Physiology II:

Reproductive System

Md. Abdul Muhit, PhD

Professor
Department of Clinical Pharmacy and Pharmacology
University of Dhaka, Bangladesh
➢ Reproductive system ensures the continuation of species.
Humans have a high level of sexual differentiation
➢ Gonads are the primary reproductive organs which produce the
gametes; a pair of testes (singular = testis) produces sperms in
males and a pair of ovaries produces ovum in females.
➢ In earthworms and snails, both sexes may be present in the same
organism and it is known as hermaphroditism.
➢ Only one sperm is required to fertilize the ovum. Upon successful
fertilization, the zygote, travels out of the fallopian tube and into
the uterus, where it implants in the uterine wall. This marks the
beginning of gestation, known as pregnancy, which continues for
around nine months.
➢ When the fetus has developed to a certain point, pregnancy is
concluded with childbirth, involving labor. During labor, the uterine
muscles contract, the cervix dilates over a period of hours,
allowing the infant to pass from the uterus through the vagina.
➢ Male reproductive system includes primary sex organs such as
testes and secondary sex organs are seminal vesicles, prostate
glands, urethra, penis etc.
➢ Two testes in almost all the species.
➢ Ovoid or walnut-shaped testes are located and suspended in a
sac-like temperature sensitive structure called scrotum. Each
testis weighs about 15 to 19 g and measures about 5 × 3 cm.
➢ The testis is composed of up to 900 coiled seminiferous tubules,
each averaging 1.5 meter long, which produce sperms. .
➢ Seminiferous tubules continue as the vas efferens, which form the
epididymis (6 m long). It is continued as vas deferens.
➢ Vas deferens is also called ductus deferens, spermatic deferens or
sperm duct.
➢ From epididymis in scrotum, the vas deferens extends on its one
side upwards into abdominal cavity via inguinal canal. Terminal
portion of vas deferens is called ampulla.
➢ Ampulla of vas deferens joins ducts of seminal vesicle of same
side, to form ejaculatory duct.
➢ Thus, there are two ejaculatory ducts each of which receives
sperm from vas deferens and secretions of seminal vesicle on its
own side.
➢ Prostatic ducts, too, empty from the prostate gland into the
ejaculatory duct and from there into the prostatic urethra.
➢ Both the ejaculatory ducts empty into a single urethra. Finally, the
urethra is the last connecting link from the testis to the exterior.
➢ The urethra is supplied with mucus derived from a large number of
minute urethral glands named bulbourethral glands (Cowper’s
glands) located near the origin of the urethra.
➢ Each seminiferous tubule contains two kinds of cells such as germ
cells and sertoli cells
➢ Germ cells lie in between sertoli cells and are arranged in an
orderly manner in 4-8 layers.
➢ In children testes is not fully developed so only primitive germ cells
called spermatogonia is present. With onset of maturity, different
germ cells are produced like spermatogonium, primary
spermatozyte, secondary spermatozyte and spermatid.
➢ The germ cells present in seminiferous tubules are attached to
sertoli cells by means of cytoplasmic connection.
➢ Their functions are supporting and nourishing the germ cells,
provide hormonal and other substances, convert androgens to
estrogen, secrete androgen binding protein for the action of
testosterone etc.
 The process by which the male gametes are formed.
 During formation of the embryo, the primordial germ cells
migrate into the testes and become immature germ cells
called spermatogonia.
 The spermatogonia begin to undergo mitotic division,
beginning at puberty, and continually proliferate and
differentiate through definite stages of development to form
sperm.
 In the first stage of spermatogenesis, the spermatogonia
migrate among Sertoli cells toward the central lumen of the
seminiferous tubule.
 Spermatogonia that cross the barrier into the Sertoli cell
layer become progressively modified and enlarged to form
large primary spermatocytes.
 Each of these, in turn, undergoes meiotic division to form
two secondary spermatocytes. After another few days,
these too divide to form spermatids that are eventually
modified to become spermatozoa (sperm).

 During the change from the spermatocyte stage to the

spermatid stage, the 46 chromosomes (23 pairs of
chromosomes) of the spermatocyte are divided, so that 23
chromosomes go to one spermatid and the other 23 to the
second spermatid.

 The entire period of spermatogenesis, from spermatogonia

to spermatozoa, takes about 74 days.
1. Testosterone, secreted by the Leydig cells located in the
interstitium of the testis, is essential for growth and division of
the testicular germinal cells, which is the first stage in forming
sperm.

2. Luteinizing hormone, secreted by the anterior pituitary gland,

stimulates the Leydig cells to secrete testosterone.

3. Follicle-stimulating hormone, also secreted by the anterior

pituitary gland, stimulates the Sertoli cells; without this
stimulation, the conversion of the spermatids to sperm (the
process of spermiogenesis) will not occur.

4. Estrogens, formed from testosterone by the Sertoli cells when

they are stimulated by follicle stimulating hormone, are probably
also essential for spermiogenesis.
5. Growth hormone is necessary for controlling background
metabolic functions of the testes.

6. Inhibin, is a peptide belonging to transforming growth factor

family, secreted from sertoli cells. It inhibits secretion of FSH by
feedback mechanism to control rate of spermatogenesis.

7. Activin, may be secreted from Leydig cells or sertoli cells

causes opposite action of inhibin.

 Increase in temperature prevents spermatogenesis. Normally the

temperature of scrotum is about 20c less than body temperature,
which is essential for spermatogenesis. When it increases then
spermatogenesis may stop.

 Infectious diseases such as mumps cause degeneration of

seminiferous tubules and absence of spermatogenesis.
 Male sex hormones are called the androgens. Testis
secretes three androgens:

 Testosterone
 Dihydrotestosterone
 Androstenedione

 Testosterone secretes in large quantities but

dihydrotestosterone is more active.
 Androgens are secreted mainly from testes interstitial cells
of leydig. Adrenal cortex also secretes small amount of
androgens but have no significant physiological effects.
 Male: 300-1000 ng/dL; Female: 30-60 ng/dL.
 About 97% of the testosterone either loosely bound with
plasma albumin or more tightly bound with a beta globulin
called sex hormone–binding globulin and circulates in the
blood in these states for 30 minutes to several hours.
 Much of the testosterone fixed to the tissues that is
converted to dihydrotestosterone. In adipose tissue,
hypothalamus and liver, testosterone is converted into
estradiol.
 The testosterone that does not become fixed to the tissues
is rapidly converted, by the liver, into androsterone and
dehydroepiandrosterone and simultaneously
conjugated as either glucuronides or sulfates. These are
excreted either into the gut by way of the liver bile or into the
urine through the kidneys.
 Testosterone secretion starts at 7th week of fetal life by fetal
genital ridge.
 Fetal testes begin to secrete testosterone at about 2nd to
4th month of fetal life. In fetal life, testosterone secretion is
stimulated by human chorionic gonadotropins, secreted by
placenta.
 But in childhood, practically no testosterone is secreted
approximately until 10 to 12 years of age.
 Afterwards, the testosterone secretion starts and it
increases rapidly at the onset of puberty and lasts through
most of the remaining part of life.
 The secretion starts decreasing after 40 years and
becomes almost zero by the age of 90 years
In fetal life:
 Sex differentiation in fetus: Fetus has two genital ducts.
Mullerian duct which gives rise to female sex organs where
as Wolffian duct gives rise to male sex organs. If
testosterone is secreted at about 7th week of intrauterine life,
the Mullerian duct system disappears because of Mullerian
regression factor (MRF) secretion from Sertoli cells and
male sex organs develop from Wolffian duct.
 Development of accessory sex organs and external genitalia
 Descent of testes: Initially testes are developed in the
abdominal cavity and later pushed into the scrotum just
before birth. The process is called descent of testes. If a
male child is born with undescended testes, the condition is
called cryptorchidism.
In Adult life:
 On primary sex organs: It increases the size of all primary
sex organs (Penis and scrotum). It is also necessary for
spermatogenesis.
 Muscular growth: It causes development of musculature in
puberty due to anabolic activity of testosterone on proteins.
It accelerates transport of amino acids into muscle cells,
synthesis of proteins and storage of proteins.
 Bone growth: The increase in bone thickness is due to
increase in total content of bone matrix with deposition of
calcium. This is due to anabolic activity of testosterone. It
also causes broadening of shoulder, funnel like shape of
pelvis, narrowing of pelvic outlet etc.
In Adult life:
 On skin: It increases the thickness of the skin over the
entire body surface due to protein deposition below the skin.

 It also increases the quantity of melanin pigment, which is

responsible for deepening of skin color.

 It also enhances the secretion of sebaceous glands. So at

the time of puberty excess secretion of glands causes
development of acne. After few years the body acclimatized
with testosterone level and acne disappeared.

 On hair: It causes male type distribution of hair throughout

the body. But it decreases the hair growth on the head and
may cause baldness.
In Adult life:
 On voice: It causes hypertrophy of laryngeal muscles and
enlargement of larynx and thickening of vocal cord. All these
causes cracking of voice at adolescent and later stage
causes bossing like sound.
 On BMR: It increases BMR upto 15%.
 Electrolyte and water balance: It increases the sodium
absorption from renal tubules. So sodium retention
increases. It leads to water retention and increases in ECF
volume.
 On Blood: It causes mild increase in blood volume by
increasing water and number of RBC’s.
 Anabolic steroids:
✓ Anabolic steroids, also known as anabolic-androgenic
steroids (AAS), are structurally related to testosterone, and
produce effects by binding to the androgen receptor (AR).
✓ Danazol, Metenolone, nandrolone, stanozolol,
methandrosteneolone, Trenbolone, Norethandrolone,
Oxymetholone etc.
✓ Therapeutic use: Growth stimulation, Bone marrow
stimulation, Hormone replacement therapy, Induction of
puberty in males, Masculinizing therapy for transgender men,
treatment of osteoporosis in postmenopausal women,
Stimulation of lean body mass etc.
✓ AAS have been used by men and women in many different
kinds of professional sports to attain a competitive edge or to
assist in recovery from injury.
 It increases rate of protein formation in the target cells. In the
prostatic gland, testosterone enters the prostatic cells within a
few minutes after secretion.
 Then it is converted to dihydrotestosterone, under the influence
of the intracellular enzyme 5α-reductase, and this in turn binds
with a cytoplasmic “receptor protein.”
 This combination migrates to the cell nucleus, where it binds
with a nuclear protein and induces DNA-RNA transcription.
 Within 30 minutes, RNA polymerase has become activated and
the concentration of RNA begins to increase in the prostatic
cells; this is followed by progressive increase in cellular protein.
 After several days, the quantity of DNA in the prostate gland
has also increased and there has been a simultaneous
increase in the number of prostatic cells.
➢ During fetal life, testosterone secretion is stimulated by human
chorionic gonadotropin. It stimulates the development of Leydig
cells in the fetal testes and promotes testosterone secretion.
➢ In adults, LH or interstitial cell stimulating hormone (ICSH)
stimulates the Leydig cells and secretes testosterone.
➢ Secretion of LH from anterior pituitary gland is stimulated by
Luteinizing hormone releasing hormone from hypothalamus.
➢ Testosterone regulates its own secretion by negative feedback
mechanism. It acts on hypothalamus and inhibits the secretion of
LHRH. When LHRH secretion is inhibited, LH is not released from
anterior pituitary resulting in stoppage of testosterone secretion
from testes.
➢ On the other hand, when testosterone production is low, lack of
inhibition of hypothalamus leads to secretion of testosterone
through LHRH and LH.
 Semen is a white or grey fluid that contains sperm. It is
the collection of fluids from testes, seminal vesicles,
prostate glands and bulbourethral glands.

 It is discharged during sexual act and the process of

discharge is called ejaculation.

 Composition: 10% sperms and 90% of fluid part which

is called seminal plasma.

 Seminal plasma contains fluid from seminal vesicle and

prostate gland (60% seminal fluid, 30% prostatic fluid).
Seminal vesicles fluid (60%): fructose, fibrinogen,
Prostaglandin, flavin, inositol, pepsinogen, phosphorylcholine,
citrate, citric acid, ascorbic acid.

Functions of Seminal Fluid:

 Nutrition of sperms by fructose in female genital tract.

 Fibrinogen from seminal vesicles is converted to coagulum

as soon as semen is ejaculated
 Prostaglandin of the seminal vesicle enhances the
fertilization of ovum by increasing the receptive capacity of
cervical mucosa for sperms and causing reverse peristaltic
movement of uterus and fallopian tubes. It increases the
rate of transport of sperms in female genital tract.
Prostatic fluid (30%): Acid phosphatase, cholesterol, clotting
enzymes, fibrinogen, glucose, lactate dehydrogenase,
phospholipids, plasminogen activator, seminin, spermine,
bicarbonate, calcium, citrate, sodium, zinc.
Functions:
➢ Maintenance of sperm motility: Provides optimum pH. Sperms
are immotile in less than 6.0 pH. Specially helps in females
genital tract where pH is acidic (3.5-4.0).
➢ Clotting of semen
➢ Lysis of coagulum
Applied physiology
➢ Benign prostatic hyperplasia: Adult age (60+), frequent
urination due to obstruction in urine flow from bladder.
➢ Malignant enlargement: Cancer occurs
 Sperm is the male gamete, developed in testis. It is also
called spermatozoon. Matured sperm is 60 µ long.

 Count: About 50-100 millions/mL of semen. Sterility occurs

when the sperm count falls below 20 millions/mL.

 Survival time: Though sperms can be stored in male

genital tract for longer period but after ejaculation the
survival time is only 24-48 hours.

 Motility: Rate of motility of sperm in female genital tract is

about 3 mm/min. Sperms reach the fallopian tube in about
30-60 minutes after sexual intercourse.
 Sperm consists of four parts:
1) Head 2) Neck 3) Body or middle piece 4) Tail
❖ Head: Oval shape, with a length of 3-5 µ and width of up to
3 µ.

❖ Head is covered by a thin cell membrane and it is formed by

a condensed nucleus with a thin cytoplasm.

❖ Anterior two thirds of the head is called acrosome or galea

capitis.

❖ Acrosome is made up of mucopolysaccharide and acid

phosphatase.

❖ Acrosome also contains hyaluronidase and proteolytic

enzymes which are essential for the sperm to fertilize the
ovum.
➢ Neck: Head is connected to the body by a short neck. It has
anterior end knob which is disk shaped called proximal
centriole as well as posterior end knob.

➢ Often the neck and body of sperm are called midpiece.

➢ Body: Cylindrical with a length of 5-9 µ and thickness of 1 µ.

The body of the sperm consists of a central core called axial
filament.

➢ Axial filament is surrounded by a closely wound spiral

filament consisting of mitochondria.

➢ Tail: It is enclosed by cytoplasmic capsule and has an axial

thread. It is 40-50 µ long.
1. Volume of semen per ejaculation must be at least
2 mL.
2. Sperm count must be at least 20 million/mL.
3. 75% of sperms per ejaculation must be alive.
4. 50% of sperms must be motile.
5. 30% of sperms must have normal shape and size.
6. Head defect must be less than 35%.
7. Midpiece defect must be less than 20%
8. Tail defect must be less than 20%
➢ Azoospermia: Lack of sperm in semen.

➢ Oligozoospermia: Low sperm count and infertility

➢ Teratozoospermia: Presence of sperms with abnormal

morphology. It occurs in Crohn’s disease, Hodgkin disease,
celiac disease.

➢ Aspermia: Lack of semen. It occurs due to retrograde

ejaculation. It is the entrance of semen into urinary bladder
instead of entering urethra.

➢ Oligospermia: Low volume of semen.

➢ Hematospermia: Appearance of blood in semen due to

infection.
 Primary sex organs:
▪ Pair of ovaries that produce ovum and secrete
female sex hormones (estrogen and
progesterone).

 Accessory sex organs:

▪ Genital ducts: Fallopian tubes, uterus, cervix
and vagina
▪ External genitalia: Labia majora, labia minora
and clitoris
 Lifespan of a female reproductive system:

▪ First period: From birth to puberty. Primary and

accessory sex organs do not function.

▪ Second Period: from onset of puberty to the onset of

menopause. First menstrual cycle is called as
menarche. Permanent stoppage of the menstrual
cycle is called menopause, which occurs at the age of
45-50 yrs. During this period, women menstruate and
reproduce.

▪ Third period: After menopause to the rest of the life.

Flattened ovoid shaped with dimensions of 4 cm in length, 2
cm in width and 1 cm in thickness.
On cross section, each ovary shows two zones:
1. Medulla : Central deeper portion
2. Cortex : Outer broader portion
Medulla is known as zona vasculosa contains blood vessels, lymphatics,
nerve fibers, smooth muscles.
Outer broader layer is cortex.
1. Glandular structures with follicles
2. Connective tissues
3. Interstitial cells formed from theca interna
Ovarian Follicles:
✓ At the 7th or 8th month of intrauterine life, about 6 million primordial
follicles are found
✓ At the time of birth, 1 million remains
✓ At the time of puberty, 3 – 4 lacs remain.
✓ During menstruation, only one of these turns into ovum and released
any one of the ovaries.
 1. Secretion of female sex hormones
2. Oogenesis
3. Menstrual cycle

✓ Mainly secrete estrogen and

progesterone.
✓ Few amount of inhibin,
relaxin and androgens.
✓ Estrogens or Oestrogens are a group of compounds named
for their importance in both menstrual and estrous
reproductive cycles.
✓ Natural estrogens are steroid hormones, while some
synthetic ones are non-steroidal.
✓ The three major naturally occurring estrogens in women
are estrone, estradiol and estriol.
✓ The quantity and potency of estradiol are more than those
of estrone and estriol.
✓ In a normal non-pregnant woman, estrogen is secreted
mainly from theca interna cells of ovarian follicles and in
small quantity from corpus luteum of the ovaries.
✓ Small quantity of estrogen also secreted by adrenal cortex.
✓ In pregnancy, large amount of estrogen is secreted from
placenta.
✓ Estrogen is derived from androstenedione which is secreted
in theca interna cells. Then it migrates to granulosa cells
and converted to estrogen by aromatase enzyme.
✓ Plasma level of estrogen in follicular phase is 30-200
pg/mL. In normal adult male, estrogen level is 12-34 pg/mL.
✓ Half life of estrogen is 30-60 minutes.
✓ Estrogen is transported mainly by the plasma protein
albumin and small quantity with globulin.
1. Ovarian follicles:
✓ Estrogen promotes the growth of ovarian follicles by increasing the
proliferation of the follicular cells.
✓ It also increases the secretory activity of theca cells.
2. Uterus:
✓ Enlargement of uterus.
✓ Increase in fat, glycogen deposition and blood supply to endometrium
✓ Increase activity of smooth muscle cell
✓ Increase sensitivity to oxytocin

3. Fallopian tubes:
✓ Increase the number and size of the epithelial cells lining the tubes.
✓ Increases the activity of the cilia so that movement of ovum is facilitated.
✓ Enhances the proliferation of glandular tissues.
4. Vagina:
➢ Changes the vaginal epithelium from cuboidal to stratified type that
allows protection from injury.
➢ Reduces pH.
5. Breast:
✓ Development of the stromal tissues of the breasts
✓ Growth of an extensive ductile system
✓ Deposition of fat in ductile system

6. Bones:
✓ Increase osteoblastic activity (synthesize bones).
✓ In old age, no estrogen occurs cessation of bone growth and
promotes osteoporosis.
1. Hair develops in the pubic region and axila. Body hair growth
is less. Scalp hair grows profusely.
2. Skin become soften and smoothness
3. Shoulders become narrow, hip broadens and fat deposition
occurs in several part of the body.
4. The larynx remains in prepubertal stage, which produces high
pitch voice.
5. Broadening of pelvis with increased transverse diameter.
Round or oval shaped.
6. Estrogen induces protein anabolism.
7. Estrogen causes deposition of fat in the subcutaneous tissues.
8. Estrogen causes sodium and water retention by the renal
tubules.
➢ A small quantity is secreted from ovaries during first half of
menstrual cycle. Large quantity in later stage of ovarian cycle.
➢ Small amount also secreted from adrenal cortex.
➢ During pregnancy, large amount secreted from corpus luteum in
first trimester but from placenta in second and third trimester.
Level:
➢ Male: 10-50 ng/dL ; Female: Follicular phase: < 50 ng/dL, Luteal: 300-
2500 ng/dL, Postmenopausal: < 40 ng/dL; Pregnancy: 1st trimester:
725-4400 ng/dL, 2nd: 1950-8250 ng/dL, 3rd : 6500-22,900 ng/dL
➢ Abrupt decline at the end of the cycle causes onset of menstruation.

M/A of progesterone-containing contraceptives: To start next follicular phase,

progesterone decreases gonadotrophin-releasing hormone (GnRH) pulse
frequency to suppress gonadotropin release and resets the hypothalamic-pituitary-
gonadal axis. Elevated level of progesterone can suppress GnRH activity.
1. Uterus:
➢ Promotes secretory activity of endometrium during secretory phase of
the menstruation cycle
➢ Increases the thickness of endometrium (1 mm to 5 mm)
➢ Increase the secretory activity of the glandular cells.
➢ Increases the deposition of lipid and glycogen
➢ Increases the blood supply to endometrium
➢ Decreases the frequency of uterine contraction during pregnancy

2. Fallopian tubes:
➢ Promotes the secretory activity of the mucosal lining of the fallopian
tubes.
➢ Helps in the nutrition and fertilization of ovum
3. Breasts:
➢ Promotes development of lobules and alveoli of the breasts
➢ Increases secretory activity and fluid accumulation in the
subcutaneous tissues

4. Others:
➢ Increases reabsorption of sodium and water through the renal tubules.
But in large doses, it increases their secretions.
➢ Inhibits the release of LH from hypothalamus through feedback effect.
This effect is utilized for its contraceptive action.
➢ Increases body temperature after ovulation but mechanism is
unknown.
➢ During luteal phase of menstrual cycle and pregnancy, progesterone
increases the ventilation via respiratory center
✓ The cyclic events that take place in a rhythmic fashion (28
days of duration) during reproductive period of a woman’s life
is called menstrual cycle.
✓ It starts at the age of 12 to 15 years which makes the onset of
puberty.
✓ It ceases at the age of 45 to 50 years of age.
✓ The permanent cessation of menstrual cycle is called
menopause
There are series of changes occur:
A. Ovarian changes
B. Uterine changes
C. Vaginal changes
D. Changes in cervix
1. Follicular phase

2. Luteal phase

Follicular phase:

From 5th day to the ovulation which takes place in 14th day.

Maturation of ovum with development of ovarian follicles occur.

1. Follicular phase:
Ovarian follicles are glandular structures which consists of the ovum
surrounded by granulosa cells.
❖ Primordial follicles
❖ Primary follicles
❖ Secondary or Vesicular follicles
❖ Graafian follicles
➢ Both ovaries contain about 4 lacs primoridial follicles.
➢ Each primordial follicle has an ovum which is incompletely surrounded
by the granulosa cell.
➢ These cells provide nutrition to the ovum.
➢ Diameter is 15-20 µ and ovum is 10µ.
➢ Under the influence of FSH and LH they
start growing.

➢ When the ovum is completely surrounded by

granulosa cell, they called primary follicles.
➢ Diameter of the follicle increases to 30-40µ
and ovum is 20µ.
➢ The follicle is not covered by connective tissue.
✓ Due to FSH, about 6-12 follicles developed into vesicular
follicles.
✓ Some irregular spaces appear in between the granulosa cells.
This spaces forms the cavity called antrum.
✓ The antrum increases in size and ovum is pushed into one side
surrounded by granulosa cells forming the germ hill or cumulus
oophorus. Cells of germ hill become columnar and form corona
radiata.
✓ Ovum diameter is 100-150µ and nucleus become large and
cytoplasm becomes granular.
✓ Thick membrane is formed surrounding the ovum which is called
zona pellucida.
✓ The covering sheath is called theca folliculi. Two types: Theca interna
and theca externa
✓ Theca interna is the inner vascular layer that contains special kinds of
epithelial cells those secrete female sex hormones.
✓ Theca externa is the outer layer that consists of thickly packed fibers and
spindle shaped cells.
✓ 7th day of cycle, one of the vesicular follicle outgrows the others
and becomes the dominant follicle to become graafian follicle.
✓ It is the matured ovarian follicle with
maturing ovum.
✓ The size of the follicle increases to
about 10-12 mm.
✓ Protrusion is occurred and formed
stigma.
✓ Follicular cavity becomes larger
✓ Zona pellucida becomes thick
✓ Corona radiata, theca interna
becomes prominent
✓ On 14th day graafian follicle is
ready for the process of ovulation
 The rupture of Graafian follicle with consequent
discharge of ovum into abdominal cavity under the
influence of LH. It occurs usually on 14th day of a
normal cycle. The ovum enters the fallopian tube.

 The ovum should be fertilized within 24-48 hours

unless it will not be viable.

 After fertilization the ovum is called zygote. From the

tube it reaches to uterus on 3rd day after ovulation.
The implantation of zygote in the uterine wall
occurs on 6th or 7th day.
➢ Between 15th day to 28th day. During this phase corpus luteum is
developed. Hence this is called luteal phase.
➢ Corpus luteum is a glandular yellow body developed from ruptured
Graafian follicle after release of ovum.
➢ Development of corpus luteum: Soon after rupture, follicle is filled
with blood and called corpus hemorrhagicum. It transformed into
corpus luteum.
Functions:
➢ It acts as temporary endocrine gland and secretes large quantity of
progesterone and small quantity of estrogen. LH influences the
secretion of these two hormones.
➢ In pregnancy: If pregnancy occurs, it remains active for 3 months.
Hormones secretes from corpus luteum is very much essential for the
maintenance of pregnancy. It secretes hormone until placenta starts
secretion. Abortion occurs if corpus luteum is inactive.
Fate of corpus luteum:
 If ovum is fertilized: It persists and increase in size, transformed into
corpus luteum graviditatis. It remains in ovary for 3 to 4 months.
During this period it secretes large amount of progesterone and small
amount of estrogen which are essential for the maintenance of the
pregnancy.
 If ovum is not fertilized: Reaches
at maximum size in one week.
Then degenerates into corpus
luteum menstrualis. The cells
decrease in size and smaller.
After then transformed into
corpus albicans. The process
by which it undergoes
regression is called Luteolysis.
Three phases:

1) Menstrual
phase

2) Proliferative
phase

3) Secretory
phase
❖ After ovulation if the fertilized ovum is implanted on the uterine
wall, pregnancy occurs. If pregnancy does not occur the
thickened endometrium is shed or desquamated and expelled
out through vagina along with some blood and tissue fluid. The
process of shedding and exit of uterine lining along with
blood and fluid is called menstruation.
❖ It lasts for 4 to 5 days. This is called menstrual phase or period,
menses, emmenia or catamenia.
❖ The day when bleeding starts is considered as the first day of
the menstrual cycle.
❖ Two days before the onset of bleeding, that is on 26th or 27th day
of the previous cycle, there is sudden reduction in the release of
estrogen and progesterone from ovary. Decreased level of
these two hormones is responsible for menstruation.
❑ Changes in Endometrium: Lack of estrogen and progesterone
causes sudden involution of endometrium and reduce the size of
endometrium by 65% of original thickness (remain 1 mm layer
only).
❑ Severe vasoconstriction occurs due to prostaglandin
(vasoconstrictor).
❑ Leads to hypoxia which results in necrosis. Necrosis causes
rupture of blood vessels and oozing of blood (about 35 mL along
with 35 mL of serous fluid) through vagina.
❑ This process is continued for 24-36 hours.
❑ The blood clots as soon as it oozes into the uterine cavity.
Fibrinolysin causes lysis of clot in uterine cavity. However in the
pathological conditions involving uterus, the lysis of blood clot
does not occur. So the menstrual fluid comes out with blood clot.
❑ Menstruation stops between 3rd and 7th day of the cycle.
➢ It extends from 5th day to 14th day (between the day when
menstruation stops and the day of ovulation). It corresponds to
the follicular phase of ovarian cycle.
➢ At the end of menstrual phase only 1 mm of endometrium
remains.
➢ Endometrial cells proliferates rapidly and reappears within 4 to 7
days.
➢ Uterine glands starts developing stroma and blood vessels. The
layers reaches at 3-4 mm of thickness.
➢ All these uterine changes occurs due to the influence of estrogen
released from ovary.
➢ On 14th day ovulation occurs due to LH. This is followed by
secretory phase.
✓ It extends from 15th day to 28th day (between the day of ovulation
and the day when menstruation of next cycle commences).
✓ After ovulation, corpus luteum is developed in the ovary. It
secretes a large quantity of progesterone along with small
quantity of estrogen.
✓ Estrogen causes further proliferation of cells in uterus.
Progesterone causes further enlargement of endometrial stroma
and growth of glands.
✓ Endometrium glands become tortuous and increase in size, and
get accommodated within the endometrium.
✓ Starts developing stroma and new blood vessels. Blood supply
also increases. The layers reaches at 6 mm of thickness.
✓ Secretory phase is the preparatory period for implantation of
ovum. If a fertilized ovum is implanted then it becomes into fetus.
 ➢ Unpleasant symptoms with discomfort, which
occurs due to hormonal withdrawal, leading to
cramps in uterine muscle before or during
menstruation.
➢ Abdominal Pain, Dysmenorrhea (menstrual pain),
headache, nausea and vomiting, irritability,
depression, migraine etc.

➢ Also called premenstrual stress syndrome. It

lasts for about 4-5 days prior to menstruation.
Symptoms appear due to salt and water
retention due to estrogen.
➢ Mood swings, Anxiety, irritability, emotional
instability, headache, depression, constipation,
abdominal cramping, bloating etc.
 Amenorrhea: Absence of Menstruation

 Hypomenorrhea: Decreased menstrual bleeding

 Menorrhagia: Excess menstrual bleeding

 Oligomenorrhea: Decreased frequency of menstrual

bleeding

 Polymenorrhea: Increased frequency of menstruation

 Metrorrhagia: Uterine bleeding in between

menstruations.
❑ Climectric is the period in old age when reproductive system undergoes
changes due to decreased secretion of sex hormones, estrogen and
progesterone. It occurs at the age of 45-55. In females, climectric is
accompanied by menopause.
❑ Menopause is defined as the period when permanent cessation of
menstruation takes place.
❑ Due to aging, the atrophy of ovaries occurs. It leads to the cessation of
menstrual cycle. Throughout a woman’s sexual life, about 450 of the
primordial follicles grow into Graafian follicles and ovulate, while
thousands of the follicles degenerate.
❑ At the age of 45 years, only few primordial follicles remain in the ovary to
be stimulated by FSH and LH. Now the production of estrogen by ovary
decreases due to the decrease in the number of primordial follicles.
❑ Early menopause may occur because of surgical removal of ovaries
(ovariectomy) or uterus (hysterectomy) as a part of treatment for
abnormal menstruation.
Postmenopausal syndrome: These symptoms may last
for few months to few years. It occurs due to the lack of
estrogen and progesterone and body gets acclimatized to
the absence of estrogen and progesterone slowly.
1. Hot flashes: Extreme flushing of the skin. It start
with discomfort in the abdomen and chill followed
by the feeling of heat spreading towards head.
Face becomes red followed by sweating.
2. Vasomotor instability: Fluctuation in BP

3. Fatigue, Nervousness, Emotional outburst like

crying and anger, Mental depression, insomnia,
palpitation, vertigo, headache, numbness or
tingling sensation, increase frequency of
micturition etc.
4. Long term effects of estrogen lack such as
osteoporosis and atherosclerosis
A. FERTILIZATION OF THE OVUM
➢ Fusion of male and female gametes to form a new offspring.
➢ Ovum is released into abdominal cavity, which enters the fallopian
tube through fimbriated end due to the presence of cilia inside of it.
➢ Primary oocyte contains diploid chromosome (23 pairs). Just before
ovulation meiosis occurs, it forms secondary oocyte (haploid with 23
chromosome) and a polar body (remaining 23 chromosome
excretes).
➢ If semen is ejaculated in vagina during ovulation, sperms reach the
uterine end of fallopian tube within 30-60 minutes.
➢ Movement of sperm is caused by antiperistaltic movement of
uterine muscles due to oxytocin secretion by neuroendocrine reflex
and by PGE2 which is present in male seminal fluid.
➢ Among 200-300 millions, only few thousands reach the target site of
fallopian tube and only one can fertilize the haploid ovum.
A. FERTILIZATION OF THE OVUM
❑ Successful sperm can secrete hyaluronidase and proteolytic
enzyme from acrosome that digests the multiple granulosa cells
around ovum called corona radiata. Proteolytic enzymes also
inactivate other sperms.
❑ Penetrating movement of sperm is enabled by protein called
CatSper present in tail portion of sperm.
❑ Nucleus of matured ovum becomes female pronucleus with 23
chromosomes among which 22 autosomes and one X
chromosome.
❑ Head of sperm swells up and becomes male pronucleus with 23
chromosomes.
❑ Then, both of the pronucleus fused together to form 23 pairs of
chromosomes in the fertilized ovum.
B. SEX DETERMINATION
❑ Ovum contains X chromosome and Sperm contains either X or Y
chromosome. If the ovum is fertilized with X chromosome of sperm, then
XX represents female fetus. And, if it is Y chromosome of sperm, then
XY represents male fetus. So, sex of the fetus depends on male sperm.
C. IMPLANTATION
❑ Process by which fertilized ovum (zygote) gets attached in the
endometrial lining in uterus. Zygote takes 3-5 days to reach the uterine
cavity from fallopian tube.
❑ It remains freely for next 2-4 days in uterine cavity and takes nutrition
from endometrial secretion called uterine milk. So, it takes 1 week for
implantation after fertilization.
❑ Before implantation, zygote develops into morula. A layer of
trophoblast cells is formed around morula called blastocyst which
release proteolytic enzymes that can digest the cells of endometrium.
Now morula enters through digested part and implants itself.
D. DEVELOPMENT OF PLACENTA AND EMBRYO
❑ After implantation, further increase in endometrium thickness occurs due
to progesterone from corpus luteum. Endometrial cells are called
decidual cells and endometrium at the implanted area is called decidua.
❑ Trophoblastic cells of morula develop into cords, which are attached to
decidual part of endometrium. Blood capillaries are developed from the
blood vessels of new embryo.
❑ At 16th day after fertilization, heart of the embryo starts pumping
towards trophoblastic cords. Same time blood sinusoids develop which
receive blood from mother.
❑ Trophoblastic cells form some vascular projections into which fetal
capillaries grow that become into placental villi. Thus, the final form of
placenta has got the fetal part and maternal part.
❑ Fetal part of placenta contains two umbilical arteries, which carry fetal
blood to the placental villi and blood returns back through umbilical vein.
Maternal part is formed from uterine arteries.
❑ Expulsion or delivery of fetus from mother’s body after normal gestation period.
❑ The process by which the delivery occurs is called labor. It involves contraction
of uterus, dilatation of cervix and opening of vaginal canal.
A. Braxton Hicks contraction
❑ Weak, irregular, short and usually painless contractions which starts at
6th week of conceptions.
❑ Do not induce cervical dilatation but may cause softening of cervix. So,
often called practice contraction that help the uterus for final preparation.
❑ Touching of abdomen, movement of fetus, physical activity, dehydration
may induce it.
B. Stages of parturition
❑ First, strong uterine contraction commence which occurs from fundus of
uterus and move downwards so that the head of the fetus is pushed
against cervix. It results the dilatation of cervix and opening of vaginal
canal.
❑ Secondly, the fetus is expelled which needs around 1 hour.
❑ Thirdly, the placenta is detached from the decidua which occurs after 10-15
minutes of child delivery.
C. Role of Uterus
❑ Once started the contraction, it develops more and more strong
contractions by further reflex through positive feedback mechanism.

D. Role of Hormone
I. Maternal: Oxytocin, Prostaglandins, Cortisol, Catecholamines, Relaxin
II. Fetal: Oxytocin, Cortisol, Prostaglandins
III. Placental: Estrogen, Progesterone, Prostaglandins
Estrogen:
❑ Increases force of uterine contraction, Increases the oxytocin receptor in
uterus, accelerate the synthesis of prostaglandins
Progesterone:
❑ It plays crucial role in labor by sudden withdrawal at the end of
pregnancy.
❑ Throughout the pregnancy it suppresses the uterine contraction and
inhibit the synthesis of prostaglandin by inhibiting the release of enzyme
phospholipase A.
Oxytocin:
❑ Causes contraction of uterine muscle because during later stage of
pregnancy, oxytocin receptors number are increased due to estrogen.
❑ Also stimulates the release of prostaglandins in the decidua
❑ Positive feedback occurs due to neuroendocrine reflex. During the
movement of fetus through cervix, receptors at cervix are stimulated and
discharge intense signal that carried to hypothalamus by somatic nerve
fibers and results large quantity of oxytocin secretion.
❑ Linda-S (Nuvista) or Inducin (Incepta) inj. are given to induce labor.
Relaxin: (secreted by placenta and mammary glands)
❑ Helps labor by softening the cervix and loosening the ligaments of pubis
so that the cervix dilatation occurs.
❑ Increases the receptors for oxytocin in myometrium and suppresses the
progesterone
❑ Facilitates the development of mammary glands
Prostaglandins:
❑ Play a vital role in labor (PGE2) that increases the force of contraction.
Catecholamines:
❑ Circulating adrenaline and noradrenaline also increases the contraction.
Cortisol:
❑ Hypothalamus releases large quantity of CRH which increases the
release of cortisol from adrenal cortex. Enhances contraction and help
mother to withstand the stress during labor.
A. Structural Changes C. Metabolic changes
B. Increase in body weight D. Physiological changes

A. Structural Changes
❑ Follicles do not develop due to lack of FSH and LH.
❑ Corpus luteum increases in size, secretes large quantity of progesterone
and small estrogen to maintain pregnancy for 3 months and then
degenerates. Later, placenta secretes these hormones.
❑ Uterus reaches to 5-7 liters in volume due to fetus and amniotic fluid.
From 30-50 gm, weight of uterus may become 1-1.2 kg.
❑ Increases vaginal size, color becomes violet and deposits glycogen.
❑ Glands number and size along with blood supply increase in cervix.
❑ Number of epithelial cells increase in fallopian tubes.
❑ Size of mammary glands increase and fat deposition occurs.
B. Increase in body weight
❑ Average body weight increase is about 12 kg.
✓ Fetus : 3.5 kg
✓ Amniotic fluid : 2.0 kg
✓ Placenta : 1.5 kg
✓ Maternal body weight : 5.0 kg
❑ Prenatal care is required otherwise weight may increase to 20-30 kg.

C. Metabolic changes
❑ BMR increases to 15%
❑ Protein anabolism occurs, deposition of protein in uterus
❑ Blood glucose level increases cause glycosuria. Ketosis may occur.
Hyperplasia of Islet’s of Langerhans cell in pancreas may occur with
high insulin secretion. Possibility of developing gestational diabetes.
❑ Deposition of 3-4 kg fat may occur.
❑ Retention of sodium and water may occur due to hormones.
D. Physiological Changes
❑ Cardiac output increases up to 30% and becomes normal later stage.
❑ Hypertension may occur if proper prenatal care is not taken.
❑ Pre-eclampsia, a hypertensive disorder may occur due to release of
vasoconstrictor substances from placenta, hypersecretion of adrenal hormones,
autoimmune response from placenta or fetus.
❑ Eclampsia, a serious case of hypertension where vascular spasm, muscular
spasms like seizure occurs. It occurs just before or during or immediately after
delivery which leads to death. (need vasodilator drugs or pregnancy termination)
❑ Tidal volume, pulmonary ventilation and oxygen utilization increases
❑ Increase urine production, urine flow and urine become diluted.
❑ Morning sickness occurs which involves nausea, vomiting due to decrease in GI
motility because of progesterone. Indigestion and hypochlorhydria also occurs.
❑ Size of anterior pituitary increases up to 50%, increases secretion of cortisol
which moves amino acid to fetus, increases secretion of Aldosterone, increased
secretion of thyroxine which prepares mammary glands for lactation, increase
PTH secretions too.
❑ The basis of the test is to determine the presence of human chorionic
gonadotropin (hCG) in urine sample of suspected pregnancy.
Immunological test kit
❑ Based on Double antigen-antibody reactions.
❑ Principle: The agglutination of sheep RBC’s coated with hCG or Latex particles
can be used.
Lactation means synthesis, secretion and ejection of milk.
❑ Two processes:
A. Milk secretion B. Milk ejection.
A. Milk Secretion:
Synthesis of milk by alveolar epithelium and its passage through the duct
system is called milk secretion.
Milk secretion occurs in two phases:
1. Initiation of milk secretion or lactogenesis
2. Maintenance of milk secretion or galactopoiesis.

1. Lactogenesis:
❑ Although small amount of milk secretion occurs at later month of
pregnancy, a free flow of milk occur after the delivery of the child.
❑ Milk, which is secreted initially before parturition is called colostrum.
❑ Lemon yellow in color and rich in protein (globulins) and salts. But sugar
content is low. It contains almost all the components of milk except fat.
❑ Prolactin is responsible for lactogenesis. During pregnancy,
particularly in later months, large quantity of prolactin is secreted.
❑ But the activity of this hormone is suppressed by estrogen and
progesterone secreted by placenta.
❑ Because of this, lactation is prevented during pregnancy. Immediately
after the delivery of the baby and expulsion of placenta, there is sudden
loss of estrogen and progesterone and prolactin shows its action.

2. Galactopoiesis:
❑ Depends upon the hormones like GH, thyroxine and cortisol, which are
essential for continuous supply of glucose, amino acids, fatty acids,
calcium and other substances necessary for the milk production.
❑ Suckling of nipple by the baby is responsible for continuous milk
production. When the baby suckles, the impulses from touch receptors
around the nipple stimulate hypothalamus.
❑ It is suggested that hypothalamus releases some prolactin-releasing
factors, which cause the prolactin secretion from anterior pituitary.
 B. Milk Ejection:
❖ Milk ejection is the discharge of milk from mammary gland. It depends
upon suckling exerted by the baby and on contractile mechanism in
breast, which expels milk from alveoli into the ducts.
❖ It is a reflex mechanism which is called milk ejection reflex. It is a
neuroendocrine reflex.

Breast Milk:
❑ Composition: 88.5% of water and 11.5% of solids such as lactose,
lactalbumin, iron, vitamins A and D and minerals.
❑ Always superior to animal milk. Breast milk also provides several
antibodies, which help resist infection. Even some neutrophils and
macrophages are secreted in milk. These phagocytic cells protect baby
by destroying microbes in baby’s body.
❑ Animal milk causes irritation to GI mucosa, contains high amount of fat
and protein which is difficult to digest, contain casein which is harder to
digest, low iron content, high Na and K irritate kidneys, Low vitamins
too.