Where does sperm maturation happen?

capacitation? 

sperm maturation happens outside the testes in the caudal epididymis; capacitation occurs in females (f. tubes??) 

What are the 3 parts of capacitation? 

1. ability to undergo acrosome reaction

2. ability to find zona pellucida

3. acquisition of hypermotility

 Acrosome Reaction

-breakdown of merging of plasma membrane & outer acrosomal membrane

-proteases release to help penetrate egg

-inner acrosomal membrane fuses w/ oocyte plasma membrane

-hyperactivity and attachment/penetration to zona pellucida. 

-cross-linking of structural proteins --> hardens extracellular layer

-inactivates ligands for sperm receptors

-depolarizes oocyte membrane (initial & transient)

-permanent block against sperm caused by Ca2+ release which releases enzymes

Zona Reaction

What are pinopods? 

surface epithelial cells found in endometrium which lose microvilli & develop small protrusions & appear around day 21; blastocyst attach to this. 

When does implantation happen? and what are the 3 stages? 

5 days after fertilization; 

1) apposition, 2) adhesion, 3) invasion/migration

What are some players during apposition & adhesion in implantation? 

Heparin-binding epidermal growth factor, adhesion molecules (integrins & selectins), cytokines

Basic process of trophoblast invasion in endometrium? 

• wall of spiral arteries destroyed & sinusoidal sacs formed --> vasculature remodeled
• intrusion of epithelium, and cells lift off BM and allow tropho to gain entry
• fusion of tropho + uterine epithelial cells (1/3 of myometrium turns to cytotrophoblast). 

major players in trophoblast invasion? 

Serine proteases and metalloproteinases & decidual cell layer [more info. on this]

When is the maternal serum HCG detectable after implantation? 

10 days after ovulation; 

USMLE: no earlier than 6 days after and may require up to 11 days

What is the triad of ectopic pregnancy?

Abdominal pain, vaginal bleeding, amenorrhea 

Most common location of ectopic pregnancy? 

Ampulla of tube 

Dx of ectopic pregnancy? 

• serial Hcg levels: falling or abnl rising
• transvaginal US: adnexal mass, free fluid in pelvis, no intrauterine pregnancy
• progesterone < 5ng/ml 

What are the 4 major categories of infertility? 

• abnormal ovulation & oocyte production
• D/Os of transport: cervix, uterus, fallopian tubes and peritoneum
• abnormal sperm 
• unexplained

What hormone increases basal body temperature? what type of curve is indicative of ovulation? 

Progesterone, 

biphasic curve 

What is the most common cause of anovulatory infertility? 

PCOS 

What causes PCOS & what is the tx? 

*high insulin & androgens

• tx: clomid: occupies estrogen receptors, alters feedback, increased FSH & LH --> ovulation! 
• metformin: insulin sensitizer
• weight loss 

In regards to infertility, do increased FSH indicate poor or good pregnancy outcomes? 

Poor

increased FSH , less sensitive [ovaries] and thus require higher levels of FSH for follicular development --> not good :( 

Three risk factors for anatomic abnormality that lead to infertility? 

Pelvic Inflammatory Disease (PID), Pelvic Surgery, Endometriosis 

Diagnosis of anatomic abnormalities --> infertility? 

Hysterosalpingogram:X-ray test that examines the inside of uterus and fallopian tubes and the surrounding area.

Ultrasound: eval of uterus

Laparoscopy

What is the gold standard for diagnosis of pelvic pathology and endometriosis? 

Laparoscopy

*I think this has been mentioned before. 

For male infertility, what is the most important factor in predicting infertility 

Morphology of sperm in Semen Analysis (SA)