Reproductive system SEX DIFFERENTIATION

 Mesodermal cells within the genital ridge develop into a bipotential

gonadal primordium, which can differentiate into either testes or ovaries
 The reproductive system is a complex network of organs and structures that
based on chromosomes and hormonal signals.
play a crucial role in the continuation of species through the processes of
reproduction.  Starts at First 6 weeks of gestation.
 It is responsible for the production of gametes (sperm in males and ova in
females), the facilitation of fertilization, and the nurturing of developing
offspring.
 The reproductive system also produces hormones that regulate sexual
development and function.

Functions of the Reproductive System

1. Gamete Production: The gonads produce gametes (sperms and ova) through
the processes of spermatogenesis and oogenesis, respectively.

2. Hormone Secretion: The reproductive organs secrete hormones that regulate

sexual development, reproductive cycles, and secondary sexual characteristics.
In males, testosterone is the primary hormone, while in females, estrogen and
progesterone are predominant.

3. Fertilization: The reproductive system facilitates the meeting of sperm and

ova, leading to fertilization, which results in the formation of a zygote.

4. Gestation: In females, the reproductive system provides an environment for

the fertilized ovum to implant and develop into a fetus during pregnancy.

5. Parturition: The reproductive system is involved in the process of childbirth, Development of the Male Reproductive System
allowing for the delivery of the baby.
 The development of the male reproductive system is a complex process
6. Lactation: In females, the mammary glands, which are part of the influenced by chromosomes and hormonal factors.
reproductive system, produce milk to nourish the newborn.  This process involves the differentiation of the bipotential gonadal primordium
into testis, the development of internal and external genitalia, and the
regulation of these processes by specific hormones.
  Produce Anti Mullerian Hormone (AMH), which causes the degeneration
of Mullerian ducts, preventing the development of female reproductive
structures.
Anti Mullerian Hormone (AMH)
 Causes the regression of Müllerian ducts, which would otherwise develop
into female reproductive structures (fallopian tubes, uterus, cervix, and
upper vagina).
 Leydig cells
 Produces Testosterone hormone
 Promotes the development of the Wolffian ducts into male internal
genitalia (epididymis, vas deferens, seminal vesicles, and ejaculatory
ducts).

Development of Internal Genitalia

 Wolffian Ducts
 Retained and differentiated into the male reproductive tract under the
influence of testosterone.
 Müllerian Ducts
 Regress due to the action of AMH, preventing the formation of female
reproductive structures.

Testicular Development

 The SRY gene (sex-determining region on the Y chromosome) encodes the Development of External Genitalia
transcription factor SRY.  Differentiation of male external genitalia occurs between weeks 9 and 12 of
 This gene induces the differentiation of the bipotential gonad into a testis gestation.
between weeks 6 and 7 of gestation.  Dihydrotestosterone (DHT) helps to develop External Genitalia
 Sertoli Cells  DHT is derived from testosterone through the action of the enzyme 5α-
 Surround male germ cells (spermatogonia) and provide structural and reductase-2.
nutritional support.
 Development of the Female Reproductive System Development of Internal Genitalia
 The development of the female reproductive system is a complex process that  Mullerian Ducts
begins early in embryonic development and is influenced by chromosomes and
 The absence of Sertoli cell-derived Anti Mullerian Hormone (AMH)
hormonal factors.
allows for the persistence and development of the Mullerian ducts into
 This process involves the differentiation of the bipotential gonadal primordium
female reproductive structures: [Oviducts (fallopian tubes), Uterus, Cervix,
into ovaries, the development of internal and external genitalia, and the
One-third of the vagina]
regulation of these processes by specific hormones.
 Wolffian Ducts
 In the absence of a testis and testosterone, the Wolffian ducts degenerate,
Ovary development
as they are not needed for female reproductive development.
 In a normal 46+XX embryo, the absence of the SRY gene (which is
responsible for male differentiation) allows for the expression of other
transcription factors that induce the differentiation of the gonad into an ovary. Development of External Genitalia
 Full ovarian differentiation does not occur until the end of the first trimester of  Absence of Dihydrotestosterone (DHT)
pregnancy.
The external genitalia develop into female structures:
 Labia Majora
 Labia Minora
 Clitoris
 Vestibular Bulbs and Glands
 Outer Two-Thirds of the Vagina

Puberty
 Puberty is a critical developmental stage characterized by the maturation of the
reproductive system and the onset of secondary sexual characteristics.
 It marks the transition from childhood to adulthood and is regulated by a
complex interplay of hormones.
 This process involves significant physiological, anatomical, and behavioral
changes in both males and females.
 Gonadotropin-Releasing Hormone (GnRH)
 GnRH is secreted in the hypothalamus. Secondary sexual characteristics in Males
 It is released in a pulsatile manner, stimulating the production of luteinizing 1. Enlargement of scrotum and testes.
hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary
gland. 2. Growth of penis in length.

 Activity During Life Stages: 3. Growth of body hair, including underarm, abdominal, chest, and pubic hair.

 GnRH are active during gestation but decrease in activity at birth. 4. Development of facial hair.

 Following this period, there is about a decade of low activity of the 5. Enlargement of the larynx (Adam's apple) and deepening of the voice.
reproductive axis. 6. Increased height, with adult males generally being taller than adult females.
 The resurgence of GnRH activity during adolescence is termed puberty, 7. Heavier skull and bone structure and strength.
leading to dramatic phenotypic and behavioral changes.
8. Increased muscle mass and strength.
 The timing of puberty varies among individuals and populations,
influenced by factors such as health, nutrition, and body composition. 9. Shoulders become broader than hips.

 Clinical Significance
 Precocious Puberty: Onset of puberty at an abnormally young age (before
8 years in girls and 9 years in boys).
 Delayed Puberty: Onset of puberty at an abnormally older age.
 Normal Milestones: Average age of breast development in girls is around
10 years, while testicular enlargement in boys occurs around 11.5 years.

 Hormonal Changes
 The onset of puberty is marked by increased secretion of sex steroids
(estrogen in females and testosterone in males).

Secondary sexual characteristics in Females

 Adrenarche
 The increase in adrenal androgens occurs before gonadal 1. Enlargement of breasts and erection of nipples.
maturation, contributing to the development of secondary
2. Increased growth of body hair, particularly underarm and pubic hair.
sexual characteristics.
 3. Widening of the hips, resulting in a lower waist-to-hip ratio compared to
adult males.
4. The labia minora may become more prominent and change in color due to
MALE REPRODUCTIVE SYSTEM
increased estrogen stimulation.
5. Regulation of menstruation takes place.
1. Primary Reproductive Organs (Gonads)
 The primary reproductive organs are the testes, which are responsible for
B. Feedback Mechanisms producing sperm and male sex hormones, primarily testosterone.

 The hypothalamus and pituitary gland are sensitive to feedback from sex 2. Accessory Reproductive Organs
steroids, which regulate the timing and progression of puberty.
 The accessory organs include the seminal vesicles, prostate gland, and
bulbourethral glands, which contribute to the formation of semen. The vas
deferens and urethra are also part of the male reproductive tract,
facilitating the transport of sperm.
3. External Genitalia
 The external genitalia include the penis and scrotum. The penis is the
organ for sexual intercourse and the delivery of sperm, while the scrotum
houses the testes and regulates their temperature.
 TESTES Leydig cells:
 Located between seminiferous tubules, these cells secrete hormones,
primarily testosterone.
Sertoli Cells:
 Support and nourish spermatogenic cells.
 Secretion of hormones (e.g., inhibin, activin, and aromatase).
 Formation of the blood-testes barrier.
Rete Testis:
 A network of channels where all seminiferous tubules converge.
Vas Efferens:
 Tubules that arise from the rete testis and lead to the epididymis.
Epididymis:
 A convoluted tubule approximately 4 meters long, where sperm mature.
 The testes are the primary male sex organs (gonads) responsible for Vas Deferens:
sperm production and hormone secretion.
 Also known as ductus deferens, it extends from the epididymis into the
 Typically, there are two testes, which are ovoid or walnut-shaped, located abdominal cavity.
in the scrotum.
Coverings of the Testis
 Each testis weighs approximately 15 to 19 grams and measures about 5 ×
3 cm. 1. Tunica Vasculosa
2. Tunica Albuginea
Seminiferous Tubules: 3. Tunica Vaginalis
 Seminiferous Tubules Composed of about 900 coiled tubules that
produce sperm.
Functions of the Testes
 Each lobule contains 1 to 4 seminiferous tubules, which are surrounded
by interlobular connective tissue. 1. Gametogenic Function:

 Spermatozoa, arranged in layers within the seminiferous tubules.  Production of sperm (spermatogenesis).

 The process of Spermatogenesis within the seminiferous tubules 2. Endocrine Function:

 Secretion of hormones such as testosterone and inhibin.
Blood-Testes Barrier SEMEN
 A mechanical barrier formed by tight junctions between Sertoli cells,  The combined seminal plasma and sperm are called semen.
protecting the seminiferous tubules from harmful substances and
preventing autoimmune reactions.  Semen may be secreted during sexual intercourse before ejaculation.
 Semen is a white or gray fluid that contains sperm.
ACCESSORY GLANDS  Composed of secretions from:
 The accessory glands are the seminal vesicles, the prostate gland, and the  Testes (sperm)
bulbourethral glands, also called Cowper’s glands.  Seminal vesicles (Fructose, fibrinogen)
 The accessory glands have three functions:  Prostate gland (milky appearance)
1. Nourish the sperm.  Bulbourethral glands (mucoid consistency)
2. Protect the sperm from the acidic environment of the woman’s vagina.  Semen consists of approximately:
3. Enhance the motility (movement) of the sperm.
 10% sperm
 90% seminal plasma (includes secretions from seminal vesicles,
prostate gland, and bulbourethral glands)

SPERM
 Sperm, or spermatozoa, are the male gametes developed in the testes.
 Approximately 60 µm in length.
 Sperm Count = 50 to 100 million/mL of semen.
 Sperm can survive in the male genital tract for extended periods.
 After ejaculation, survival time is about 24 to 48 hours at body temperature.
 Sperm reach the fallopian tubes approximately 30 to 60 minutes after sexual
intercourse.
 Movement is aided by uterine contractions.
 STRUCTURE OF SPERM  Contains the axial filament surrounded by a spiral filament of
mitochondria.
4. Tail:
 Enclosed by a cytoplasmic capsule, measuring 40 to 50 µm long.
 Contains only the axial filament.

Pathway for the passage of sperms

Sperm consists of four main parts:

1. Head:
 Oval (3 to 5 µm long, up to 3 µm wide).
 Contains a condensed nucleus and thin cytoplasm, covered by a
cell membrane.
 The anterior part of the head, developed from the Golgi apparatus,
contains enzymes essential for fertilization (e.g., hyaluronidase,
proteolytic enzymes).
2. Neck:
 Connects the head to the body.
 Contains the proximal and posterior centrioles, which contribute to
the axial filament.
3. Body:
 Cylindrical (5 to 9 µm long, 1 µm thick).
 SPERMATOGENESIS Spermatogenesis occurs in four distinct stages:

 Spermatogenesis is the biological process through which male gametes, 1. Stage of Proliferation
known as spermatozoa (sperms), are formed from primitive spermatogenic  Each spermatogonium contains a diploid number of chromosomes
cells (spermatogonia) within the testes. (23 pairs), consisting of 22 pairs of autosomes and one pair of sex
 This intricate process takes approximately 74 days from the initial germ cell chromosomes (one X and one Y).
to the formation of mature sperm.  During this stage, spermatogonia undergo mitotic divisions without
 Throughout spermatogenesis, spermatogenic cells maintain cytoplasmic changing the chromosomal number.
connections with Sertoli cells, which provide essential materials for the
process. 2. Stage of Growth
 The primary spermatocyte enlarges. There are no significant changes
in the chromosomal structure during this phase.
Stages of Spermatogenesis
3. Stage of Maturation
 The primary spermatocyte undergoes meiotic division, which occurs
in two phases:
A. First Phase: Each primary spermatocyte divides into two secondary
spermatocytes, each receiving a haploid set of chromosomes (23
chromosomes: 22 autosomes and either an X or a Y chromosome).
B. Second Phase: Each secondary spermatocyte undergoes a second
meiotic division, resulting in two smaller cells called spermatids,
which also have a haploid number of chromosomes.
4. Stage of Transformation
 There is no further division at this stage.
 Spermatids are transformed into mature spermatozoa through a
process called spermiogenesis, followed by their release into the
lumen of the seminiferous tubules through spermination.

SPERMIOGENESIS
Spermiogenesis is the transformation process where spermatids develop into
mature spermatozoa. Key changes during spermiogenesis include:
 The nuclear material condenses to form a more compact structure.
  The acrosome, a cap-like structure that contains enzymes necessary for FEMALE REPRODUCTIVE SYSTEM
fertilization, is formed.
 Mitochondrial spiral filaments and tail structures are developed to
facilitate motility.
 Extraneous cytoplasm is removed, resulting in a streamlined sperm
structure.

SPERMINATION
Spermination is the final process in which mature spermatozoa are released from
Sertoli cells into the lumen of the seminiferous tubules, ready for transport through
the male reproductive tract.

TESTOSTERONE
 Testosterone secretion begins around the 7th week of fetal life from the
fetal genital ridge.
 In fetal life, testosterone secretion is stimulated by human chorionic
gonadotropin (hCG), which is secreted by the placenta.
 No testosterone secretion during childhood, lasting until approximately 10
to 12 years of age.
 Leading to the development of secondary sexual characteristics.
FUNCTIONS OF TESTOSTERONE
 Increases muscle mass and strength.
 Promotes growth of long bones.
 Increases basal metabolic rate.
1. Primary Reproductive Organs (Gonads)
 Enhances production of red blood cells.
 Produces enlargement of vocal cords.  The primary reproductive organs are the ovaries, which produce ova (eggs)
 Affects the distribution of body hair. and female sex hormones, including estrogen and progesterone.
 Testosterone influences the development of male characteristics. 2. Accessory Reproductive Organs
 Testosterone is essential for the growth and development of external
genitalia, including the penis and scrotum, as well as accessory sex organs  The accessory organs include the fallopian tubes, uterus, cervix, and
vagina. The fallopian tubes transport the ova from the ovaries to the uterus,
such as the genital ducts, seminal vesicles, and prostate.
where fertilization may occur. The uterus provides a nurturing
 Testosterone is necessary for this process, ensuring that the testes are environment for the developing fetus.
positioned correctly for optimal function.
3. External Genitalia  Glandular structures (ovarian follicles at various stages)
 The external genitalia include the labia majora, labia minora, clitoris, and  Connective tissue cells
vaginal opening. These structures protect the internal reproductive organs
and play a role in sexual arousal.  Interstitial cells (clusters of epithelial cells with lipid
granules).
Functions of the Ovaries
OVARY 1. Secretion of female sex hormones (estrogen and progesterone)
2. Oogenesis
3. Menstrual cycle.

FUNCTIONS OF ESTROGEN

1. Promotes growth and proliferation of ovarian follicles.

2. Enhances the secretory activity of theca cells.

3. Doubles the size of the uterus through endometrial cell proliferation.

4. Increases blood supply to the endometrium.

5. Promotes glycogen and fat storage in the endometrium.

6. Increases uterine muscle activity and contractility, enhancing sensitivity to

oxytocin.

7. Enhances ciliary activity for ovum movement in the fallopian tubes.

8. Transforms vaginal epithelium to a stratified type, increasing resistance to

 Ovaries are flattened ovoid bodies measuring approximately 4 cm in trauma and infection.
length, 2 cm in width, and 1 cm in thickness.
 They are attached to the broad ligament via the mesovarium and ovarian 9. Promotes development of secondary sexual characteristics, such as breast
ligament. development and body shape changes.
 Each ovary consists of two portions:
10. Increases osteoblastic activity, enhancing bone growth during puberty and
1. Medulla: The central, deeper portion containing loose connective affecting bone density in later life.
tissue, blood vessels, lymphatics, nerve fibers, and smooth muscle
bundles. FUNCTIONS OF PROGESTERONE
2. Cortex: The outer portion with compact cellular layers, lined by 1. Promotes secretory activities of the mucosal lining, essential for
germinal epithelium and covered by the tunica albuginea. It contains: nourishing the fertilized ovum before implantation.
 2. Enhances secretory activities of the uterine endometrium during the  At puberty, hormonal changes trigger the resumption of meiosis in some
secretory phase of the menstrual cycle. primary oocytes.
3. Increases thickness of the endometrium from approximately 1 mm to  Each month, during the menstrual cycle, typically one primary oocyte
about 5-6 mm. completes the first meiotic division, resulting in a secondary oocyte and a
polar body (which is usually non-functional).
4. Enlarges uterine glands.
 The secondary oocyte is arrested in metaphase II of meiosis and is released
5. Enhances secretory activities of epithelial cells in uterine glands. during ovulation.
6. Promotes deposition of lipids and glycogen in stromal cells of the  If fertilization occurs, the secondary oocyte will complete meiosis II,
endometrium. producing a mature ovum and another polar body.
7. Increases blood supply to the endometrium through vessel enlargement  Throughout oogenesis, polar bodies are produced during the meiotic divisions.
and vasodilation. These are small cells that contain little cytoplasm and are typically not
8. Decreases frequency of uterine contractions during pregnancy to prevent involved in fertilization.
expulsion of the implanted ovum.
9. Increases thickness of cervical mucosa, inhibiting sperm transport into the FOLLICULOGENESIS
uterus.
Folliculogenesis is the process of ovarian follicle development, which is closely
10. Promotes development of lobules and alveoli in mammary glands. linked to oogenesis.
Stages of Folliculogenesis
OOGENESIS  Primordial Follicle
 Oogenesis is the process of female gamete (egg) formation in humans.
 Present at birth

 Composed of a primary oocyte surrounded by a single layer of flat

Stages of OOGENESIS granulosa cells
 Oogenesis begins with the proliferation of oogonia, which are diploid (2n)  Primary Follicle
germ cells. These cells undergo mitosis to increase in number.
 Granulosa cells become cuboidal
 Some oogonia differentiate into primary oocytes, which enter the first meiotic
division but are arrested in prophase I until puberty.  Zona pellucida begins to form around the oocyte
 Each primary oocyte is surrounded by a layer of granulosa cells, forming a
 FSH receptors start to appear in granulosa cells
primordial follicle.
 As the female matures, some follicles will develop further, leading to the  Secondary Follicle
formation of primary and secondary follicles.  Multiple layers of granulosa cells develop
  Theca cells differentiate into theca interna and externa

 Antrum formation begins, accumulating fluid between granulosa

cells

 Tertiary (Graafian) Follicle

 Fully developed antrum forms

 Oocyte reaches full size (approximately 120 µm)

 Follicle prepares for ovulation, characterized by increased fluid

accumulation

 Ovulation

 Release of the mature oocyte from the graafian follicle

 Triggered by a surge in LH (luteinizing hormone)

 Corpus Luteum

 Formed from the remnants of the ovulated follicle

 Produces progesterone and estrogen to support potential

pregnancy

 Deterioration of Corpus Luteum

 If fertilization does not occur, the corpus luteum degenerates

 Leads to a decrease in hormone levels, initiating menstruation

 MENSTRUAL CYCLE
 The menstrual (or uterine) cycle begins with the first day of bleeding,
counted as day 1, and ends just before the next menstrual period.
 Menstrual cycles typically range from about 25 to 36 days, with only 10%
to 15% of women having cycles that are exactly 28 days.

Uterine Cycle

Days 1-5: Menstrual Phase

 This phase spans from the first day of menses to the last day of bleeding,
usually lasting from 3 to 5 days, but can extend up to 7 days.

 Bleeding occurs when fertilization does not take place.

 Low levels of both progesterone and estrogen cause the blood vessels of
the endometrium to constrict, cutting off blood flow to the uterine lining.

 The cells of the uterine lining begin to die, leading to the sloughing off of
the lining and resulting in bleeding.

 Approximately two-thirds of the endometrial lining sheds during menses.

 During this time, the ovaries begin the follicular stage.

Days 6-14: Proliferative Phase

 This phase occurs from the cessation of menses to ovulation.

 The endometrial lining thickens in preparation for the implantation of a

fertilized ovum, doubling in thickness to about 4 to 6 mm.

 Uterine secreting glands increase in size and produce mucus.

 Uterine blood vessels begin to grow.

 Ovulation occurs in the ovaries at the end of this stage, usually around day
14, triggered by a surge in luteinizing hormone (LH) from the anterior
pituitary gland.
Days 15-28: Secretory Phase  After ovulation, the ruptured follicle transforms into the corpus
luteum, which turns yellow (luteinizing).
 This phase extends from ovulation to the start of the next menses.
 The corpus luteum secretes increasing quantities of progesterone,
 Endometrial glands secrete mucus, preparing the uterus to receive a
which prepares the uterine lining for a fertilized ovum.
fertilized ovum.
 If fertilization does not occur, approximately 12 days after
 The corpus luteum produces estrogen, while the cells of the ovaries
ovulation, the corpus luteum degenerates, leading to a decrease in
produce progesterone.
progesterone and estrogen levels.
 The endometrium continues to thicken.

Ovarian Cycle

The ovarian cycle consists of three phases:

1. Follicular (Preovulatory) Phase

 This phase begins on the first day of menstruation and lasts until
ovulation.

 The anterior pituitary gland secretes follicle-stimulating hormone

(FSH), which stimulates the maturation of follicles in the ovary,
each containing a single ovum.

 Several follicles begin to mature during each cycle, but usually,

only one reaches final maturity.

2. Ovulation

 Ovulation occurs approximately 14 days before the onset of the

next menstrual period.

 A surge in luteinizing hormone (LH) stimulates the final

maturation and release of the mature ovum from the follicle.

 About two days before ovulation, vaginal secretions increase

noticeably, indicating the body is preparing for potential
fertilization.

3. Luteal (Postovulatory) Phase

Note:
Ovarian Cycle

Phase Days Events

Follicular Phase 1-13  FSH secretion begins.

  Follicle maturation occurs.

Ovulation 14*  LH spike occurs.

  LH secretion continues.

Luteal Phase 15-28  Corpus luteum forms.

Uterine Cycle

Phase Days Events

Menstruation 2-5  Endometrium breaks down.

Proliferative Phase 6-13  Endometrium rebuilds.

  Estrogen secretion is prominent.

Secretory Phase 15-28  Endometrium thickens, and glands are secretory.

Notes:

 The cycles are based on a typical 28-day cycle.

 The ovarian cycle focuses on the development of follicles and ovulation,

while the uterine cycle focuses on the changes in the endometrium in
preparation for potential implantation.
 OVULATION
The process by which the graafian follicle in the ovary ruptures, releasing the
ovum into the fallopian tube.

 Typically occurs on the 14th day of a normal 28-day menstrual cycle.

 The released ovum enters the fallopian tube through the fimbriated end.

 Usually, only one ovum is released from one of the ovaries.

 Luteinizing hormone (LH) is primarily responsible for triggering ovulation.

Stages of Ovulation

1. The graafian follicle migrates towards the periphery of the ovary.

2. New blood vessels form in the ovary due to LH and progesterone.

3. Blood vessels protrude into the wall of the follicle.

4. Increased blood flow to the follicle occurs.

5. Prostaglandin is released from granulosa cells of the follicle.

6. Plasma leaks into the follicle due to prostaglandin release.

7. The follicle swells and protrudes against the ovarian capsule, forming the
stigma.

8. Progesterone activates proteolytic enzymes in the theca interna cells.

9. These enzymes weaken the follicular capsule and lead to stigma degeneration.

10. Approximately 30 minutes later, fluid begins to ooze from the follicle through Determination of Ovulation Time
the stigma.
 Various indirect methods to determine ovulation time:
11. Fluid release decreases the size of the follicle, resulting in stigma rupture.
1. Determination of basal body temperature.
12. The ovum is released from the follicle along with fluid and granulosa cells into
the abdominal cavity. 2. Determination of hormonal excretion in urine.

3. Determination of hormonal levels in plasma.

4. Ultrasound scanning.
Determination of Basal Body Temperature:

 Measured for several days during the mid-phase of the menstrual cycle. Significance of Determining Ovulation Time:

 Taken in the morning via rectum or vagina.  Helpful for family planning, particularly through the rhythm method.

 A slight decrease in basal temperature occurs just prior to ovulation,

followed by an increase post-ovulation.
PHYSIOLOGICAL CHANGES DURING PREGNANCY
 Temperature change is mild, typically around ± 0.3°C to 0.5°C, due to the
thermogenic effect of progesterone. Pregnancy triggers a wide array of physiological changes across nearly every
system in the body to support fetal development and prepare for childbirth.
Determination of Hormonal Excretion in Urine:

 Increased urinary excretion of metabolic end products of estrogen and

progesterone during ovulation.  Cardiovascular System

 End products of estrogen metabolism: estrone, estriol, and 17-β-estradiol.  Blood volume increases by ~40–50% to support uteroplacental circulation.

 End product of progesterone metabolism: pregnanediol.  Cardiac output rises by 30–50%, peaking mid-pregnancy.

Determination of Hormonal Level in Plasma:  Heart rate increases by 10–20 bpm.

 Plasma levels of FSH, LH, estrogen, and progesterone are measured.  Blood pressure may drop in the second trimester and normalize later.

 At the time of ovulation:  Vascular resistance decreases due to progesterone-induced vasodilation.

 FSH level decreases.  Mild anemia occurs due to plasma volume expansion exceeding red cell
mass.
 LH level increases.
 Respiratory System
 Estrogen level increases.
 Tidal volume increases by ~40%, leading to higher minute ventilation.
 After ovulation:
 Respiratory rate may slightly increase.
 Progesterone level increases.
 Diaphragm elevation reduces lung capacity, causing mild breathlessness.
Ultrasound Scanning:
 Respiratory alkalosis is common due to increased CO₂ exhalation.
 The process of ovulation can be observed through
ultrasound scanning.  Nervous System

 Fluid retention may compress nerves (e.g., carpal tunnel syndrome).

 Mood changes like anxiety, vivid dreams, and insomnia are common.
  Increased sensitivity to anesthetics due to epidural vein engorgement.  Gastrointestinal System

 Musculoskeletal System  Nausea and vomiting (morning sickness) due to hCG and estrogen.

 Ligament laxity from relaxin and progesterone increases joint mobility.  Constipation and reflux from progesterone relaxing smooth muscles.

 Postural changes due to weight gain and altered center of gravity.  Gallbladder stasis increases risk of gallstones.

 Pelvic joint loosening facilitates childbirth but may cause discomfort.  Urinary System

 Endocrine System  Renal blood flow and GFR increase by ~50–60%.

 Hormonal surges include progesterone, estrogen, hCG, relaxin, and  Bladder compression causes frequent urination.
placental lactogen.
 Ureter dilation raises risk of urinary tract infections.
 Thyroid activity increases; T3 and T4 rise, but free hormone levels may
 Skin and Breast Changes
stay stable.
 Breast enlargement and colostrum production begin late in pregnancy.
 Insulin resistance develops, increasing risk of gestational diabetes.
 Hyperpigmentation (e.g., linea nigra, melasma) due to melanocyte-
 Metabolic Changes
stimulating hormone.
 Basal metabolic rate increases by ~15–20%.
 Stretch marks (striae gravidarum) may appear.
 Fat storage is promoted by cortisol and progesterone.

 Glucose metabolism shifts to favor fetal needs.

PREGNANCY TESTS
 Hematological System
 Pregnancy tests are used to detect or confirm pregnancy by determining the
 Clotting factors (I, VII, VIII, IX, X) increase, creating a hypercoagulable presence of human chorionic gonadotropin (hCG) in the urine of women
state. suspected of being pregnant.
 White blood cells rise, especially during labor.
 There are two main types of tests:
 Platelet activity increases, but protein S decreases. 1. Biological tests
 Reproductive System 2. Immunological tests

 Uterus enlarges from 50g to ~1000g, displacing abdominal organs.

 Cervix softens and secretes a mucus plug (operculum).

 Vagina becomes more elastic and vascularized. Types of Biological Tests

 1. Aschheim-Zondek Test Immunological tests have largely replaced biological tests due to their accuracy
and efficiency. They are based on antigen-antibody reactions to detect hCG.
 Method: 2 mL of urine is injected daily into immature mice for 2
days. Common Immunological Test: Gravindex Test

 Observation: Ovaries are examined for corpora lutea and Principle: Determines agglutination of sheep red blood cells (RBCs) coated with
hemorrhages after 5 days, indicating ovulation due to hCG. hCG or latex particles.

2. Kupperman Test Requisites

 Modification: Uses immature rats instead of mice for quicker 1. Antiserum from Rabbit:
results.
 Urine from a pregnant woman is used to immunize a rabbit,
3. Friedman Test producing antibodies against hCG.

 Method: 10 to 15 mL of urine is injected intravenously into  The serum containing these antibodies is called rabbit antiserum.
rabbits, with ovulation observed after 48 hours.
2. Red Blood Cells from Sheep:
4. Hogben Test
 Sheep RBCs are coated with pure hCG. Latex particles can also be
 Method: 20 to 30 mL of concentrated urine is injected into the used.
dorsal lymph sac of the South African toad, Xenopus levis.
3. Urine:
Ovulation occurs after 12 hours if hCG is present.
 Fresh urine sample from the woman to confirm pregnancy.
5. Galli-Mainini Test
Procedure
 Method: 2 mL of urine is injected into male amphibians (toads or
frogs), causing spermatozoa expulsion within 2 hours if hCG is 1. Mix one drop of hCG antiserum with one drop of the woman's urine on a
present. glass slide.

2. Add one drop of latex particles and mix.

Disadvantages of Biological Tests Observation and Results
 Require the use of animals.  Absence of Agglutination: Indicates pregnancy. If hCG is present, it
binds to antibodies, preventing agglutination of latex particles.
 Can only be performed 2 to 3 weeks post-conception.
 Presence of Agglutination: Indicates no pregnancy. Free antibodies
 Results take time (2 to 48 hours).
agglutinate the latex particles, visible to the naked eye.
 Involve tedious procedures, including sacrificing animals.

Immunological Tests
 Braxton Hicks Contractions

 Weak, irregular, and usually painless uterine contractions that begin after
the 6th week of pregnancy.

 Named After: Dr. John Braxton Hicks (discovered in 1872).

 Function:

 Do not induce cervical dilation.

 May help soften the cervix in preparation for labor.

 Triggers:

1. Touching the abdomen

2. Fetal movement
3. Physical activity
4. Sexual intercourse
5. Dehydration
Advantages of Immunological Tests

1. More accurate results.

False Labor Contractions
2. Quick results within minutes.
 Intensified Braxton Hicks contractions as delivery approaches.
3. Easier procedures compared to biological tests.
 Believed to assist in cervical dilation.
4. Can be performed as early as the 5th day of conception.

5. Highly sensitive tests can detect hCG levels as low as 20 mIU/mL.

Stages of Parturition

1. First Stage [dilation stage]

PARTURITION
 Strong uterine contractions (labor contractions) begin.
 The process of expelling or delivering the fetus from the mother's body at
the end of pregnancy.  Contractions originate from the fundus of the uterus and move
downward.
 The delivery process involving uterine contractions, cervical dilation, and
the opening of the vaginal canal. 2. Second Stage [expulsion stage]

 Pushes the fetus's head against the cervix, leading to cervical

dilation and vaginal canal opening.
  Duration varies.  Initial contractions stimulate further contractions, leading to more intense
uterine contractions.
 The fetus is delivered from the uterus through the cervix and
vaginal canal.  The cervix stretches as the fetus's head presses against it, stimulating
cervical muscles and resulting in reflex contractions of the uterus.
3. Third stage [placental stage]

 Typically lasts about 1 hour.

Role of Hormones in Parturition
 Following delivery, the placenta detaches from the decidua and is
expelled within 10 to 15 minutes. 1. Oxytocin:

 Causes uterine smooth muscle contraction and enhances labor.

 Increases the number of oxytocin receptors in the uterine wall.

 Released by the fetus, contributing to labor.

2. Prostaglandins:

 Increase the force of uterine contractions.

 Secreted from uterine tissues, fetal membranes, and the placenta.

 Released by the fetus, facilitating labor.

3. Cortisol:

 Released from the adrenal cortex during labor.

 Enhances uterine contractions and helps the mother withstand stress.

 Released by the fetus, playing a role in labor.

Mechanism of Labor
4. Catecholamines:
 Slow and weak contractions begin about a month before parturition,
 Circulating adrenaline and noradrenaline may increase uterine
gradually strengthening into labor contractions.
contractions through alpha-adrenergic receptors.
 Believed to be induced by signals from the fetus.
5. Relaxin:
 Reflexes from the uterus and cervix contribute to powerful uterine
 Secreted from the corpus luteum and placenta.
contractions.
  Softens the cervix, loosens ligaments, increases oxytocin receptor  Color: Lemon yellow
numbers, and suppresses progesterone's inhibitory effects on uterine
 Rich in proteins (especially globulins) and salts
contractions.
 Low in sugar; contains almost all components of milk
6. Estrogen:
except fat.
 Increases uterine contraction force, the number of oxytocin receptors,
 Prolactin: The hormone responsible for lactogenesis.
and prostaglandin synthesis.
 High levels during pregnancy, but activity is suppressed by
7. Progesterone:
estrogen and progesterone from the placenta.
 Suppresses uterine contractions during gestation.
 After delivery, the drop in estrogen and progesterone
 Sudden withdrawal at the end of pregnancy increases uterine allows prolactin to promote lactogenesis.
contractions and prostaglandin synthesis.
2. Maintenance of Milk Secretion (Galactopoiesis):

 Maintained by hormones such as:

LACTATION  Growth hormone
 The synthesis, secretion, and ejection of milk from the mammary glands.  Thyroxine
 Involves two primary processes:  Cortisol
1. Milk secretion  These hormones provide glucose, amino acids, fatty acids, calcium,
2. Milk ejection and other substances necessary for milk production.

Milk Secretion  Role of Hypothalamus:

 The process by which milk is synthesized by the alveolar epithelium and  Continuous suckling stimulates the hypothalamus to release
passed through the duct system. prolactin-releasing factors.

 Phases:  Leads to increased prolactin secretion from the anterior

pituitary, maintaining breast function for nursing.
1. Initiation of Milk Secretion (Lactogenesis):
Milk Ejection
 Small amounts of milk are secreted during the later months of
pregnancy.  The discharge of milk from the mammary glands.

 Free flow of milk occurs only after childbirth.  Depends on the suckling action of the baby and contractile mechanisms in
the breast that expel milk from the alveoli into the ducts.
 Initial milk before parturition is called colostrum:
  A neuroendocrine response triggered by suckling, facilitating milk  Vitamins A and D
ejection during breastfeeding.
 Minerals

Effect of Lactation on Menstrual Cycle

Advantages of Breast Milk
 Women who nurse regularly may not experience a menstrual cycle for
 Superior to animal milk (cow or goat) due to balanced nutrient
about 24 to 30 weeks postpartum.
composition necessary for infants, including:
 Continuous stimulation of prolactin secretion from nursing inhibits
 Iron
GnRH (gonadotropin-releasing hormone) secretion.
 Vitamins
 Suppression of gonadotropin secretion leads to inactive ovaries
and prevents ovulation.  Minerals
 As nursing frequency decreases (after about 24 weeks), GnRH and  Provides antibodies that help infants resist infections from harmful
gonadotropin secretion resumes, leading to the return of the menstrual bacteria.
cycle.
 Contains neutrophils and macrophages that protect the infant by destroying
microbes.
Breast Milk

 The primary source of nutrition for infants. Disadvantages of Animal Milk

Composition 1. Can irritate the gastrointestinal (GI) tract and cause anemia.
 Water: Approximately 88.5% 2. Excess proteins and fats are difficult for infants to digest and absorb.
 Solids: Approximately 11.5% 3. High casein content can lead to GI bleeding and anemia.
 Important solids include: 4. Elevated sodium and potassium levels can overstrain immature kidneys.
 Lactose 5. Low iron content can lead to iron deficiency anemia.
 Lactalbumin 6. Generally lower in vitamins and essential fatty acids compared to breast
milk.
 Iron
 CONTRACEPTIVE METHODS
Procedure/Method Description Effectiveness Risks

Abstinence Refrain from sexual intercourse 100% None

Rhythm Method Intercourse avoided for about an 8-day span around ovulation 70-80% None

Withdrawal Man withdraws before ejaculation 70-80% None

Tubal Ligation (Vasectomy) Oviducts are cut and tied Almost 99% Irreversible, about 75% risk

Hormonal IUD Flexible coil inserted, releases estrogen About 99% Infections, uterine perforation

Oral Contraceptive Daily hormone medication More than 90% Blood clots, especially in smokers

Contraceptive Implants Tubes of progesterone implanted under the skin More than 90% None known

Contraceptive Injections Hormonal injections About 99% Possible osteoporosis

Diaphragm Latex cup inserted to cover cervix With spermicide, about 90% Latex or spermicide allergy

Cervical Cap Latex cup held by suction over cervix Almost 85% UTI, latex or spermicide allergy

Female Condom Polyurethane liner fitted inside vagina Almost 85% None

Male Condom Soft sheath enclosing penis, trapping sperm 90% None

Jellies, Creams, Foams Spermicidal products inserted before intercourse About 75% Same as oral contraceptive

Natural Family Planning Record ovulation, avoid intercourse near ovulation About 70% None known

Douche Cleanses vagina after intercourse Less than 70% UTI, allergy to spermicides

Plan B Pill Taken after intercourse to prevent pregnancy About 89% None known

Notes:

 Effectiveness percentages indicate the likelihood of preventing pregnancy with proper use.

 Risks include potential health issues or side effects associated with each method.