Block 7 Physio Fertilzn & Erly Preg Dr Keator W Xpl

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Block 7 Physio Fertilzn & Erly Preg Dr Keator W Xpl - Quiz

Reproduction in a human being is something fascinating. A female can give birth to about 35 babies in a lifetime thanks to the largest cell in the body. Are you in Dr. Keaton class on reproduction? If so then the quiz below is exactly what you need to review block 7 of physio fertilization and early pregnancy. Why don’t you take it up!


Questions and Answers
  • 1. 

    Which of the following events of fertilization are associated with changes in intracellular calcium?

    • A.

      Acrosome reaction

    • B.

      Cortical reaction

    • C.

      Hyperactivation

    • D.

      Germinal vesicle breakdown

    • E.

      All of the above

    Correct Answer
    E. All of the above
    Explanation
    All of these events are associated with changes in intracellular calcium, and in
    some instances (such as GVBD) the changes in calcium are classic hallmark indicators of the event.
    In some events, such as hyperactivation and the acrosome reaction, because changes in intracellular occur so rapidly it has been difficult for scientists to determine if the changes in calcium directly cause the event or are a direct result of the event. Regardless, changes in calcium are associated with the events occurring.

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  • 2. 

    If a typical menstrual cycle is 30 days long and ovulation occurs on day 15, on what day of the cycle do the intraovarian levels of progesterone typically start to rise?

    • A.

      Day 12

    • B.

      Day 15

    • C.

      Day 14

    • D.

      Day 16

    • E.

      Day 18

    Correct Answer
    C. Day 14
    Explanation
    A rise is progesteone is always associated with ovulation and formation of a functional corpus luteum, but progesterone levels actually start to increase prior to ovulation, and these levels then climb rapidly following ovulation and formation of the corpus luteum. Cohorts of granulosa cells express a functional LH receptor prior to ovulation, and during the peri‐ovulatory period these cohorts of granulosa cells bind LH and actively start secreting progesterone into the maternal circulation. Thus, this early rise in progesterone appears to be an essential component of the physiological processes regulating ovulation.
    Following a successful ovulation, the follicle will involute and form the corpus luteum. The luteinized granulosa cells will then produce large quantities of progesterone, the hormone of pregnancy that is required to prime the uterus for subsequent implantation. Day 15 or 16 would be reasonable answers if the question had asked for changes in measurable serum levels of progesterone. These changes in progesterone prior to ovulation, especially as measured in a single blood draw, may be below the threshold of assay detection in a single serum sample. Measurable increases in serum progesterone, secreted by the newly formed corpus luteum, are detectable (above baseline) within 24 ‐ 48 hrs following ovulation, (and most of the time much sooner, within 6 ‐12 hrs). Further, increases in progesterone above baseline are always indicative of a successful ovulation and associated with the formation of a corpus luteum.

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  • 3. 

    The dominant follicle is likely selected during the preceding menstrual cycle, and then grows prolifically during the proliferative phase of the next cycle. You want to administer a receptor antagonist designed to block growth of the dominant follicle. Inhibition of which receptor would most likely result in suppressed growth and development of the dominant follicle?

    • A.

      Gonadotropin releasing hormone receptor

    • B.

      Luteinizing hormone receptor

    • C.

      Follicle stimulating hormone receptor

    • D.

      Estrogen receptor

    • E.

      Progesterone receptor

    Correct Answer
    A. Gonadotropin releasing hormone receptor
    Explanation
    Blocking the GnRH receptor will result in decreased production of LH and FSH,
    which will subsequently inhibit growth of the dominant follicle. Interestingly, you could also suppress follicle growth and development by administering receptor antagonists designed to inhibit FSH receptor pathway or the LH receptor pathway, but the best answer is a GnRH antagonist that blocks both
    LH and FSH activity. Recall the 2‐cell theory of steroidogenesis, and how LH and FSH action on the theca and granulosa cells is a complementary system that results in estradiol production.

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  • 4. 

    A woman goes to her doctor because she is experiencing annovulatory menstrual cycles of 45‐60 days. The gynecologist wants the woman to experience a normal menstrual cycle of 28 to 30 days, so the doctor prescribes pills that release high levels of hCG over a 24 hour period. If day 1 is the first day of menses, on which day of the menstrual cycle should this woman take the hCG pill to have the best chance of experiencing a 28 to 30 day menstrual cycle?

    • A.

      Day 10

    • B.

      Day 12

    • C.

      Day 15

    • D.

      Day 18

    • E.

      Day 20

    Correct Answer
    C. Day 15
    Explanation
    You should recognize that LH and hCG exhibit a high degree of homology and both
    bind with high affinity to the LH receptor. In a typical menstrual cycle, the peak of the LH surge occurs approximately
    10‐12 hours before ovulation, which is considered the same day as ovulation (i.e. within a 24 hr period). An acute
    release of hCG would mimic the LH surge, resulting in ovulation of the dominant follicle.
    You also remembered that the corpus luteum has a finite lifespan of 12‐16 days, and therefore to induce a 28 to 30 day
    menstrual cycle, ovulation must occur approximately 12‐16 days before menses. Thus, of the choices offered the
    optimal day to induce ovulation is Day 15, since this will result in elevated progesterone for approximately 12‐16 days
    resulting in a menstrual cycle length of 27‐31 days.
    Day 18 is the next best choice, but taking the hCG pill on Day 18 would likely result in an extended menstrual cycle
    lasting 30‐34 days.

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  • 5. 

    A woman in her early 30s wants to start a family, but is currently on a progesterone‐only method of birth control.  She has the intra‐uterine system (IUS) device removed, and has 3 normal menstrual cycles of exactly 29 days before trying to get pregnant. The woman and her husband engage in daily intercourse for the next 8 months, but she does not get pregnant. She charts her menstrual cycle, and notes that 1 of her menstrual cycles lasted 36 days. Of the following options, what is the most likely explanation for the variation that caused her to experience a single elongated menstrual cycle during the last 8 months?

    • A.

      An extended secretory phase of the menstrual cycle

    • B.

      Elevated levels of estradiol during the secretory phase

    • C.

      An extended proliferative phase of the menstrual cycle

    • D.

      Elevated levels of progesterone during the secretory phase

    • E.

      A spontaneous abortion

    Correct Answer
    E. A spontaneous abortion
    Explanation
    It is estimated that 80% of all zygotes are lost to spontaneous abortion before
    implantation, and that another 20‐30% of all pregnancies are lost during the implantation process. Thus, the slightly
    extended menstrual cycle is most likely due to a spontaneous abortion during very early pregnancy.
    The only other logical answer is an extended proliferative phase, which is the primary cause for variations in the
    menstrual cycle (remember the secretory/luteal phase is 12‐16 days and dependent on the lifespan of the CL). However,
    because this woman experienced 10/11 menstrual cycles of exactly 29 days (3 prior to trying to get pregnant and 7/8
    while trying), this suggests her proliferative phase is tightly controlled. This woman was having unprotected intercourse
    for 8 months, and therefore the lone deviation in menstrual cycle length in this woman's specific situation is more likely
    due to a spontaneous abortion than a result of an extended proliferative phase.

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  • 6. 

    A mature spermatazoan typically survives for how many weeks?

    • A.

      1‐2 weeks

    • B.

      3‐4 weeks

    • C.

      4‐6 weeks

    • D.

      6‐10 weeks

    • E.

      10‐15 weeks

    Correct Answer
    C. 4‐6 weeks
    Explanation
    Mature sperm survive in the epididymis for approximately 4 to 6 weeks before
    being ejaculated or being catabolized and resorbed. A man is informed that he can father a child for up to 6 weeks
    following a vasectomy. Most urologists and or vasectomy clinics will test a man's sperm count after 20 ejaculations or 6
    weeks following a vasectomy.
    Sperm are able to survive for this extended duration due to the lower temperatures within the scrotum. In the female
    reproductive tract, most sperm die within 24‐48 after ejaculation, although viable sperm can be recovered up to 5 days
    after a single ejaculation during intercourse.

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  • 7. 

    Elevated production of estriol is associated with which of the following major events of early pregnancy?

    • A.

      Blastocyst invasion

    • B.

      Formation of the placenta

    • C.

      Spiral artery remodeling

    • D.

      Luteal‐placental shift

    • E.

      Syncytiotrophoblast hCG production

    Correct Answer
    D. Luteal‐placental shift
    Explanation
    A fully functional placenta begins to secrete increasing concentrations of estriol
    at approximately 8 weeks of pregnancy. The rise in estriol indicates that the maternal‐fetal‐placental unit is fully functional. Therefore, the rise in estriol is associated with the luteal‐placental shift, which typically occurs between 7‐9 weeks of gestation. The other four major events occur within the first 2 weeks of pregnancy and are not associated with estriol.

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  • 8. 

    Human chorionic gonadotropin (hCG) rescues the corpus luteum during early pregnancy by acting directly on the granulosa‐lutein cells. Which of the following statements best describes the primary functions of the granulosa‐lutein cells (GLC) and theca‐lutein cells (TLC) during early pregnancy?

    • A.

      GLC secrete estrogen and progesterone; TLC secrete androgen and estrogen

    • B.

      GLC secrete progesterone and estrogen; TLC secrete androgen and progesterone

    • C.

      GLC secrete androgen and estrogen; TLC secrete progesterone and estrogen

    • D.

      GLC secrete progesterone and androgen; TLC secrete progesterone and androgen

    • E.

      GLC secrete progesterone and androgen; TLC secrete androgen and estrogen

    Correct Answer
    B. GLC secrete progesterone and estrogen; TLC secrete androgen and progesterone
    Explanation
    Granulosa‐lutein cells (GLC) and theca‐lutein cells (TLC) both express
    functional LH receptors, and the GLC secrete progesterone and estrogen whereas the TLC secrete androgen
    (predominantly androstenedione) and progesterone. The GLC then aromatize the androgen into estrogen. These cells
    types can also be distinguished histologically, since the TLC express high levels of CYP17 (the enzyme required to convert
    progesterone into androgen) whereas the GLC express CYP19 (aromatase, required to convert androgen into estrogen).
    Remember that the primary function of the CL is to secrete progesterone.
    Steroidogenesis Summary:
    Granulosa cells = estrogen during the follicular phase
    Granulosa cells = estrogens and progesterone during the ovulatory window (after they acquire the LH
    receptor)
    Granulosa-lutein cells = progesterone and estrogen during the luteal phase
    Theca cells = androgens
    Theca-lutein cells = androgens and subsidiary amounts of progesterone
    hCG = binds to the LH receptor and therefore maintains luteal steroidogenesis resulting in continued
    progesterone production
    The CL predominantly secretes progesterone. Follicles predominantly secrete estrogen.

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  • 9. 

    Flutamide is an androgen receptor antagonist that markedly suppresses stromal expansion of the endometrial functionalis zone. Which of the following events would be adversely affected the greatest by suppressing the functionalis zone?

    • A.

      Implantation

    • B.

      Gamete transport

    • C.

      Menstruation

    • D.

      Decidualization

    • E.

      Fertilization

    Correct Answer
    A. Implantation
    Explanation
    An adequate functionalis layer is required to support an invading blastocyst
    during the process of implantation. Progesterone exerts profound effects on the functionalis layer, inducing sacculation
    of the endometrial glands and stimulating epithelial secretion.
    An underdeveloped endometrium is not capable of supporting implantation, but to date there is no evidence to suggest an inadequate functionalis zone will inhibit gamete transport or subsequent fertilization. The processes of decidualization and menstruation will occur in a normal manner, there will just be less tissue to undergo differentation and enzymatic breakdown during those processes, respectively.

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  • 10. 

    Acquisition of the LH receptor by the granulosa cells is absolutely necessary for ovulation of the dominant follicle.  Which of the following compounds is secreted by the granulosa cells in response to LH stimulation?

    • A.

      Testosterone

    • B.

      Progesterone

    • C.

      Estradiol

    • D.

      Fibronectin

    • E.

      Serine proteases

    Correct Answer
    B. Progesterone
    Explanation
    LH stimulation leads to the acquisition of the LH receptor by granulosa cells, which is necessary for ovulation of the dominant follicle. In response to LH stimulation, granulosa cells secrete progesterone.

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  • 11. 

    The process of fertilization is a complex set of temporospatially coordinated interactive events between male and female gametes. The adequate transportation of both sperm and oocyte in the female reproductive tract is critical for fertilization. Which physiological change occurs during the ovulatory window that enhances gamete transport in the female reproductive tract?

    • A.

      Decidualization of the endometrial stroma

    • B.

      Decreased vaginal secretions

    • C.

      Increased uterine blood flow

    • D.

      Decreased uterine contractility

    • E.

      Thinning of the cervical mucous

    Correct Answer
    E. Thinning of the cervical mucous
    Explanation
    Thinning of the cervical mucous, coupled with increased vaginal secretions
    during intercourse, enhance sperm transport through the lower portion of the female reproductive tract. Slight contractility of the uterus aids in sperm transport through the endometrial lumen. Cilia beat frequency becomes rhythmical and secretions increase in the fallopian tube, which enhances both sperm and oocyte transport. Decreased vaginal secretions, increased uterine blood flow, decidualization of the endometrial stroma and decreased uterine contractility are all effects induced by progesterone during the secretory phase of the menstrual cycle, and are not associated with ovulation.

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  • 12. 

    Estriol is synthesized in large amounts during pregnancy. What is the most likely physiological activity of this estrogen during pregnancy?

    • A.

      Stimulates vasodilation and uterine blood flow

    • B.

      Stimulates endometrial decidualization

    • C.

      Stimulates the secretion of luteal progesterone

    • D.

      Stimulates vascular remodeling of the spiral arteries

    • E.

      Stimulates blastocyst invasion

    Correct Answer
    A. Stimulates vasodilation and uterine blood flow
    Explanation
    All three estrogens are secreted in large amounts and (estrone, estradiol,
    estriol) act as vasodilators to increase blood flow to the uterus and growing placenta. Estriol is synthesized by the fully functional placenta after the luteal‐placental steroidogenic shift, and is considered the estrogen of pregnancy. Additional roles of estrogen during pregnancy are being examined, but to date, remain largely unknown.

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  • 13. 

    A 42 yo married woman in a monogamous relationship has not experienced a menstrual period for 3 months.  The woman is concerned that she is entering menopause, and notes that her mother and older sisters all experienced horrible migraine headaches during the hormone withdrawal associated with menopause. The woman also complains of minor nausea for the past week, which she attributes to a "bug going around". Based on this woman's  history, which hormones should you assay to determine this woman's current menopausal status? 

    • A.

      Progesterone

    • B.

      Estradiol

    • C.

      Human chorionic gonadotropin

    • D.

      Estriol

    • E.

      Estrone

    Correct Answer
    C. Human chorionic gonadotropin
    Explanation
    This woman may be experiencing peri‐menopause, but nausea is not a typical
    symptom associated with menopause. The history of no menstrual period for 3 months and onset of nausea is
    indicative of pregnancy, likely the end of the first trimester. An hCG test will quickly determine pregnancy status. The
    woman is worried about menopause, but as a physician you need to look at the entire picture. Additionally, you are
    told in the first sentence that the woman is in a "monogamous relationship", therefore in this instance you should
    assume the woman is engaged in sexual activity.
    Estrone is considered the estrogen of menopause, but in this case, it would be prudent to evaluate progesterone and
    estradiol levels to first determine cyclicity. If estradiol levels are normal, then the woman may have an underlying
    pathophysiological disorder, such as PCOS or leiomyoma (uterine fibroids). Reproductive pathophysiological disorders
    will be covered in detail in Semester 4.

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