dr.heny anggraeny lenap - fisiologi sistem reproduksi

DR. HENY ANGGRAENY LENAP

Fisiologi Sistem Reproduksi

Essential female reproductive System functions:

Alat-alat Reproduksi Wanita

Alat reproduksi pada wanita berupa:

- Sepasang ovarium- Oviduk/tuba

fallopii)- Uterus- Vagina- Organ kelamin

bagian luar

Alat-alat Reproduksi Wanita

Ovarium (indung telur):Merupakan kelenjar kelamin yang memproduksi ovum (sel telur) dan menyekresi hormon estrogen dan progesteron

Alat-alat Reproduksi Wanita

Oviduk/tuba Fallopii

(saluran telur):Berfungsi menyalurkan sel telur ke uterus (rahim) dengan gerakan peristaltik dan dibantu oleh gerakan silia pada dindingnya.

Alat-alat Reproduksi Wanita

Uterus (rahim):Tempat berkembangnya embrio. Selama kehamilan volume uterus mampu mengembang hingga 500 kali

Alat-alat Reproduksi Wanita

Vagina:Tempat penis pada saat kopulasi dan sebagai jalan keluar bayi pada proses kelahiran

Alat-alat Reproduksi Wanita

Organ kelamin luar:- klitoris/klentit: struktur

yang sama dengan penis

- Vulva: terdiri atas labium mayor (bibir besar) dan labium minor (bibir kecil)

- Lubang saluran kencing

- Lubang vagina: bagian terluar vagina

- Fundus: bagian lipat paha

Physiological Stages

Neonatal period: birth---4 weeksChildhood: 4 weeks----12 yearsPuberty: 12 years---18 yearsSexual maturation: 18 year---50 yearPerimenopause: decline of ovarian

function (40 years)----1 year postmenopause

Postmenopause:

Oogenesis

Tahapan oogenesis (pembentukan sel kelamin)

Oogenesis

Oogenesis pada ovarium.

Siklus menstruasi

• Fase menstruasi

• Fase pra-ovulasi

• Fase ovulasi

• Fase pasca-ovulasi

Menstruation

Menstruation cyclic endometrium sheds and bleeds due

to cyclic ovulation Mense1. Endometrium is sloughed (progesterone

withdrawal)2. Nonclotting menstrual blood mainly

comes from artery (75%)3. Interval: 24-35 days (28 days). duration:

2-6 days. the first day of menstrual bleeding is consideredy by day 1

4. Shedding: 30-50 ml

Menstruation (Menstrual cycle):

The menarche is the age at the first menstrual bleeding. It often occurs between the 12th and the 14th year.

A normal bleeding corresponds to a loss of up to 50 ml of whole blood. The mixture of vaginal fluid and menstrual blood produces a pH close to that of normal blood. The average cycle length is 28 days.

Fertilisasi

Proses terjadinya fertilisasi di dalam oviduk pada organ reproduksi wanita.

Fertilization & implantation:

Fertilization & Implantation:1-Site: Fertilization occur at mid portion of fallopian tube,sperms

become more able of fertilization after their journey in female genital tract (sperm capacitation)

2-Method Sperm bind to zona pellucida followed by acrosomal reaction(i.e. breakdown of acrosome and release of enzymes as acrosin (trypsin like protease) which facilitate penetrationPolyspermy (penetration of ovum by more than one sperm is prevented by fusion of sperm with zona pellucida causing structural changes in it)

3-Zygote Formed from fusion of sperm&ovum

4-Blastocyst: Formed due to mitotic division of the zygote

5-Implantation Occurs about 6-7 days after fertilization(blstocyst reaches the uterus within 3 days,remains for another 3 days) during this period the endometrium is prepared by progesterone from CLThe outer layer (syncytiotrophoblast erodes the endometrium till the blastocyst become implanted (usually in dorsal wall of uterus)

Kehamilan (gestasi)

Tahapan pembelahan zigot hasil fertilisasi dalam perjalanan ke uterus untuk proses implantasi.

Kehamilan (gestasi) (2)

Proses pembentukan membran kehamilan pada embrio.

Amnion

Amnion

Korion

Sakus vitelinus

Kantung telurPembuluh darah

Awal korion

Massa sel dalam

Endometrium

Uterus

Blastosol

Trofoblas

Kehamilan (gestasi) (3)

Bagian plasenta, cairan amnion, dan tali pusar.

Kehamilan (gestasi) (4)

Embrio manusia pada usai kehamilan: (a) 4 minggu, (b) 5-6 minggu, (c) 8 minggu, dan (d) 16 minggu.

Laktasi

Kondisi payudara(a) sebelum kehamilan dan (b) setelah kehamilan.

Hormonal control of the Breasts:

1-Estrogen: Causes proliferation of the ducts,development of the nipples and increase fat deposition

2-Progesterone: Causes growth of the lobules & alveoli

3-Prolactin: Causes milk formation and secretionTogether with estrogen,progesteron,hCS produce full lobuloalveolar development of breasts during pregnancy

4-Oxytocin: Causes milk ejection (milk let down)Its secretion is stimulated by breast suckling and also affected by conditioned reflexes (mothers hearing their baby cry milk secretion)

5-Other hormones:

Insulin, glucocorticoids, growth hormone needed for breast response to other hormones. thyroid hormones are also necessary for milk secretion

Functions and regulation of prolactin hormone:

Functions of prolactin: Regulation of prolactin:

1-Causes milk secretion from breasts prepared 1st by estrogen & progesterone

1-Suckling reflexly stimulate prolactin (and Oxytocin) secretion

2-Shares other hormones in full breasts development during pregnancy

2-estrogen increase prolactin secretion during pregnancy but antagonizes its milk producing effect (so inhibit lactation during pregnancy)

3-causes amenorrheoa during lactation(as it inhibits GnRH secretion and antagonizes the action of FSH&LH on the ovaries)

3-PIH (prolactin inhibitoryhormone=dopamine) secreted from hypothalamus inhibit prolactin secretion, so L-dopa decrease prolactin secretion while serotonin increase prolactin secretionProlactin increase release of PIH so inhibit its own secretion(-ve feedback)

4-Sleep,exercise ,surgical & psychological stresses increase prolactin secretion

Suckling reflex for lactation

Central reproductive hormones

Hypothalamus-Pituitary-Ovary(H-P-O axis)

Central reproductive hormones

Neuroendocrine regulation1. Gonadotropin-releasing

hormone,GnRH1) chemical structure (pro)Glu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-

Gly-NH2

2) Synthesize and transport

nerve cells

hypothalamus

portal vein

pitutaryanterior lobe

Central reproductive hormones

Central reproductive hormones

3) Regulation of GnRH

Hypothalamus

GnRH

Pituitary

FSH, LH

Ovary

E,P

Central reproductive hormones

2. Gonadotropins1) Composition (glycoprotein) Follicle stimulating hormone,FSH Luteinizing hormone,LH2) Synthesize and transport

Gonadotroph (pulse)

Blood circulatio

n

ovary

Central reproductive hormones

3. Prolactin (PRL)Regulated by the prolactin inhibiting

factor (PIF)

The Ovarian cycle

Function of ovary1. Reproduction development and maturation of

follicle; ovulation2. Endocrine estrogens, progesterone, testosterone

The Ovarian cycle

Cyclic changes of ovary1. The development and maturation of follicle1) Primordial follicle: before meiosis2) Preantral follicle: zona pellucida, granulosa

cells (FSH receptor)3) Antral follicle: granulosa cells (LH receptor),

E↑ 4) Mature follicle: E↑,P↑Theca externa, theca interna, granulosa, follicular

antrum, mound, radiate coronal5) Follicular phase: day 1 to follicle mature (14

days)

The Ovarian cycle

The Ovarian cycle

2. Ovulation1) First meiosis completed → collagen

decomposed → oocyte ovulated2) Regulationa) LH/FSH peakE2↑(mature follicle) → GnRH ↑

(hypothalamus) → LH/FSH peak (positive feedback)

b) P cooperationLH ↑ → P ↑(follicle luteinized before

ovulation) →positive feedback

The Ovarian cycle

3. Corpus luteum1) follicle luteinized after ovulation:

luteal cells2) LH → VEGF → corpus hemorrhagicum3) Regression non fertilized → corpus albicans4) Luteal phase Ovulation to day 1

The Ovarian cycle

sex hormones secreted by ovary1. Composition Estrogen, progesterone, testosterone2. Chemical structure Steroid hormone3. SynthesisCholesterol→pregnenolone→androstenedi

one→testosterone→estradiolΔ5 or Δ4 pathway of estrogen production

The Ovarian cycle

4. Metabolism: liver5. Cyclic change of E and P in ovary1) Estrogena) E↑(day 7) → E peak (pre-ovulate) → E↓

→ E↑ (1 day after ovulate) →E peak (day 7-8) → E↓

b) theca interna cells (LH receptor) → testosterone

c) Granulosa (FSH receptor) → estrogen

The Ovarian cycle

2) ProgesteroneP↑ (after ovulation) → P peak (day 7-8) →

P↓

granulosa

progesterone

LH

The Ovarian cycle

H-P-O axis1. Positive feedbackSex hormones (E)↑ → GnRH or LH/FSH↑E peak (≥200pg/ml) → LH/FSH peak →

ovulation2. Negative feedbackSex hormones (E)↑ → GnRH or LH/FSH↓Follicular phase: E↑ → FSH↓Luteal phase: E↑P↑ → LH/FSH↓(formation) E↓P↓ → LH/FSH↑(regression)

Ovarian Cycle Phases

Fate of corpus luteum?

1-If fertilization of the released ovum takes place it prepares the endometrium for the implantation of the fertilized ovum (continue to secret estrogen & progesterone)

2-if no fertilization occur it degeneratesWhich leads to loss of hormonal support to the uterine

lining disintigration & sloughing (menstrual blood flow)

*Then the cycle restarted by the follicular phase again to rebuild the endometrium (under effect of estrogen)

The endometral cycle

Proliferative phase1. E↑(mitogen)→ stroma thickens and

glands become elongated → proliferative endometrium

2. Duration: 2 weeks3. Thickness: 0.5mm → 5mm

The endometral cycle

Secretory phase1. P↑(differentiation) → secretory

endometrium2. Featuresstroma becomes loose and edematousblood vessels entering the endometrium

become thickened and twistedglands become tortuous and contain

secretory material within the lumina3. Duration: 2 weeks4. Thickness: 5-6mm

Change of Other genital organs

Cervixendocervical glands (E↑)→

mucus(thin,clear, watery) → maximal (ovulation)

endocervical glands (P↑)→ mucus(thick, opaque, tenacious)

VaginaVaginal mucosa (E↑)→ thickening and

secretory changesVaginal mucosa (P↑) → secrete↓

Functional Comparison Between Male & Female reproductive systems

1-Male 2-FemaleA-Pair of

gonads=Testes

B-Produce gametes (sperms) +sex

hormones (testosterone)

A-Pair ofgonads=Ovaries

B-Produce gametes)ova +(Sex hormones

(estrogen-progesterone)

Hormones roles in Female reproductive physiology:

1-In non pregnant state: 2-In pregnant state:

Controlled by: hypothalamic (GnRH) –

pituitary(FSH&LH)-ovarian(estrogen,proges

terone ) axis

Controlled by:Placental hormones

Cyclic changes in Cervix, vagina & breasts:

1-Cervix 2-Vagina 3-Breasts

Estrogen: make mucusthinner, more alkaline If spread on slide dries

in fern like manner

Progesterone : make mucus thick, more

cellular, If spread on slide doesn’t fern

Estrogen: cornification of vaginal epithelium

Progesterone: thick mucus secretion,

proliferation of vaginal epithelium and

leucocytes infiltration

Estrogen:Proliferation of breasts ducts

Progesterone:growth of breast lobules &

alveoli

Functions of estrogen and Progesterone:

Estrogen Progesterone1-Facilitate growth of follicles 1-Causes secretory phase of menstrual cycle

2-growth of female external genitalia,breasts duct system

2-Stimulate developmentof breast lobules & alveoli

3-Produce female 2ry sex characters,body configuration,fat distribution & increase libido

3-Essentia for maitenance of pregnancy

4-Produce proliferative phase ofMenstrual cycle,++uterine blood flow,musculature and make it more sensitive to oxytocin

4-Decrease sensitivity of uterus to oxytocin

5-produce cyclic changes in cervix & vagina 5-Produce cyclic changes in cervix & vagina

6-Control FSH&LH secretion & causes the LH surge at midcycle

6-Inhibit LH secretion during pregnancy (producing amenorrhea)

7-Has metabolic anabolic effects, cause epiphyseal closure of bones (also ++bone density), decrease serum cholesterol level,++angiotensinogen secretion from liver,increase HDL,--LDL(Cardioprotective)Produce salt & water retention

7-Thermogenic effect (++body temperature by 0.5 C at ovulation)++respiratory rate alveolar CO2Produce natriuresisNo anabolic functions

Thank you