3rd yr med student seminar, Intro to repoductive endocrinology and fertility

1. TheLifeofaFemale A story in 4 acts

2. ACT1 Scene 1 Embryo 5th-7th week Necessary elements Gonads Testes > Y Ovary > 2 intact and functional XX Uterus / Vagina No MIF (produced by Sertoli- Leydig cells) Complete midline fusion External Genitalia Female > nothing Male > Testosterone and responsive tissues

3. Midline defects

4. Androgens Cholesterol 17 OHProgesteroneCortisol 21 hydroxylase (Ovary ) (adrenal) Androstendione DHEA Androstenedione Testosterone aromatase Testosterone 5 alpha reductase (in cell) Estrogens DHT

5. Scene 2 Infancy thru Childhood Birth – 1 million follicles Maternal estrogens Breast tissue Vaginal discharge Follicles on US Baby acne Withdrawal of moms’ E2 Slight bleed Childhood Drifting down of # of follicles

6. ACT 2 Puberty Initiation PulsatileGnRH release Range = 8-13 y/o to start Menarche av age= 12 y/o Range 10-16 y/o Sequence TAG-M Thelarche, adrenarche, growth spurt, menarche Timing Av length 2-3 yrs Av from menarche to ovulation = 3 +yrs

7. ACT 3 Reproductive LifeScene1Menses Hypothalamus GnRH Pituitary FSH & LH Ovary Estrogen & Progesterone

8. ACT 3 Scene2Pregnancy Start up Embryo makes HCG Corpus luteum continues making progesterone till placenta takes over HCG Nausea Progesterone Temp, respiratory effects Relaxes smooth muscle Mucus plug Estrogen Breast enlargement Leukorrhea The baby Takes up space Changes center of gravity HPL Insulin resistance Hyperinsulinemia Picture and short video

9. Physiologic responses Blood Increase volume Hemodilution Coagulation Cardiac Increased output Increased HR Pulmonary Feel short of breath Increase O2 uptake Decreased capacity GI Loose sphincters Slow gut GU Increased GFR Mechanical changes Immunologic Decreased cell med imm Leukocytes act poorly Musculoskeletal Lordosis of lower & cervical spine Relaxin Rectus issues

10. Act 4 To Menopause and BeyondClimacteric Ovulation diminishes then stops FSH levels rise Estrogen levels drop Progesterone levels drop Androgen levels stay about the same www.menopause .org (North American Menopause society)

11. The Final Frontier www.nof.org Vaginal Issues Increased pH Thinning and drying Urologic changes Increased incontinence Sexual implications Desire Function Bone Health Osteoporosis

12. www.nccam.nih.gov The End