Fertility

Question 1

Is the female fertile period unlimited? Why/why not?

Answer 1

No, it isn’t.
The optimal fertility window for women in between 20s-30s, since there’s still a high number of follicles and oocytes are still in perfect quality.

The fertile period of women starts with the menarch (first menses) and finish with menopause.

Question 2

What genetic and environmental factors contribute to menopause?

Answer 2

Menopause is the spontaneous cessation of menstruation, due to exhaustion of primordial follicles in ovary.
Women in menopause have a high level of FSH
1. Natural menopause
2. Surgical menopause
3. Temporary pharmacological menopause

The natural menopause is influenced by other factors:
- genetic
- stress
- smoking (decrease length of normal cycle and shorten peri-menopause
duration

Question 3

What type of female contraception there are?

Answer 3

1. Early pill: release estrogen, which has an inhibitory effect on proliferation of the other follicles.
2. Present pill: release progesterone-like hormones, which inhibit GnRH release, thus stopping the normal hormone production.
3. Sterilization:
   
   • Tubal ligation
   • Ductal plugs

Question 4

What type of male contraception there are?

Answer 4

1. Male pill: release testosterone, to diminish spermatogenesis.
2. Sterilization:
   
   • Vasectomy

Question 5

What types of abortion exist?

Answer 5

1. Spontaneous:
   
   • occur without intentional intervention
2. Therapeutic:
   
   • performed to maintain the health of the mother
3. Birth control:
   
   • morning-after pill (progesterone)
   • abortion pill

Question 6

What is amenorrhea? What types of amenorrhea exist? What can it be the result of? What is the diagnosis? Are there any treatments?

Answer 6

Amenorrhea is the failure of menstruation to occur:

1. Primary amenorrhea (failure of spontaneous menses to occur before 16 years of age)
   Can be caused by stress (Drought and famine, Overcrowding, Social
   stress, Overtraining).
   
   • The ovary is not stimulated (hypogonadotropic amenorrhea, pituitary
     deficiency, cerebral tumour, CNS defect, constitutional growth delay,
     weight loss, thyroid disorder)
   • The ovary can’t respond (hypergonadotropic amenorrhea, ovarian
     failure, chromosomal insufficiency)
   • There is no uterus (syndroms)
   • There is obstruction to outflow of menses
     It is investigate by:
   • physical examination
   • hormonal assessment
   • control of the presence of the uterus
     Treatments:
   • normalise body mass index
   • hormone replacement
   • surgery

2. Secondary amenorrhea (absence of menstruation for 6 months in a 
     previously menstruation woman)
     Can be caused:
     - Pregnancy, lactation, menopause
     - Premature ovarian failure
     - Hyperprolactinaemia
     - Polycystic ovarian syndrom
3. Oligoamenorrhe (cycles longer that 3 months)
    Investigated:
    - Pregnancy test
    - Hormones
    - Transvaginal scan
    Treatments:
    - normalise body mass idex
    - hormone replacement therapy
 For both:
 The cause can be:
    - physiological (pregnancy, lactation, menopause)
    - pathological (anovulation, syndrome)