Male Gonadal Function

• Gonadal function depends upon factors interfering with testicles

General Information

• Chemotherapy, radiation, alcohol abuse, testicular pain/volume, and drug use can cause male issues
• Physical examination aids in determining if development matches age, and detects testicle inflammation

Semen Analysis

• Semen analysis identifies sperm count, shape and movement
• Normal values are around 15 million sperm/ml of fluid or >39 million/ejaculate
• Over 40% sperm should be motile and >50% morphologically normal cells
• Abnormal semen needs repeating over months before reaching clinical relevance

Endocrinology

• Measuring testosterone is key to endocrine testicular function; low values generally mean hypogonadism
• Evaluate FSH and LH if testosterone or sperm is irregular
• Gonadotropin increase indicates primary dysfunction
• Normal or subnormal concentrations mean central cause

Sperm Count Considerations

• When sperm declines, testosterones and LH is normal but FSH has risen, indicates seminiferous tubule damage and normal Leydig cell production
• Secondary hypogonadism should trigger complete SNC image exam

Testicular Biopsy

• Lack of sperm and normal hormone levels usually prompts this
• Might expose ejaculatory duct obstruction or tubule alterations

The Female Anatomy

• Ovaries and the genital tract constitute the female reproductive system
• The genital tract includes fallopian tubes, uterus, and vagina

Female Life Stages

• The female system is distinct structurally and functionally in each life stage
• Fetal: reproductive system differentiates and develops
• Childhood: quiescence is maintained
• Adolescence/Puberty: transition between childhood and adulthood
• Adulthood: menstrual cycle occurs
• Climacteric: menstrual cycles become irregular, fertility declines
• Senescence: ability to reproduce is exhausted

Characteristics of Female Life Stages

• Cycles usually span 28 days, range between 25-35 days during menarche and climacteric
• After the first menstruation, cycles are commonly anovulatory and longer
• Throughout each cycle, the body readies gestationally
• The cycle restarts if egg implantation doesn't occur
• Menopause results from final cycle irregularity and fertility decline

Synchronization

• Events that happen are timed and involve peripheral factors to facilitate hormones

Ovarian Hormones

• Ovary matures gametes and creates sex hormones to act reproductively.
• Secretion controlled by pituitary gonadotropins (LH, FSH), released by hypothalamic GnRH

Ovarian Makeup

• Cortex holds follicles, stroma tissue and hilus cells
• Medulla comprises stroma, hilus, smooth muscle, vessels, nerves
• Hilus carries innervation, blood, lymph

Innervation and Bloodflow

• Predominantly sympathetic innervation from renal, hypogastric, intermesenteric nerves
• Ovarian irrigation done by arteries from ovaries and the uterus
• Cappillary blood makes pampiniform plexus to create ovarian veins

Phases of Ovarian Cycle

• Recurring ovarian cycle in women means period between 2 ovulations
• Preovulatory (9-23 days) involves follicular development and estrogen activity to prepare genetalia for fertilization
• Ovulatory phase takes 1-3 days with gonadotropin peak and egg release
• Postovulatory/luteal is ~14 days preparing for embryo implantation and being managed by progesterone

Follicle Development

• Follicle growth plus follicle decline happen continuously from intrauterine phase to reproductive phase’s end
• Follicle growth starts meiotically forming oogonia, with division arrested in prophase

Primordial Makeup

• Oocytes become encased by stromal cells for priming
• Oocytes stay quiescent until the moment of ovulation
• A basel lamina completes the external enclosure together called primordial follicle
• Oogonias get mitotically divided around the 20th gestation week
• Meiosis begins from the 11-12th weeks creating oocytes

Oocyte Material Decline

• Atresia, the programmed cell death that eliminates unneeded oocytes, occurs for discarded material
• Primordial follicles that launch development don't become preantral, undergoing atresia
• At birth ~2 million follicles are reduced to ~400,000 at puberty, continuous decline occurs during childhood

Oocyte Replenishment

• Processes to create follicle continue from childhood to menopause, being disrupted only with ovulation
• Contraception does not stop the normal loss of oocytes
• Though follicles seem independent in construction
• FSH and rising androgens are present and the follicle dies due to decreasing estrogen

Thecal Cells Function

• Dominance establishes with greater estrogen release
• Vascularization rises given VEGF, supporting gonadotropin access for one follicle to mature while other atresia occurs
• Inhibitors are produced that kill other cells, with 8th order follicles rupturing about 10-12 hours after gonadotropin burst

The Ovulation Event

• When 8th order follicle breaks, an oocyte shoots outward
• LH helps complete oocyte meioss and cumulus oophulus expansion
• Angiogenesis and muscle contraction occur in the ovum

Hormone Fluctuations

• Progesterone helps create distension in folicule walls, while collagenase dissolves said walls as stimulated by LH and FSH, finally breaking the follicle

Corpus Luteum

• Granulosa and theca invaded as follicular antrum expels an oocyte
• Follicular antrum consists of fibrin network, blood vessels, granulosa and theca in conjunction
• Granulosa stop dividing and create granules
• Theca consist lutein cell

Luteinization Under LH

• Luteinization transformation via leutenizing hormone, becoming rich in mitochondria and lipids, gaining pigment

Corpus Luteum Functions

• Temporary endometrial gland making hormones as most is set 7-8 days post oocyte expelling
• Absent is fertilization, degradation finishes by 12 day, and its fluctuations guide cycle changes
• Changes in luteal hormone is the cause of period length changes

Luteolysis Underway

• When atresia, necrosis cells cause white scars
• Process to is not understood, presumed from hormone reduction
• Low LH makes lutein cells non-viable

Follicle Maturation

• Primordial to primary conversion with oocyte growth
• Zona pellucida creation causes granular cell alteriation from cuboid shape keeping them as one layer

Granular Changes

• Primary to secondary sees granular cells prolifferating with liquid gathering
• Connective cells become structural as thecal layer, becoming secretoyt, becoming interal of outer tissue

Follicule Groups

• Secondary creates groupings of pre-antral, measuring about 120-200 nm
• Clusters initiate another follicle growth round

Oocyte to Ovulation

• Fully developed follicle takes ~85 days to mature from the pre antral form
• Full phase with slow rise lasting ~70 days needing FSH to move to secondary, or 3rd level.

Antral Events

• From primarly, the antrum emerges as connection points at each granular layer
• Cumulus oophorus shifts with fluid and is contained from cells internally
• Layer is 2-3 cells that connect to inner wall to suspend the oocyte

FSH/LH Connection

• Of cohorts with similar attributes, on the luteal phase in that cycle during subsequent cycles where cohorts die off
• This is dependent upon rising FSH levels

Dominance Events

• Rising above ~5mm with quick growth, the FSH guides which cells proliferate, generating estrogen and creating inner fluids
• These cause lesser follicles to be more androgenic and atretic
• VEGF triggers growing follicle blood supply, and one becomes a top follicle, with more access to FSH, estrogen, and with greater production of LH and greater granulosa numbers

Female Hormones in Depth

Estradiol

• Most crucial with estrone, estriol
  • More adrenal gland based and 1/12 as potent
• Liver then makes another potent hormone via a more low level hormone.

Progesterone

• Top progesterone released as primary, then from adrenal
• Progesterone modified via other channels which influence
• P450, known as side chain cleavage

Sex Steroid Transport

• Proteins and hormones bind blood vessels and are made readily available for hormones
  • The percentage is based on activity to circulate
• SHBG and Liver generate a strong estrogen release

Non Steroid Hormone Synthesis

• Glandular hormones form by endo, para, auto mechanisms that has an unidentified biological function
• Chains of beta will have Atrivina A/B to inhibit feedback
• Follistatin is like a peptide that decreases FSH action

Relax Hormone

• Is stimulated wth by gonadotropin having influence in the muscle areas for relaxation
  • Appears to help mobilize in the uterus, or with sperm.

Steroids in Reproduction

• Two cells are involved when synthezing those coordinated systems
  • On around day 7 you get a higher creation of FSH and androgens as things are more receptive to being sensitive
• In that action you can get less receptors

Feedback Systems

Phase Events

• LH and adenylyl produce cAMP causing the enzime and also synthesis from cholerseral
  • This will cause faster production and a peak in gondotropins

Aromatase and Progesterone and more.

• Gland synthesis peaks to control to ovulation hormone release
• The process to get there means high estrogen/progesterene.

Uterian and Menses Cycle Overview

• Coordinated release in function is to induce follicles, increase libido and create genital structure
  • If no ovulation then endometrium is impacted, prostaglandins are made from ischemic spasms

Action and Process

• Uterian shedding and muscular contractions occur, the flow lasting to about 5 days
• Follicule growth and a new menses begin, the cells becoming thin
• This process releases cells on about day 4 to cause prolifreration by the estrogon, that causes vascular activity and glandular endometial

Lutea Impact

• Increases gland actitviy from a high release of protein plus amino acids called uterine milk that is the function of helping an embryo
• Helps get an embryo and the spiral artery is well maintained to deliver food

Tubes Role

• Thin tube that has serous exterior that has cilial structure
  • Function is to move things in ways influeneced by steroids
• High estrogen and proliffertaion has more cilial movement

Cervical Impact

• There are vaginal based cell types that form the vagina
• Super, interment, basais form in childhood, to increase the ability and lower chance in infections
• Progesterone causes the structures to take on new form, though this means it takes longer for cells to recover