Overview Overview

Female and Male: Reproductive Female Female

z Anatomy
A t z Anatomy
A t
anatomy & physiology
z Physiology z Physiology
z Relevance physiology to infertility treatment z Relevance physiology to infertility treatment
Professor Julian Jenkins, D.M, F.R.C.O.G.
Director Medical Sciences, OB/GYN Male Male
Ferring International Center SA z Anatomyy z Anatomy y
CH 1162 St. Prex, Switzerland z Physiology z Physiology
z Relevance physiology to infertility treatment z Relevance physiology to infertility treatment

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Female and Male Anatomy How many oocytes ovulate? How many sperm are ejaculated?

z From puberty stem cells in testicles produce

z In utero over 5,000,000 oocytes develop
Similarities 10 30 billion sperm per month.
10-30 month
z By birth typically only 2,000,000 oocytes remain
& z These move through seminiferous tubules to
Differences z By puberty typically 400,000 oocytes remain epididymis.
z Usually only 1 oocyte is released each month z Sperm production takes a few months then
from puberty to menopause mature in epididymis in a few days
z So in a life time around 400 oocytes ovulate z Typically 40,000,000 sperm per ml in 5 ml
ejaculate ie 200,000,00 sperm released in a
single ejaculate.

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Overview Female Reproductive Organs Laparoscopy

Female
z Anatomy
A t Ovary
z Physiology
z Relevance physiology to infertility treatment Fallopian Tube
Male Uterus
z Anatomyy
z Physiology
Vagina
z Relevance physiology to infertility treatment

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Hysteroscopy Female Anatomy Transvaginal Ultrasound

Bladder

Vagina

Uterus
Ovary
Rectum
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Overview Hypothalamic pituitary ovarian axis Two-cell, two-gonadotrophin theory
Hypothalamus
Hormone production in ovarian follicle is due to
Female co-ordinated action of two cells acting together.
GnRH pulses
z Anatomy
A t
Pituitary gland
z Physiology
FSH LH Theca cells Granulosa cells
z Relevance physiology to infertility treatment
Male Ovary
z Anatomyy Oestrogens /
Ovary Theca cells Granulosa cells
Progesterone
z Physiology • Convert cholesterols • Convert cholesterols
to progesterone to progesterone
z Relevance physiology to infertility treatment • Convert progesterone • Convert androgens to
to androgens oestrogens
Uterus, Breasts etc.

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Two-cell, two-gonadotrophin theory Two-cell, two-gonadotrophin theory Menstrual cycle – the start
Gonadatrophins
The activity of the two cells is controlled FSH Follicle stimulating Hormone FSH activates the
by two gonadotrophins acting together. FSH LH Luteinising Hormone Thecal Cells Granulosa cells FSH proliferation and
hCG Human Chorionic Gonadotrophinp
(LH activity) (FSH & LH activity) A
maturation of
A granulosa cells
z Cholesterol z Cholesterol A A A

A
Theca cells Granulosa cells Theca cells Granulosa cells
Cholesterols ►
androgens
z Progesterone z Progesterone Androgens
transferred to
granulosa cells

Theca cells Granulosa cells • LH acts on theca

• only respond to LH • respond to FSH z Androgens z Androgens cells and promotes
(or similar but more • as follicle develops start to androgen production
potent hCG following respond to LH (or hCG
conception) post conception) z Oestrogens z Oestrogens
LH activity LH activity

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Menstrual cycle - oestradiol Menstrual cycle - oocyte Menstrual cycle - ovulation
• FSH induces • Together FSH and LH activity results in Ovulation
FSH aromatase activity in follicular growth, estradiol production FSH
the granulosa cells, and oocytey maturation
A A
A facilitating the A e
A A A
conversion of A A A

A
androgens to estradiol A
Theca cells Granulosa cells Theca cells Granulosa cells
Cholesterols ► Androgens ► Cholesterols ► Androgens ► Oocyte
androgens estradiol androgens estradiol
Androgens
transferred to
Androgens
transferred to
maturation
granulosa cells granulosa cells
• FSH induces the
development of
Follicular
LH/hCG receptors growth
E E
E E
E E
E E Estradiol E E Estradiol
E E
LH activity LH activity

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 Insufficient LH activity to balance FSH hyperstimulation
Menstrual cycle - progesterone Overview will lead to excess progesterone, too soon.

Following ovulation Female Thecal Cells Granulosa cells

z ovarian follicle forms corpus
p luteum
z Anatomy
A t (LH activity) (FSH & LH activity)
z producing large amounts of progesterone
z lasts 2 weeks then menstruation follows … unless z Physiology z Cholesterol z Cholesterol
z Relevance physiology to infertility treatment
Following embryo implantation z Progesterone z Progesterone
z embryo produces human Chronic Gonadotrophin (hCG) Male
z hCG stimulates LH/hCG receptors on corpus luteum to continue z Anatomyy
to produce progesterone, which prevents menstruation and z Androgens z Androgens
supports early pregnancy. z Physiology
z Relevance physiology to infertility treatment z Oestrogens z Oestrogens

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Hence different gonadotrophins used for ovarian
stimulation could affect clinical outcome. Overview Male Reproductive Organs
Different composition of gonadotrophins
Female
z Anatomy
A t
Difference in endocrine profiles
z Physiology
z Relevance physiology to infertility treatment
Embryo quality Endometrial receptivity z Testes outside body
Male to keep cool
z Anatomyy
O
Ongoing
i pregnancy z Barrier between
z Physiology blood & sperm to
prevent immune
z Relevance physiology to infertility treatment
response to sperm
Live births

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Overview Male reproductive system Male reproductive system
Hypothalamus Hypothalamus
Female GnRH pulses GnRH pulses

z Anatomy
A t Pituitary gland Pituitary gland
z Physiology
LH LH
z Relevance physiology to infertility treatment
Leydig
Male cells
z Anatomyy
Testosterone
z Physiology
z Relevance physiology to infertility treatment
Testis Testis

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Male reproductive system Male reproductive system Overview
Hypothalamus Hypothalamus
GnRH pulses GnRH pulses Female
z Anatomy
A t
Pituitary gland Pituitary gland
FSH FSH z Physiology
LH LH
z Relevance physiology to infertility treatment
Leydig Leydig
Sertoli
cells
Sertoli
cells
Male
cells cells
z Anatomyy
Testosterone Testosterone
z Physiology

Sperm Production z Relevance physiology to infertility treatment

Testis Testis

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Stimulating sperm production in men, who lack
gonadotrophins (Male hypogonadism)
Conclusions
Initial phase to raise serum testosterone z Although similarities exist between females
z hCG stimulation (because LH half life too short) for and males
males, there are big differences
LEYDIG CELLS z e.g. 1 oocyte vs over 10 billion sperm per month.
z Injections thrice weekly for few months

z Understanding gonadotrophin physiology

Then stimulate sperm production
z Then also add FSH stimulation for SERTOLI CELLS
helps to plan optimal treatment of infertile
z Injections thrice weekly may take 6 months or longer
couples
couples.

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