Human chorionic gonadotropin and infertility-1 (1).pptx

HUMAN CHORIONIC GONADOTROPI N AND Infertility HUMAN CHORIONIC GONADOTROPIN (HCG): Is a hormone produced during pregnancy that is made by the developing placenta after conception, and later by the placental component. Some cancerous tumors produce this hormone; therefore, elevated levels...

HUMAN CHORIONIC GONADOTROPI N AND Infertility HUMAN CHORIONIC GONADOTROPIN (HCG): Is a hormone produced during pregnancy that is made by the developing placenta after conception, and later by the placental component. Some cancerous tumors produce this hormone; therefore, elevated levels can be measured. when the patient is not pregnant elevated levels can lead to a cancer diagnosis. However, it is not known whether this production is a contributing (come from growth factors and steroid hormones …e.tc) cause or an effect of tumor carcinogenesis. Structure: Human chorionic gonadotropin is a glycoprotein composed of 244 amino acids with a molecular mass of 36.7 KDs with an α (alpha)subunit. identical to that of luteinizing (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH). And β (beta) subunit that is unique to hCG. The α (alpha) subunit is 92 amino acids long. The β-subunit of hCG gonadotropin contains 145 amino acids. Concentration of beta hCG Throughout Normal Pregnancy Week from the Last Amount of HCG in Menstrual Period mIU/ml 3 5 -50 4 3 - 426 5 19 - 7,340 6 1,080 - 56,500 7-8 7,650 - 229,000 9 - 12 25,700 - 288,000 13 - 16 13,300 - 254,000 17 - 24 4,060 - 165,400 25 - 40 3,640 - 117,000 Function Human chorionic gonadotropin interacts with the L/HCG receptor and promotes the maintenance of the corpus luteum (‫فر‬:‫الص‬:‫لجسم (ا‬::‫ا‬ during the beginning of pregnancy, causing it to secrete the hormone Progesterone , Progesterone enriches the uterus with a thick Lining ((‫طانة‬:::‫ ب‬of blood vessel and capillaries so that it can sustain Due to its highly negative charge, hCG may repel the immune cells of the mother, protecting the fetus during the first trimester. It has also been hypothesized that hCG may be a placental link for the development of local maternal((‫الم‬:‫ا‬ immunotolerance. (state of unresponsiveness to immune system). Human chorionic gonadotropin also plays a role in cellular differentiation/proliferation and may activate apoptosis (‫ج‬:‫لمبرم‬::‫وت‬: ‫م ا‬ ‫ا‬:‫يه‬::‫رغوبف‬:‫لغير (م‬::‫ية ا‬:‫لخال‬::‫ل‬. HCG FORMS Three major forms of HCG are produced by human, with each having district((‫نطقة‬:‫م‬ physiological roles. These include: Regular HCG Hyperglycosylated HCG Free beta – subunit of HCG Other forms HCG include: Total hCG C-terminal peptide total hCG Intact hCG ß-core fragment hCG Nicked hCG Alpha hCG Pituitary hCG. Testing: Levels of hCG may be measured in the blood or urine. Most commonly, this is done as a pregnancy test, intended ((‫لمقصود‬::‫منوي ا‬ - ‫ل‬::‫ ا‬to indicate the presence or absence of an implanted embryo. Testing for hCG may also be done when diagnosing or monitoring germ cell tumors and gestation trophoblastic (name of abnormal cells or tumors grow during or after pregnancy) disease. As pregnancy tests, quantitative blood tests and the most sensitive urine tests usually detect hCG between 6 and 12 days after ovulation. Choriocarcinoma may produce high levels of βhCG despite the absence of an embryo. This, as well as several other conditions, can lead to elevated hCG readings in the absence of pregnancy. Methodology: Most tests employ a monoclonal antibody, which is specific to the β- subunit of hCG (β-hCG). This procedure is employed to ensure that tests do not make false positive by confusing hCG with LH and FSH. (The latter two are always present at varying levels in the body, whereas the presence of hCG almost always indicates pregnancy.)  Many hCG immunoassays are based on the sandwich principle, which uses antibodies to hCG labeled with an enzyme or luminescent dye. Pregnancy urine dipstick tests are based on the lateral (( ‫بي‬:‫ان‬:‫ ج‬flow technique The urine test may be a chromatographic immunoassay or any of several other test formats. The serum test, using 2-4 mL of venous blood, is typically a chemiluminescent or fluorimetric immunoassay that can detect βhCG levels as low as 5 mIU/ml and allows quantification of the βhCG concentration.  The ability to quantitate the βhCG level is useful in the monitoring germ cells and trophoblastic tumors, follow-up care after miscarriage (‫اض‬:‫ه‬:‫ج‬:‫)ا‬, and in diagnosis of follow-up care after treatment of ectopic pregnancy.  The lack of a visible fetus on vaginal ultrasound after the βhCG levels have reached 150,000 mIU/ml is strongly indicative of an ectopic pregnancy. Infertility: An inability to conceive ((‫لحمل‬::‫ ا‬-‫لحبل‬::‫ا‬ and produce children -Investigate the two partners Male infertility: -Good clinical history -External or physical examinations -Usually the investigation started after 2-years. -Do seminal analysis. -Hormonal investigations (LH, FSH, TESTOSTERONE.) low testosterone , high gonadotropin = testicular defect. low testosterone , low gonadotropin = 2ndry hypogonadism (pituitary or hypothalamus). *Gn--------------RH –test to differentiate the defect from pituitary or from hypothalamus. -Good response = hypothalamus defect (increased of more than 5mg/dl in LH). -Subnormal response = defect in pituitary..Estimate the level of prolactin- high prolactin cause Gynecomastia (enlargement of male breast) Female infertility:.Good clinical history. -External or physical examinations. -U/S to check the ovaries, fallopian tubes and uterus. -Hormonal analysis (LH, FSH, estradiol) -uterine biopsy usually done in the luteal phase. -Luteal phase is preparation the uterus to received fertilized ova. -Present of luteal phase indicate that ovulation occur. -luteal phase is associated with high level of progesterone. -Fibroid (benign tumor in the uterus ). -Level of testosterone (maybe high). -estrogen, progesterone (ovarian hormones). -prolactin level.