hormones.
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Which follicular cells produce estrogen?
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FSH stimulates the Granulosa Cells to produce Estrogen (via an aromatase conversion of androgens.)
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Female oocytes have been arrested in Meiosis 1 since birth. What's the clue to restart one?
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The LH surge is the cue to restart meiosis for the dominant follicle during a menstrual cycle.
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What must happen to a follicle before the LH surge may trigger ovulation?
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Follicles must be "primed" by FSH and Estrogen (i.e., production of FSH receptors) if it is to respond to an LH surge
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From what follicular tissue layer does the Corpus Luteum derive?
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The Granulosa Layer
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What is the primary hormonal product of the luteal phase?
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Progesterone, produced by the corpus luteum. Estrogen is still produced as well.
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What pituitary hormone is required for the maintenance of the corpus luteum? What pregnancy hormone may prolong it?
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LH from the pituitary is required to maintain the function of the corpus luteum. hCG will maintain the corpus in the condition of pregnancy.
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Can pituitary LH maintain the Corpus Luteum indefinitely?
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No, spontaneous luteolysis will occur even in the face of high LH levels.
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How do high Estrogen levels prompt a surge in GnRH, initiating ovulation?
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Two Ways:
Pituitary: increases # of GnRH receptors and gonadotropins Hypothalamus: Incr. GnRH pulse via Kiss-1 |
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How does stress cause amenorrhea?
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Stress results in high circulating CRH levels, which up-regulate beta-endorphins in the CNS. BEs then INHIBIT the release of GnRH, causing a cessation of menses.
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What is the last event to define puberty in girls?
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Menarche
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What is the first event to define puberty in girls?
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Thelarche: onset of breast development
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Is the onset of puberty the same for boys and girls?
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No - girls tend to initiate puberty at a younger age
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What's the pathology behind Kallmann's Syndrome?
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Kallmann's is a congenital lack of GnRH-producing neurons.
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Is Kallmann's a primary or secondary dysfunction?
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Secondary - the problem is in the CNS, not in the gonads.
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What's the treatment for Kallmann's Syndrome?
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* Sex hormones
* Pulsatile GnRH administration |
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What's at risk in Precocious Puberty?
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Although these children will undergo a growth spurt, excess estradiol will prematurely close their epiphyseal growth plates, resulting in short stature.
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Does a delayed growth curve always require intervention?
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No - a 'Constitutional Delay of Puberty,' where everything is norma but delayed, requires only support.
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What's the first step in evaluating a pubertal issue?
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Is it HYPER or HYPO gonadotrophic?
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What are the top three causes of primary amenorrhea?
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1) Turner's Syndrome (XO)
2) Mullerian Agenesis (XX c/normal externals) 3) Adrogen Insensitivity (XY) |
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What are 4 was to confirm ovulation?
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1) Basal body temperature
2) LH Levels 3) Cervical mucous changes 4) Progesterone Levels |
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Can you test for advanced maternal age as a cause of infertility?
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Basal FSH testing will show elevated levels (need more FSH to stimulate fewer follicles)
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What are the 2 most common reasons for tubal scarring?
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1) PID due to Chlamydia
2) Endometriosis |
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What test is used to evaluate patent Fallopian Tubes?
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Hysterosalpingogram (HSG)
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What are the SXS of endometriosis?
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** Dysmenorrhea
* Fixed and retroverted Uterus * Pain on palpation * Dyspareunia |
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What is Clomid? How does it work?
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Clomid/Clomiphene is a Selective Estrogen Receptor Modulator. Clomid blocks the negative feedback inhibition of GnRH, thereby increasing GnRH pulse # and amplitude.
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What's the downstream effect of Clomid administration?
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Increased GnRH pulse #/amplitude will increase FSH levels.
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What's the risk of multiple pregnancies when treating anovulatory women with Clomid?
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8-10%
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Clomid + Metformin
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Polycystic Ovarian Syndrome
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What are PCOS women's ovaries packed with?
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Not Cysts. Atretic follicles.
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Why do women with PCOS show masculinized features?
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The atretic follicles replete in their ovaries produce high levels of both estrogen and ANDROGENS.
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Do PCOS women show normal menstrual cycles?
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Possibly. They may ovulate, however they may be anovulatory, or they may produce insufficient progesterone to sustain the endometrium.
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What is one of the major co-morbidities with PCOS?
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The Metabolic Syndrome
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Name three signs/RFs of PCOS
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1) Irregular cycles
2) Facial hair/acne 3) Acanthosis Nigricans 4) Obesity 5) Endometrial Hyperplasia |
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Why are oral contraceptives given to PCOS women?
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PCOS is assoc. with endometrial hyperplasia. The OCPs are given to reduce the risk of endometrial carcinoma
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Why are gonadotropins not used to induce ovulation?
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Gonadotropins are associated with a HIGH RISK of MULTIPLE pregnancies.
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What are the 4 BEST methods of contraception?
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1) IUD
2) Sterilization 3) Hormonal implants 4) Hormone injections |
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What are the 2 GOOD methods of contraception?
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1) OCPs
2) NuVa vaginal ring |
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How does Plan B emergency contraception work?
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* High dose of Progestin
* Progestin thickens mucous, makes implantation difficult * Must be used w/in 5 days |
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How does Progestin work as a contraceptive?
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* Higher levels of progestin inhibit LH release and suppress ovulation
* Progestin thickens cervical mucous * Higher Progestin levels result in thinning of the endometrium |
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How does Estrogen function in contraception?
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* Suppresses FSH
* Suppresses follicle development * Promotes formation of Progestin receptors |
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When are progestin-only pills indicated for contraception?
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During pregnancy
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When switching OCP brands, what's one thing to think about?
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FDA allows up to 20% inter-brand differences in bioavailability. May not work the same!
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What are some of the beneficial SEs of OCP?
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* Decr. dysmenorrhea
* Acne tx * Decr. incidence of ovarian and endometrial cancer * Increased bone density |
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What are the risks in OCP?
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* Thromboembolism
* MI * HTN * Incr. Breast CA |
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Are the risks in OCP any different than pregnancy?
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Overall mortality of OCP is LOWER than that of pregnancy.
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What's the risk of a pill-free interval in OCP use?
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Up to 25% of women have a follicle ready to ovulate by day 7 of the interval.
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What's one problem with the Transdermal E&P Patch?
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Higher risk of failure in overweight women (not true of OCP).
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What's one effective female contra. method that doesn't involve oral medications?
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* E&P Vaginal Ring
* Requires only monthly changes |
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Does the depot Progestin injection have an effect on bone mineral density?
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No. It's safe for 2-5 years of continuous use, with no need for bone mineral density testing.
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Why does estrogen increase risks of clotting?
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After 2-4 weeks of use, liver metabolism of estrogen causes changes in clotting factors and coagulation.
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What's one absolute contraindication in the use of OCPs?
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History of ARTERIAL clotting (CVA, MI)
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What are the two long-term 'injectable' methods of contraception? What drug do they use?
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* Depo-Provera and Implanon
* They both use Progestin only |
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What's the major problem with pregnancies that DO establish following a tubal ligation?
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Many are ECTOPIC
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How do Copper IUDs function?
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Primary:
* disrupt sperm motility * disrupt oocyte division * prevent fertilization Secondary: * Sterile inflammation of endometrium |
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Besides Plan B, what other emergency contraception is available?
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Placement of a Copper IUD
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How does the Mirena accomplish contraception with such low does of drug?
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Mirena uses LOCAL doses of drug (intra-uterine)
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What are the additional benefits of Mirena?
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* Decrease in menstrual blood loss (40% women amenorrheic after 1 yr)
* Decrease in fibroid/endometriosis symptoms |
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What are the support cells of the seminiferous tubules?
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The Sertoli Cells. They Support Spermatogenesis and respond to FSH.
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Which are the testosterone-producing cells in the testes?
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The Leydig cells: respond to LH
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Where is most circulating testosterone located?
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Testosterone is mostly bound to Albumin in the serum.
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What are the two derivative hormones of testosterone?
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Estradiol - made by Aromatase
DHT - made by 5 alpha Reductase |
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What are the systemic effects of DHT?
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1) Dev't. of male external genitalia
2) Male pattern baldness 3) Prostatic hypertrophy |
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What does estradiol do in the male?
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* Incr. bone mineral density
* Epiphysial closure after puberty |
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What is one condition is associated with gynecomastia in males?
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Hypogonadism.
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A postnatal but pre-pubertal androgen deficiency will result in what phenotype?
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Eunichoid:
* Small genetalia, long limbs * Delayed puberty: high voice, lack of hair, aspermia |
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What is PRIMARY hypogonadism?
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High FSH/LH levels with LOW testosterone. Kleinfelter's
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What are the fertility treatment options for Kleinfelter's?
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* Adoption
* Sperm donation * ICSI |
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What are the causes of hypergonadotrophic hypogonadism?
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* Kleinfelter's
* Mumps Orchitis * Cryptorchidism * Trauma * Radiation |
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What are the causes of hypogonadotrophic hypogonadism?
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* Kallmann's Syndrome
* Pituitary Disease * Severe Illness/Stress * Aging * Hemochromatosis * Hyperprolactinemia |
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What are the fertility treatment options for Kallmann's Syndrome?
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FSH/LH Therapy
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Name one pharm agent for premature ejaculation.
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SSRIs
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What's one physical sign of testosterone abuse?
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Large body physique with small testicular volume
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What are two pharm tx options for BPH?
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* Alpha antagonists to relax prostatic smooth mm
* 5-alpha Reductase Inhibitor to block DHT production |
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What are two important physiologic questions to ask when evaluating male infertility?
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1) Coital frequency
2) Ejaculation |
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When evaluating infertility, what are 3 important elements in the male exam?
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1) Testicular size
2) Varicocele 3) Presence of the vas Deferens |
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Causes of male ENDOCRINE infertility?
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* Kallman's
* Pituitary Tumor |
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Causes of male ANATOMIC infertility?
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* Congenital absence of the vas
* Varicocele * Hydrocele * Hernia |
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Causes of male COITAL infertility?
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* Infrequency (every other day)
* Timing (two days PRIOR to ovulation) |
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Causes of male EJACULATORY infertility?
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* Retrograde ejaculation
* Anejaculation |
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Causes of male INFECTIOUS/TOXIC infertility?
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* Mumps orchitis (post-pubescent)
* Chemotherapy * Radiation * Drugs |
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What is the most common cause of congenital male infertility?
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Klinefelter's Syndrome
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ICSI
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Intra-Cytoplasmic Sperm Injection
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TESE
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Testicular Sperm Extraction
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