Uploaded by Dr. Gshankar Yadav

1. Female Infertility

2. The most likely causes for female infertility are:
1. Pelvic Inflammatory Disease (PID) - PID is the most
common cause of infertility worldwide.
• It‘s an infection of the pelvis or one or more of the reproductive organs,
including the ovaries, the fallopian tubes, the cervix or the uterus.
• PID usually stems from the same bacteria that cause sexually transmitted
diseases, such as gonorrhea or chlamydia. Chlamydia, in fact, causes 75
percent of fallopian tube infections.
• PID may also develop from bacteria that reach the reproductive organs
through abortion, hysterectomy, childbirth, sexual intercourse, use of an
intrauterine (IUD) contraceptive device or a ruptured appendix.
• Not only does PID cause infertility, but it may also lead to ectopic pregnancy
and blood poisoning, a potentially fatal complication.

3. 2. Polycystic ovary syndrome (PCO)
• Another major cause of infertility.
•Due to hormones in the wrong quantities, follicles do not produce eggs. Instead they
form fluid-filled cysts that eventually cover the ovaries.
• It also increases the risk of diabetes, cancer and even heart disease
•The symptoms include: Excessive facial hair , Acne , Depression , Unexplained weight
gain , Irregular or no periods , High insulin or cholesterol readings

4. 3. Endometriosis
• Endometriosis refers to a condition in which sections of the
uterine lining implant in the vagina, ovaries, fallopian tubes
or pelvis.
• These implants eventually form cysts that grow with each
menstrual cycle, and may eventually turn into blisters and
scars. The scars can then block the passage of the egg.

5. 4. Fibroids
• Fibroids, or benign growths, may form in the uterus near the fallopian tubes or cervix.
As a result, the sperm or fertilized egg cannot reach the uterus or implant there.
Other Uterine Problems - Abnormal reproductive organs or endometritis (an abnormal
swelling of the uterine lining) may make it difficult for the fertilized egg to implant.

6. 5. Illness
• Certain diseases, such as diabetes, kidney disease or high blood pressure. Ectopic
pregnancy and some urinary tract infections may also elevate the risk of infertility.
6 . Medications
• Hormones, antibiotics, antidepressants, and pain killers may bring on temporary
infertility.
• Commonly used medications such as aspirin and ibuprofen can also impair fertility if
taken mid-cycle. Acetaminophen (Tylenol) pills can reduce the amount of estrogen and
luteinizing hormones in the body, impairing fertility.

7. 7. Surgical Complications
•Scar tissue left after abdominal surgery can cause problems in the movement of the
ovaries, fallopian tubes, and uterus, resulting in infertility.
•Frequent abortions may also produce infertility by weakening the cervix or by leaving
scar tissue that obstructs the uterus

8. Regulation of Female Monthly Rhythm:
- Puberty  onset of adult sexual life
- Menarche  beginning of menstrual cycles
- Menopause  at 40 – 50 yrs  irregular cycles, failure of ovulation  female hormones
diminish
Due to: Ovaries are used up
Sx: Hot flushes, Psychic dyspnea, irritability, fatigue, anxiety, decreased strength and
calcification of bones

11. WHPL

12. 1. What is menstruation?
2. Significance
3. Which hormones play a role in
menstruation?
4. Significance of each hormone
5. What medical conditions will arise due
to problems in hormones associated?

13. ■ The process in a woman of discharging
blood and other material from the
lining of the uterus at intervals of
about one lunar month (28 days) from
puberty until the menopause, except
during pregnancy.

14. ■ Menstruation is not the same as the menstrual
cycle.
■ The Menstrual cycle describes the cyclic
changes in a woman’s body going through
menstruation, the follicular phase, ovulation,
the luteal phase and back to menstruation
again to begin the cycle.
■ Menstruation is therefore one of the 4 phases
of the menstrual cycle.

15. 1. Cycle of natural changes that occurs in
the uterus and ovary as an essential part of
making sexual reproduction possible.
2. Essential for the production of eggs.
3. Preparation of the uterus for pregnancy.
4. Fertile period of a woman’s life between
menarche and menopause.

16. ■ Menarche: Age at onset of menstruation
■ Primary
despite signs of puberty
■ Secondary amenorrhea:
for 3-6 months in a
Absence of menstruation
Absence of menstruation
woman who previously
menstruated
■ Dysfunctional uterine bleeding: Irregular bleeding
due to anovulation or anovulatory cycle
Menarche age 12
9 years
amenorrhea:
16 years

17. ■ Menorrhagia: Regular menstrual intervals,
excessive flow and duration
■ Metrorrhagia: Irregular menstrual intervals,
excessive flow and duration
■ Oligomenorrhea: Menstrual interval greater
than 35 days
Menstrual cycle
■ Anovulation / anovulatory:
without ovulation
■ Dysmenorrhea: Menstrual cramping/pain

18. 1. Duration of menstrual flow
2. Quality of the menstruum,
3. Amount of blood loss,
4. The flow pattern and
5. Associated symptoms.

19. ■ Last from 3 to 7 days.
▪ The exact duration varies from woman to woman.
▪ It however shows little or no variation for the
same woman from cycle to cycle.
▪ Most women do not experience cycle to cycle
changes more than 1 or 2 days.
▪ It is unusual for the same woman to have wide
swings such as 3 days duration in one cycle and 7
days in another.

20. ■ Menstrual blood is normally bright or light
red in color like the bleeding that occurs after
a knife cut or similar injury.
▪ It could look brown in some few
women and still be normal menstruation.
▪ It must not have a foul odor.
▪ Small clots may be a normal part of menstrual
blood.

21. ■ The average blood loss during normal
menstruation is about 35 ml, with a
range of 10 to 80 ml.
▪ Usually understood from the number of
pads soaked.

22. ■ Normally, as menses begin to flow, the
amount of blood loss seems to increase
gradually until it attains a maximum and
then starts diminishing as the end of the
flow draws near.
■ This pattern is described as crescendo-
decrescendo pattern.

23. ■ Normal menstruation may be accompanied by other
symptoms such as
▪ Breasts fullness,
▪ Mild lower abdominal pain or Irritability.
▪ Fluid retention
▪ Cramping
▪ Mood swings
▪ Weight gain
▪ Breast tenderness
▪ Diarrhea
▪ Constipation
■ These symptoms are never debilitating.

25. ■ Begins when estrogen levels are low
■ Anterior pituitary secretes FSH and
LH, stimulation follicle to develop
■ Cells around egg enlarge, releasing
estrogen
■ This causes this uterine lining to
thicken

26. ■ LH and FSH still being released, for
another 3-4 days
■ Follicle ruptures, releasing ova into
the Fallopian tubes

27. ■ Now empty follicle changes to a yellow
colour, becomes corpus luteum
■ Continues to secrete estrogen, but now
beings to release progesterone
■ Progesterone further develops uterine
lining
■ If pregnant, embryo will release
hormones to preserve corpus luteum

28. ■ If no embryo, the corpus luteum begins
to disintegrate
■ Progesterone levels drop, uterine lining
detaches, menstruation can begin
egg all
■ Tissue, blood, unfertilized
discharged
■ Can take from 3-7 days

31. Hormonal
Regulation
of Menstruation
WITHOUT
ESTROGEN AND
PROGESTERONE,
ENDOMETRIUM
BREAKS DOWN –
MENSTRUATION
OCCURS.

34. FEMALE HORMONES
PROTEIN HORMONES
l hCG
l hPL
l hCT
l Hypothalamic and
pituitary like hormones
l Others like inhibin, relaxin
and beta endorphins
STEROID
HORMONES
l Esrogens
l Progestin

35. HPL (Human placental
lactogen)
HCG (Human
chorionic
gonadotropin)
1)It is a hormone produced by the
syncytiotrophoblast, a portion of
the placenta following
implantation
2)The pituitary analog of hCG,
known as luteinizing hormone
3)promotes the maintenance of the
corpus luteum during the
beginning of pregnancy
4) hCG can also be used clinically
to induce ovulation in the ovaries
as well as testosterone production
in the testes.
1)Also called human chorionic
somatomammotropin (HCS), is a
polypeptide placental hormone.
2)Its structure and function is
similar to that of human growth
hormone
3)↓ maternal insulin sensitivity
leading to an increase in maternal
blood glucose levels.
4) ↓ maternal glucose utilization,
which helps ensure adequate fetal
nutrition (the mother responds by
increasing beta cells). Chronic
hypoglycemia leads to a rise in
hPL.

36. • The estrogens are steroidal hormones synthesized
from cholesterol and produced primarily by the ovaries,
placenta and corpus luteum.
ESTROGEN

38. Secondary sexual characters
• Estradiol is responsible for the secondary sex characteristic of the
female
• It causes the growth of the duct system of the mammary gland
• It stops growth of long bones by initiating the closure of epiphyseal
growth plate
• It causes disposition and distribution of body fat.
• They are required for the development of the secondary sex
characteristics of the female including hair growth, deposition of body
fat, mammary gland development, plumage, etc.
• They play a role in the normal health and function of the skin

39. EFFECTS OF ESTROGEN ON
REPRODUCTIVE TRACTS
• VAGINA- slight mucous secretion, hyperemia, oedema
• CERVIX – Relaxation, Liquefaction of mucous plug
• UTERUS- Stimulates uterine gland development,
sensitization of the endometrium to oxytocin, immune
activation (local), leucocyte infiltration .
• FALLOPIAN TUBE-Increased motility & cilia activity
• MAMMARY GLAND- Stimulates mammary duct
development

40. Progesterone:

41. SOURCES
• Luteal cells of corpus luteum
• Also produced from adrenal cortex
and placenta.

42. FUNCTIONS
• Progesterone causes growth of the glandular system of the
endometrium of the uterus, and the secretions from the
endometrial glands (uterine milk) for the nutrition of the ovum
and the attachment of the embryo.
• Progesterone plays a role in the maintenance of pregnancy (and
pseudopregnancy) by providing a favorable environment for
survival of the embryo.
• Progesterone causes growth of the alveolar system of the
mammary gland.
• Progesterone inhibits the smooth muscle activity of the uterus -
renders it less sensitive to oxytocin.

43. • Target tissues are relatively insensitive to progesterone unless
primed by estrogen - At low levels progesterone acts with
estrogen to stimulate ovulation by promoting LH release.
• At high levels progesterone inhibits the secretion of FSH and
LH via a negative feedback and thus also prevents the
ovulation of follicles during the luteal phase and during
pregnancy.
• Progesterone increases the efficiency of nutrient utilization.

44. EFFECTS ON PEPRODUCTIVE
ORGANS
• Vagina- slight mucous secretion, paleness .
• Cervix- Closure, formation of mucous plug
• Uterus- stimulates uterine gland secretions, sensitization of
endometrium to oxytocin, decreases uterine motility,
• Fallopian tube- increased secretion , decreased motility
• Mammary gland – Stimulates lobulo-alveolar development