FEMALE REPRODUCTION SYSTEM
OOGENESIS
DEVELOPMENT: 6-8 weeks GERMINAL EPITH.
hormonally OOGONIA FOLLICLE
independent mitotic division PRIMORDIAL
24 weeks OOCYTES I. 7 x 106
1. meiosis
birth prophase 2 x 106
hormonally puberty OOCYTES II. 3 x 105
dependent haploid DOMINANT
(cyclic) 2. meiosis ATRETIC
metaphase GRAAF
OVUM OVULATION
2. meiosis – end
climacterical 0
Daan and Fauser, Maturitas 82 (2015) 257–265
UTERINE CYCLE
ovarian
uterine
gonadoliberin
(GnRH)
FSH, LH
estradiol
basal temper.
0 4 14 28
MENS. PROLIPHER. SECRETORY PHASE
+
_
0,5°C
FOLICULLAR OV. LUTEAL PHASE
6-10x
2-3x
progesteron
Daan and Fauser, Maturitas 82 (2015) 257–265
OVARIAL CYCLE
Germinal epithelium
Primordial Primary Graaf Corpus haemorrhagicum C. luteum
follicle
25m 150m up to 2 cm
estradiol progesteron
Oocyte-maturation inhibiting factor
Vesicular
follicle
Luteinisation inhibiting factor
(estrogens)
(progestins)
OVULATION
methrorhagia
VESICULAR FOLLICLE
PRIMARY FOLLICLE - FSH
Growth acceleration of primary follicle – change into vesicular follicle:
1) estrogens released into follicle stimulate granul. cells
increased number of receptors for FSH – POSITIVE FEEDBACK
(higher sensitivity for FSH!!!)
2) Increased number of receptors for LH (estrogens and FSH) – another
acceleration of growth due to „higher sensitivity“ to LH
3) Increased estrogens and LH secretion accelerates growth of theca cells,
secretion is increased
explosive growth of follicle
DOMINANT FOLLICLE
1. High level of estrogens from the fastest-growing follicle
2. Negative feedback on FSH production from adenohypophysis
3. Drop in FSH secretion
4. „Dominant follicle“ continues in growing due to intrinsic
positive feedback
5. Other follicles grow slowly and subsequently become atretic
MECHANISM OF OVULATION
LH
PROGESTERON
Hyperaemia of follicle
Secretion of prostaglandins
Weakening of follicle wall
PROTEOLYTIC ENZYMES
(collagenases from theca externa)
Degeneration of stigma
Rupture of follicle
Release of oocyte
Transudation of plasma into follicle
Swallowing of follicle
HUMOURAL REGULATION OF CYCLE
GnRH GnRH GnRH
FSH
LH
FSH
LH
FSH
LH
Follicular phase Ovulation Luteal phase
P FSH-rec. LH-rec. P P
P
A E A E A E A E
90´ 360´
GnRH
FSH
LH
30´
Artesia of follicle (except of one) Feedback -/+ Involution of corpus luteum
EFFECTS OF OVARIAL HORMONES
E P
Ovaries: maturation of follicles
Hysterosalpinx: motility motility
Uterus: proteosynthesis proteosynthesis
vascularisation and proliferation of endom. secretion of endom. glands
motility glycogen
motility
Cervix: colliquation of „plug“ creation of „plug“
Vagina: cornification of epithelium proliferation of epithelium
Mamma: growth of terminals growth of acines
Secondary sexual signs + Adipose
tissue: store (predilection), (critical amount) Bone
tissue: absorption closure
of fissures development
of pelvis Total
water retention: + +
Sexual behaviour: + -
ASSISTED REPRODUCTION TECHNIQUES
1. STIMULATION OF OOGENESIS (maturation of more follicles)
2. STIMULATION OF SPERMIOGENESIS (vit. E)
3. INSEMINATION (treated sperm, applied deeply into uterus)
4. IVF (in vitro fertilisation)
Ad 1) PROTOCOLS OF OVARIAL STIMULATION (short of long stimulation
protocols)
Stimulation of ovaries –FSH and LH, 3. - 12. day of cycle, SOMETIMES
combined with GnRH agonists or antagonists
IVF PROCEDURES
1. STIMULATION OF OVARIES
2. TIMING OF TAKING THE OOCYTES
3. EXTRACORPOREAL FERTILISATION OF OOCYTES
4. EMBRYOTRANSFER AND MAINTAINANCE THERAPY
Ad 2) TIMING OF TAKING THE OOCYTES
Between 12. and 17. days of cycle, US controlled, after stimulation of oocyte
maturation by hCG, aspiration from follicular liquid in analgesia or anaesthesia
Ad 3) EXTRACORPOREAL FERTILISATION OF OOCYTES (cultivation of
sperm and oocytes in vitro for 48 hrs; test of sperm surviving – min.40%;
micromanipulation techniques – ICSI a AH = gentle rupture of zona pellucida;
prolonged cultivation – up to 120 hrs)
Ad ) EMBRYOTRANSFER (transfer of max. 3 embryos in stage of morula or
blastula; genetic examinations) and MAINTENANCE THERAPY
(progesterone)
CONTRACEPTION (BIRTH CONTROL)
• RHYTHM METHOD
• SPERMICIDE SUBSTANCES
• COITUS INTERRUPTUS
• CONDOM, PESSARY
• IUD
• HORMONAL CONTRACEPTIVES – risk of failure less than 1%
• VASECTOMY AND LIGATION OF HYSTEROSALPINX
Hormonal curettage (excochleation). Substitution therapy in climacterium.
HORMONAL CONTRACEPTION
• block of ovulation by suppression of hypothalamic releasing hormones
(block of preovulatory surge of LH)
• changes of character of cervical plug (progestin thickens mucus)
• changes of endometrium (suppression of its growth)
• changes of hysterosalpinx motility
Combined hormonal contraceptives:
• monophasic (amount of oestrogen and gestagen is stabile)
• biphasic and triphasic
• combiphasic contraceptives (after 7 days gestagen content
increases and oestrogen content decreases)
15mg estrogenu
60mg progestinu