Medical Pathophysiology: Altered Reproductive Function

Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease

• This lecture material is adapted from a 2022 textbook.
• It focuses on the mechanisms of disease, specifically altered reproductive function.
• The author is Dr. Romeo Batacan Jr.
• The lecture series is titled MPAT12001 Medical Pathophysiology.

Altered Reproductive Function

• Hormonal Imbalance:
  • Absence or infrequent ovulation
  • Impaired oocyte development
• Motility Impairment:
  • Issues with sperm or egg movement through reproductive tracts
• Pathway Obstruction:
  • Adhesion or blockage in the pathway from cervix to ovary
  • Problems with sperm and egg joining
  • Inhospitable cervical mucus that blocks sperm
  • Infections leading to adhesions
  • Leiomyomas (fibrous tumors in uterus) distorting the endometrial cavity
• Immune Problems:
  • Antibodies to sperm destroying them rapidly

General Manifestations of Altered Reproductive Function

• Infertility: inability to conceive
• Pain: indicative of infection, inflammation, or structural problems
• Amenorrhea: hormonal alterations affecting menstruation

Male Contribution to Pregnancy

• Men need sufficient sperm quantity and motility
• Semen analysis assesses:
  • Volume (2-5 mL)
  • Sperm density (15-39 million/mL)
  • Motility (>32% good/progressive)
  • Viability (>58% alive)
  • Morphology (>4% normally shaped)
  • Viscosity (full liquefaction within 20 minutes)

Female Contribution to Pregnancy

• Female contribution is complex and requires:
  • Production of mature ovum
  • Cervical mucus for sperm transport/viability
  • Patent fallopian tubes for ovum transfer
  • Endometrium suitable for implantation and fetal growth.
  • Vagina without obstructions or malformations

Sexual Response Physiology

• Four Phases:
  • Excitement: Vasocongestion, myotonia, increased heart rate, gland secretions
  • Plateau: Variables sustained or slightly increase, with vasocongestion and myotonia possible increase
  • Orgasm/Climax: Short, intense reaction (3-15 sec), heart rate increase( ~180 bpm), male ejaculation (emission of sperm into urethra & expulsion), female orgasmic platform contractions, cervix plunges rhythmically into vagina
  • Resolution: cardiovascular and respiratory functions return to normal. Male-refractory period; Female-multiple orgasms possible.

Infertility

• Inability to conceive after a year of unprotected intercourse
• Causes are almost equally divided between:
  • Male factors (30-40%)
  • Female factors (30-40%)
  • Combined factors (30-40%)
• ~10% to 25% of infertile couples have an unknown cause.
• Common causes include: Infections, inflammation, endocrine disorders, autoantibodies to sperm, environmental and lifestyle factors.

Male Altered Reproductive Function

• Causes: Varicocele (10-15% of males), hormonal issues (hyper/hypogonadism) infection/immune probs (antisperm antibodies), obstruction and congenital anomalies, ejaculatory dysfunction

• Treatment: depends on the cause; surgery, medication, artificial insemination (with donor sperm)

Female Altered Reproductive Function

• Causes of female infertility can be located in the following areas:Hypothalamus-pituitary, Ovaries, Fallopian tubes, Uterus, and Vagina. Numerous factors can contribute to each anatomical locations difficulties in the reproductive process.

Sexually Transmitted Infections (STIs)

• Single most important cause of reproductive disorders in many situations
• Reporting not mandatory for all types, but in Australia there are approximately 70,000 reported cases per year
• Transmission preventable with barrier contraception (latex condoms, female femidoms)
• Treatment effectiveness differs in ease or difficulty.

Hormonal and Menstrual Alterations

• Dysmenorrhea: Primary -ovulatory cycle related painful menstruation, Secondary- related to pelvic pathology
• Amenorrhea: Primary-absence of menstruation by age 14 (or 16), Secondary- Absence of menstruation for 3+ cycles or 6 months in menstruating women.
• Premenstrual Syndrome (PMS): Distressing symptoms in the luteal phase of women's menstrual cycles. Symptoms range from physical discomfort, emotional distress, and behavioral changes.

Detecting Altered Reproductive Function

• History and physical examination
• Sperm analysis
• Ovulation determination (cervical mucus/basal body temp/LH surge)
• Lab hormone levels, antibody detection
• Reproductive structures patency (hysterosalpingogram)
• Laparoscopy
• Genetic testing

Treating Altered Reproductive Function

• Dependent on the underlying cause.
• Supportive counseling and education
• Treatment options vary depending on the cause of problem, including infection, hormone imbalance, motility problems, and immune system problems.

Assisted Reproductive Technology (ART)

• Surgical removal of oocytes.
• Fertilization of oocytes
• Return of fertilized oocytes to the woman's body (in vitro fertilization)
• In vitro fertilization (IVF) is an expensive and sometimes painful procedure dealing with oocytes, hormones, and embryos.

Contraception

• Behavioral (rhythm method, abstinence) and barrier methods (condoms, diaphragms) along with hormonal methods to prevent pregnancy. Methods of hormonal contraception include:
• Using constant blood levels of ovarian hormones or
• Tricking the hypothalamic-pituitary axis
• Using high hormone concentrations or
• Interfering with normal hormone signals
• Preventing fertilization or
• Using progestin only methods like thickening cervical mucus, decreasing ovulation frequency, creating inhospitable endometrium etc.