REPRODCTION
DR SABREEN
CONTENT
• MENOPAUSE
• PRODUCTION OF OESTROGEN AND PROGESTERONE
• PREGANCY AND THE PHYSIOLOGYCAL CHANGES TAKING PLACE IN THE
MOTHER.
• FUNCTION OF THE PLACENTA
• PARTRITION AND LACTATION
MENOPAUSE
• Menopause is defined as the period when permanent cessation of menstruation takes place.
• Normally, it occurs at the age of 45 to 55 years.
• In some women, the menstruation stops suddenly.
• In others, the menstrual flow decreases gradually during every cycle and finally it stops.
• Sometimes irregular menstruation occurs with lengthening or shortening of the period with less
or more flow.
• Early menopause may occur because of surgical removal of ovaries (ovariectomy) or uterus
(hysterectomy) as a part of treatment for abnormal menstruation.
• Usually, females with short menstrual cycle attain menopause earlier than the females with
longer cycle.
• Cigarette smoking causes earlier onset of menopause.
CAUSE
• Major cause for the symptoms is the lack of estrogen and progesterone.
• Symptoms may persist till the body gets acclimatized to the absence of estrogen and progesterone.
SYMPTOMS:
• Symptoms do not appear in all women.
• Some women develop mild symptoms and some women develop severe symptoms, which last for
few months to few years.
• Fatigue
• Nervousness
• Emotional outburst like crying and anger
• Mental depression
• Vertigo
• Headache
• Urinary disturbances such as increased frequency of micturition
PRODUCTION OF OESTROGEN AND PROGESTERONE
• ESTROGEN
• SOURCE OF SECRETION
• In a normal non-pregnant woman, estrogen is secreted in large quantity by theca interna cells of
ovarian follicles and in small quantity by corpus luteum of the ovaries.
• Estrogen secretion is predominant at the later stage of follicular phase before ovulation
• Estrogen is derived from androgens, particularly androstenedione, which is secreted in theca interna
cells.
• Androstenedione migrates from theca cells to granulosa cells, where it is converted into estrogen by
the activity of the enzyme aromatase.
• A small quantity of estrogen is also secreted by adrenal cortex.
• In pregnant woman, a large amount of estrogen is secreted by the
placenta.
SYNTHESIS
• The different forms of estrogen are synthesized from the cholesterol or acetate.
• If estrogen is formed from acetate, first acetate is converted into cholesterol.
• PATHWAY FOR SYNTHESIS OF ESTROGEN
Acetate → Cholesterol → Pregnenolone ↓ Estrogen ← Testosterone ←
Progesterone
• During synthesis of estrogen, progesterone and testosterone are synthesized
first.
• Then, before leaving the ovaries, almost all the testosterone and much of the
progesterone are converted into estrogen.
• About 1/15 of testosterone is secreted into the plasma of the female by the
ovaries.
FUNCTIONS OF ESTROGEN
• Major function of estrogen is to promote cellular proliferation and tissue growth in the reproduction organs.
• In childhood, the estrogen is secreted in small quantity.
• During puberty, the secretion increases sharply, resulting in changes in the reproduction organs.
1. EFFECT ON OVARIAN FOLLICLES
Estrogen promotes the growth of ovarian follicles by increasing the proliferation of the follicular cells.
2. EFFECT ON UTERUS
Estrogen produces the following changes in uterus:
• Increase in the contractility of the uterine muscles
3. EFFECT ON VAGINA
Estrogen
Increases the layers of the vaginal epithelium by proliferation.
Reduces the pH of vagina, making it more acidic.
[Link] ON BONES
Estrogen increases osteoblastic activity.
So, at the time of puberty, the growth rate increases enormously.
But, at the same time, estrogen causes early fusion of the epiphysis with the shaft.
[Link] OF ESTROGEN SECRETION
• Estrogen secretion is regulated by follicle-stimulating hormone (FSH) released from anterior pituitary.
• Release of FSH is stimulated by the gonadotropin-releasing hormone (GnRH) secreted from
hypothalamus.
6. EFFECT ON ELECTROLYTE BALANCE
Estrogen causes sodium and water retention from the renal tubules.
7. EFFECT ON Secondary Sexual Characters
• Estrogen is responsible for the development of secondary sexual characters
i. Hair distribution: Hair develops in the pubic region and axilla.
ii. Skin: Skin becomes soft and smooth
iii. Body shape: Shoulders become narrow, hip broadens, thighs converge and the arms diverge.
iv. Pelvis:
• Broadening of pelvis with increased transverse diameter
• Round or oval shape of pelvis
8. Effect on Metabolism
i. On protein metabolism
• Estrogen induces anabolism of proteins, by which it increases the total body protein.
ii. On fat metabolism
• Estrogen causes deposition of fat in the subcutaneous tissues, breasts, buttocks and thighs.
9. Effect on Fallopian Tubes
• Estrogen:
• Acts on the mucosal lining of the fallopian tubes and increases the number and size of the epithelial cells,
especially the ciliated epithelial cells lining the fallopian tubes
PROGESTERONE
Source of Secretion
• In non-pregnant woman, a small quantity of progesterone is secreted by theca interna cells of ovaries
during the first half of menstrual cycle, i.e. during follicular stage.
• But, a large quantity of progesterone is secreted during the latter half of each menstrual cycle, i.e. during
secretory phase by the corpus luteum.
• Small amount of progesterone is secreted from adrenal cortex also.
• In pregnant woman, large amount of progesterone is secreted by the corpus luteum in the first trimester.
• In the second trimester, corpus luteum degenerates.
• Placenta secretes large quantity of progesterone in second and third trimesters.
Synthesis
• Progesterone is synthesized from acetate or cholesterol in the ovaries, along with estrogen
FUNCTIONS OF PROGESTERONE
1. Effect on Fallopian Tubes
Progesterone promotes the secretory activities of mucosal lining of the fallopian
tubes.
Secretions of fallopian tubes are necessary for nutrition of the fertilized ovum, while
it is in fallopian tube before implantation
2. Effect on the Uterus
Progesterone promotes the secretory activities of uterine endometrium during the
secretory phase of the menstrual cycle.
Thus, the uterus is prepared for implantation of the fertilized ovum.
3. Effect on Cervix
Progesterone increases the thickness of cervical mucosa and thereby inhibits the
transport of sperm into uterus
5. Effect on Hypothalamus
Progesterone inhibits the release of LH from hypothalamus through feedback effect.
[Link] on Electrolyte Balance
Progesterone increases the reabsorption of sodium and water from the renal tubules
[Link] Effect
Progesterone increases the body temperature after ovulation.
It is suggested that progesterone increases the body temperature by acting on hypothalamic centres for
temperature regulation.
8. Effect on the Mammary Glands
• Progesterone promotes the development of lobules and alveoli of mammary glands by proliferating and
enlarging the alveolar cells.
9. Effect on Respiration
• During luteal phase of menstrual cycle and during pregnancy, progesterone increases the ventilation via
respiratory center.
10. Effect on Electrolyte Balance
• Progesterone increases the reabsorption of sodium and water from the renal tubules.
• However, in large doses, it is believed to cause excretion of sodium and water.
PLACENTA
• Placenta is a temporary membranous vascular organ that develops in females during
pregnancy.
• It is expelled after childbirth.
• Placenta forms a link between the fetus and mother.
• It is considered as an anchor for the growing fetus.
• It is not only the physical attachment between the fetus and mother, but also forms
the physiological connection between the two.
• Placenta is implanted in the wall of the uterus.
• It is formed from both embryonic and maternal tissues.
• So, it consists of two parts namely the fetal part and the mother’s part.
• It is connected to the fetus by umbilical cord, which contains blood vessels and
connective tissue
FUNCTION OF PLACENTA
NUTRITIVE FUNCTION
• Nutritive substances, electrolytes and hormones necessary for the development
of fetus diffuse from mother’s blood into fetal blood through placenta
EXCRETORY FUNCTION
• Metabolic end products and other waste products from the fetal body are
excreted into the mother’s blood through placenta.
RESPIRATORY FUNCTION
• Fetal lungs are non functioning and placenta forms the respiratory organ for
fetus.
• Oxygen necessary for fetus is received by diffusion from the maternal blood and
carbon dioxide from fetal blood diffuses into the mother’s blood through
placenta.
PARTURITION
• Parturition is the expulsion or delivery of the fetus from the mother’s body.
• It occurs at the end of pregnancy.
• The process by which the delivery of fetus occurs is called labor.
• It involves various activities such as contraction of uterus, dilatation of cervix and opening
of vaginal canal.
• BRAXTON HICKS CONTRACTIONS
• Braxton Hicks contractions are the weak, irregular, short and usually painless uterine
contractions, which start after 6th week of pregnancy.
• Braxton Hicks contractions are triggered by several factors such as:
1. Touching the abdomen
2. Movement of fetus in uterus
3. Physical activity
5. Dehydration.
• FALSE LABOR CONTRACTIONS
• While nearing the time of delivery, the Braxton Hicks contractions become
intense and are called false labor contractions.
• The false labor contractions are believed to help cervical dilatation.
STAGES OF PARTURITION
• Parturition occurs in three stages:
• FIRST STAGE
• First, the strong uterine contractions called labor contractions commence.
• Labor contractions arise from fundus of uterus and move downwards so that the
head of fetus is pushed against cervix.
• It results in dilatation of cervix and opening of vaginal canal.
• Exact cause for the onset of labor is not known.
• This stage extends for a variable period of time
• SECOND STAGE
• In this stage, the fetus is delivered out from uterus through cervix and vaginal canal.
• This stage lasts for about 1 hour
• THIRD STAGE
• During this stage, the placenta is detached from the decidua and is
expelled out from uterus.
• It occurs within 10 to 15 minutes after the delivery of the child.
LACTATION
• Lactation means synthesis, secretion and ejection of milk.
• Lactation involves 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. Initiation of Milk Secretion or Lactogenesis
• Although small amount of milk secretion occurs at later months of
pregnancy, a free flow of milk occurs only after the delivery of the child.
• The milk, which is secreted initially before parturition is called colostrum.
2. Maintenance of Milk Secretion or Galactopoiesis
• Galactopoiesis depends upon the hormones like growth hormone,
thyroxine and cortisol, which are essential for continuous supply of
glucose, amino acids, fatty acids, calcium and other substances necessary
for the milk production
• 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.
Milk ejection is a reflex phenomenon. It is called milk ejection reflex
or milk let-down reflex. It is a neuroendocrine reflex.
PREGANCY AND THE PHYSIOLOGYCAL CHANGES TAKING PLACE IN THE
MOTHER
1. Blood
The blood volume increases by about 20% or about 1 L.
This increase is mainly because of increase in plasma volume. It causes
hemodilution.
Because of great demand for iron by the fetus, the mother usually develops
anemia.
It can be rectified by proper prenatal care and iron replacement.
• 2. Cardiovascular System
• Cardiac output Generally, cardiac output increases by about 30% in the
first trimester.
• After the 3rd month, cardiac output starts decreasing and reaches almost
the normal level in the later stages of pregnancy.
• Blood pressure Arterial blood pressure remains unchanged during the
first trimester.
• During the second trimester, there is a slight decrease in blood pressure.
It is due to the diversion of blood to uterine sinuses.
• And, hypertension develops if proper prenatal care is not taken.
• 3. Respiratory System
• Overall activity of respiratory system increases slightly.
• Tidal volume, pulmonary ventilation and oxygen utiliza tion are
increased.
• 4. Excretory System
• Renal blood flow and GFR increase resulting in increase in urine
formation.
• It is because of increase in fluid intake and the increased excretory
products from fetus.
• The urine becomes diluted with the specific gravity of 1,025.
• In the first trimester, the frequency of micturition increases because
of the pressure exerted by the uterus on bladder.
• 5. Digestive System
• During the initial stages of pregnancy, the morning sickness occurs in
mother. It involves nausea, vomiting and giddiness. This is because of
the hormonal imbalance. The motility of GI tract decreases by
progesterone and constipation is common. Indigestion and
hypochlorhydria (decrease in the amount of hydrochloric acid in
gastric juice) also occur
• 6. Endocrine System i. Anterior pituitary During pregnancy, the size of
anterior pituitary increases by about 50%. And secretion of
corticotropin, thyrotropin and prolactin increases. However, the
secretion of FSH and LH decreases very much. It is because of
negative feedback control by estrogen and progesterone, which are
continuously secreted from corpus luteum initially and placenta later
on.
• ii. Adrenal cortex There is moderate increase in secretion of cortisol,
which helps in the mobilization of amino acids from the mother’s
tissues to the fetus. Aldosterone secretion also increases. It reaches
the maximum at the end of pregnancy. Along with estrogen and
progesterone, aldosterone is responsible for the retention of water
and sodium
• iii. Thyroid gland The size and the secretory activity of thyroid gland
increase during pregnancy. The increased secretion of thyroxine helps
in the preparation of mammary glands for lactation. It is also
responsible for increase in basal metabolic rate.
• iv. Parathyroid glands Parathyroid glands also show an increase in the
size and secretory activity. Parathormone is responsible for
maintenance of calcium level in mother’s blood in spite of loss of
large amount of calcium to fetus.
• 7. Nervous System There is general excitement of nervous system
during pregnancy. It leads to the psychological imbalance such as
change in the moods, excitement or depression in the early stages of
pregnancy. During the later months of pregnancy, the woman
becomes very much excited because of anticipation of delivery of the
baby, labor pain, etc.
CLINICAL MODULE
• Male infertility
• Female infertility
• Contraception
• Basis for pregnancy tests
INFERTILITY
• Infertility is the inability to produce the offspring. In females, it is the
inability to conceive a child by natural process or inability to carry
pregnancy till the completion of term.
• Infertility occurs due to various factors such as immature reproductive
system, defective reproductive system, endocrine disorders, etc
MALE INFERTILITY
1. DECREASED SPERM COUNT – OLIGOZOOSPERMIA
• Normal sperm count in a male is about 100 to 150 millions/mL of semen.
• Infertility occurs when the sperm count decreases below 20 millions/mL of semen.
• Sperm count decreases because of disruption of seminiferous tubules or acute infection in
testis.
• In some males, there is possibility of sterility (permanent inability to produce offspring)
because of absence of spermatogenesis as in the case of cryptorchidism or underdeveloped
testis
2. ABNORMAL SPERMS
• Sometimes, the sperm count may be normal, but the structure of the sperm may be abnormal.
• The sperms may be without tail and nonmotile or with two heads or with abnormal head.
• When a large number of abnormal sperms are produced infertility occurs
3. OBSTRUCTION OF REPRODUCTIVE DUCTS
Obstruction of reproductive ducts like vas deferens leads to infertility.
4. OTHER DISORDERS
i. Trauma I
ii. Longterm use of drugs
iii. Alcoholism
iv. Genetic disorders
v. Hypothalamic disorders
INFERTILITY IN FEMALES
1. ABNORMALITIES OF OVARY
• Sometimes, a thick capsule develops around the ovaries and prevents ovulation.
• In some women, ovaries develop cysts (membranous sac containing fluid) or become fibrotic (hardened
tissues resulting from lymphedema).
• In these conditions, maturation and release of ovum does not occur.
2. ABNORMALITIES OF UTERUS
A type of endometrial tissue similar to uterine endometrium grows in the pelvic cavity surrounding the uterus,
fallopian tubes and ovaries.
It is called endometriosis.
And, pregnancy does not occur in this condition.
In some cases, there is low grade infection or inflammation or abnormal hormonal stimulation in the cervix.
It leads to the abnormal secretion of thick mucus in cervix, which prevents entry of sperm and fertilization of
ovum
3. Absence of Ovulation
• Ovulation does not occur in some females, because of hyposecretion
of gonadotropic hormones.
• Quantities of these hormones are not sufficient enough to cause
maturation of ovum or release of ovum.
• The cycle without ovulation is known as anovulatory cycle
4. Other Disorders
i. Diabetes mellitus
ii. Renal diseases
iii. Liver diseases
iv. Hypothalamic disorders
v. Disorders of pituitary gland, thyroid and adrenal glands.
Contraception.
Basis for pregnancy tests.
PRACTICAL
• Pregnancy tests
PREGNANCY TEST
• Pregnancy test is the test used to detect or confirm pregnancy.
• The basis of pregnancy tests is to determine the presence of the human
chorionic gonadotropin (hCG) in the urine of woman suspected for
pregnancy.
• Both biological and immunological tests are available to determine the
presence of hCG in the urine of the pregnant woman
• Urine Fresh
• urine sample of the woman, who needs to confirm pregnancy is used for Gravindex test.
PROCEDURE. One drop of hCG antiserum is taken on a glass slide.
[Link] drop of urine from the woman who wants to confirm pregnancy is added to this and both are
mixed well.
2. Now, one drop of latex particles is added to this and mixed.
OBSERVATION AND RESULT
Result is determined by observing the agglutination of latex particles added to mixer of hCG antiserum
and woman’s urine
ABSENCE OF AGGLUTINATION OF LATEX PARTICLES
If hCG is present in urine, it is agglutinated by antibodies of antiserum and all the antibodies are fully used
up.
No free antibody is available.
Agglutination of hCG molecules by antibodies is not visible because it is colorless.
Later when latex particles are added, these particles are not agglutinated because, free antibody is not
available. Thus, absence of agglutination of latex particles indicates that the woman is pregnant.
• PRESENCE OF AGGLUTINATION OF LATEX PARTICLES
• If urine without hCG is mixed with antiserum, the antibodies are
freely available.
• When latex particles are added, the antibodies cause agglutination of
these latex particles.
• Agglutination of latex particles can be seen clearly even with naked
eye.
• Thus, presence of agglutination of latex particles indicates that, the
woman is not pregnant