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The first British woman to become pregnant using her own frozen eggs has given birth to a healthy baby girl. Helen Perry, 36, from Ludlow, Shropshire, became pregnant using an egg which had been taken from her ovary six months earlier, frozen, stored then thawed and replanted.
Dr Gillian Lockwood, whose team made the breakthrough, says: "The technology ... will work just as well for the Bridget Jones generation who want to freeze their eggs to keep their reproductive options open.. On ITV1's Tonight with Trevor McDonald on Friday, she explains: "I think that egg freezing may come to be seen as the ultimate kind of family planning."
Pregnancy
Lactation
Male
Puberty
Menstruation is an external indicator of ovarian events controlled by the hypothalamicpituitary axis Feedback
Hypothalamus
GnRH (gonadotrophin
Pituitary releasing hormone) LH FSH (gonadotrophins)
Ovaries
Oestradiol-17
HO
CH3
Brain Answer: Steroids with characteristic effects, esp. on female reproductive tract. Some are more potent than others. Breast ` Cardovascular system
Bone
Reproductive tract
GnRH
Pituitary LH FSH
Pulses of GnRH
Pulses of LH
Ovaries
Plasma LH
24 hours
Natural suppression Before puberty Lactation Diet induced Anorexia Malnutrition Exercise
Hypothalamic neurones GnRH pulse generator
Pituitary
Day 1
Day 1
12
16
20
24
28
Menstruation
Day 1
Day 1
Follicular phase
Luteal phase
12
16
20
24
28
Menstruation
OVULATION
12
Oestra diol
16
20
24
28
Menstruation
OVULATION
LH
Day 1
12
Oestra diol
16
20
24
28
Menstruation
OVULATION
LH
3. Luteal function
Day 1
12
Oestra diol
16
20
24
28
Menstruation
OVULATION
LH
3. Luteal function 4. Luteal regression
Day 1
12
Oestra diol
16
20
24
28
Menstruation
OVULATION
Theca
Granulosa cells
Antrum
Oocyte
Cumulus cells
Zona pellucida
(non-cellular glycoprotein coat)
Male
Spermatogonia
Female
Primordial germ cells (oogonia)
Mitoses
Spermatozoa
~7 m
~ 300,000
20 years 40
Conception
Growth of follicles:
Antral follicle Graafian follicle
Primordial follicle
Ovulation
Lets look at follicular growth first There are a number of questions to ask
Ovulation
Menstruation
Many! 30-50
How many follicles are growing at the start of the cycle?
Ovulation
Menstruation
Many! 30-50
How many follicles are growing at the start of the cycle?
Ovulation
Menstruation
Hypothalamus
GnRH (gonadotrophin
Pituitary
LH
releasing hormone)
Steroid feedback
Ovaries
FSH
(gonadotrophins)
Oestradiol (E2)
OVULATORY FOLLICLE
??????
Gonadotrophin independent
FSH
+ LH Ovulation
Menstruation
OVULATORY FOLLICLE
FSH
+ LH Ovulation OESTRADIOL
Menstruation
Theca
Granulosa cells
LH
Androgens (Note: the production of androgens is a normal part of ovarian physiology)
Androgens are converted (aromatized) to oestradiol by the granulosa cells
_
Increasing amounts of oestradiol.
Pituitary
Ovaries
LH
Oestradiol (E2)
Pituitary INHIBIN
(suppresses FSH)
Ovaries
Decreased FSH
Oestradiol (E2)
As the follicles grow, FSH levels fall due to the negative feedback,
FSH Oestradiol
12
16
20
24
28
Ovulation
Menstruation
Hypothalamus
GnRH
Pituitary
Ovaries
FSH
Large follicles: less Small follicles: Population of growing follicles dependent on FSH very dependent Oestradiol (E2) on FSH
Hypothalamus
GnRH
Pituitary
Ovaries
FSH
Large follicles: less Small follicles: dependent on FSH very dependent Oestradiol (E2) on FSH
Oestradiol
INHIBIN
Ovaries
Insufficient FSH
Large follicles: less Small follicles: dependent on FSH very dependent Oestradiol (E2) on FSH Growth factors Oestradiol + +
Dominant follicle
12
16
20
24
28
Polycystic ovaries
The classical picture of PCO: a string of follicles, 2-8 mm in diameter
Theca
Granulosa cells
LH
Androgens (Note: the production of androgens is a normal part of ovarian physiology)
Androgens are converted (aromatized) to oestradiol by the granulosa cells
FSH
OESTRADIOL (steroid)
4. The disturbed steroid feedback may re-inforce the abnormal LH/FSH secretion
3. The high LH induces high androgen secretion from the theca HIRSUTISM
4. The disturbed steroid feedback may re-inforce the abnormal LH/FSH secretion
3. The high LH induces high androgen secretion from the theca HIRSUTISM
HIRSUTISM
12
16
20
24
28
LH
12
16
20
24
28
12
16
20
24
28
NOT HUMANS!
What causes the LH surge? Reflex ovulation
0
Mating
12
16
LH
20
24
28
Neuroendocrine reflex
Oestradiol
12
16
20
24
28
Hypothalamus
_
Pituitary LH FSH
GnRH
Inhibited by oestradiol
Oestradiol
Ovary
Hypothalamus
GnRH
Pituitary
Oestradiol
Hypothalamus
Increased GnRH
Pituitary
Oestradiol
Oocyte: Completion of the 1st meiotic division (unequal division; extrusion of 1st polar body) 2nd meiotic division starts but becomes arrested before completion. Microvilli across the zona pellucida are withdrawn. Loosening of cumulus cells
Transformation of ruptured follicle into corpus luteum (CL) Ruptured follicle becomes solid corpus luteum Thecal cells and blood vessels invade Granulosa cells hypertrophy and terminally differentiate (luteinisation). Steroid secretion changes Progesterone
+ Oestradiol
Oestradiol Progesterone
Why does the CL degenerate at the end of the cycle?
12
16
20
24
28
OVULATION
Hypothalamus
GnRH Pituitary
CL
LH (low levels)
Progesterone + E2
CL very sensitive to LH
What maintains the CL? Steroid negative feedback keeps LH and FSH levels relatively low
Progesterone + E2 Reproductive tract etc
Hypothalamus
GnRH Pituitary
CL
CL very sensitive
Hypothalamus
GnRH
LH
Progesterone + E2
CL degenerates
Hypothalamus
GnRH
Pituitary
FSH + LH
Progesterone + E2
Hypothalamus
GnRH
As CL degenerates steroid negative feedback reduces .. New wave of follicles stimulated by rising Progesterone FSH and LH +E
2
Pituitary
FSH + LH
Oestradiol Progesterone
12
16
20
24
28
OVULATION
Oestradiol Progesterone
12
16
20
24
28
OVULATION
Oestradiol Progesterone
12
16
20
24
28
OVULATION
Oestradiol Progesterone
12
16
20
24
28
OVULATION
a) Outer muscle layer the myometrium b) Inner glandular mucosa the endometrium
More secretion from the glands hence the term secretory phase
12
16
20
24
28
Menstruation
OVULATION
12
16
Menstruation
28
1. At end of the luteal phase, steroid production declines. 2. Loss of oedema and gradual shrinking of endometrial tissue. The spiral arteries become more highly coiled 3. Gradual reduction in blood flow to superficial layers leading to ischaemic hypoxia and damage to the epithelial and stroma cells. 4. 4 24 hours prior to menstrual bleeding, an intense constriction of spiral arteries occurs. 5. Individual arteries re-open at different times, tearing and rupturing the ischaemic tissues. 6. Bleeding into the cavity occurs via: 1. red cells diapedese between surface epithelial cells; 2. tears develop in the surface epithelium 3. pieces of weakened superficial endometrium crumble away 7. About 50% of degenerating tissues is resorbed and 50% is lost as 'menstrual bleeding'.
Onset of menstruation is rapid. Probably 95% of women have a total blood loss of less than 60 mls. This blood loss can represent a significant loss of iron (leading to anaemia) especially in women on marginal diets
Menstruation - WHY?
In preparation for pregnancy, the human uterine stromal cells go through complex changes and the stromal cells terminal differentiate - Decidualization. If implantation and pregnancy do not occur, this tissue is lost - and the uterus prepares itself again for another possible pregnancy.
LH
3. Luteal function 4. Luteal regression
Day 1
12
Oestra diol
16
20
24
28
Menstruation
OVULATION
Ovulation?
Probability of clinical pregnancy following intercourse on a given day relative to ovulation (estimated from basal body temperature).
Cervical mucus
Abundant mucus - like raw egg white
Cervical mucus
12
16
20
24
28
Menstruation
OVULATION
With increasing oestradiol: 1. The mucus becomes more abundant - up to 30x more and its water content increases. 2. Its pH becomes alkaline. 3. Increased elasticity ("spinnbarkeit test") 5. Ferning pattern caused by the interaction of high concentrations of salt and water with the glycoproteins in the mucus.
12
16
20
24
28
Menstruation
OVULATION
Anovulatory cycle?
Fertility
LH
Oestradiol Progesterone
Ovulation
12
16
20
24
28
OVULATION
Plasma oestradiol
Plasma progesterone Volume of cervical mucus and sperm penetration Uterine endometrium
There are a number of potential ways of trying to identify the fertile period..: a) Calendar Method - which is essentially based on the previous menstrual history. b) Temperature method - using a midcycle rise in body temperature as a sign when ovulation has occurred. c) Cervical changes - which can be detected by feeling the cervix and cervical mucus. d) Hormonal methods - using over-thecounter "kits" to assess urinary hormone levels.
Problem-based powerpoint presentation (using many of the same screens as this lecture) on the menstrual cycle can be found at: www.kcl.ac.uk/ip/stuartmilligan/ppt/pptpage.h tml