2Back •One white board between you

•1s faces board •2s away from board

•No cheating!

•Now 1’s DESCRIBE what you see [3]

•2s can you see what it is yet?

Great data handling skill in the exam – many of you FAILED to score an easy 2 marks in the NAB. Make sure you describe each

part

Urghh hate doing this! Why! Pointless!

Luteinising hormone!

• One actual patient – so not exact• 1 mark - steadily increases from day 1 to 12 +/- 1 day

• 1 mark – peaks day 13+/- 1 day at 18 IU/L• 1 mark - EITHER – decreases to 2 IU/L but then increases on day 16 up to 6 IU/L

OR - sharp decrease from 5.5 IU/L to 1 IU/L on day 22.

NOW SWAP OVER !

Progesterone hormone

• One actual patient – so days may be out etc.• 1 mark - Remains very low, just over 0ng/mL for first 9 days

• 1 mark – Rises from day 10 to 18 up to peak of 24 ng/mL

• 1 mark - Decreases back to baseline from day 19 to 27.

Learning Outcomes

•Examine the fertile period in females (cyclical) compared with continuous fertility in males

•Apply the principles of the biology fertilisation in;•Treatments for infertility•Methods of contraception

•Compare and contrast contraception methods

Fertile Period•Men are continuously fertile as they maintain a relatively steady level of testosterone, which means they regularly secrete sperm.

•However women are only fertile cyclically, 1-2 days after ovulation Not so different now!

My cycle is just once a year – whereas humans are twelve times

that !

Calculation of the fertile period

3 main ways ; TemperatureTemperature increases by 0.2 – 0.5oC ~ 1 day after ovulation and remains high during the luteal phase

Fertile for ~ 3 days after this rise in tempCervical MucusBecomes less viscous during fertile periodIncreases in viscosity due to progesterone after

Rhythm Methods of contraceptionAvoiding sexual intercourse based on temperature and mucus viscosity to indicate fertile period

Not reliable because cycle period varies

TEMPERATURE AND TEMPERATURE AND OVULATIONOVULATION

Body temperature rises by about 0.5Body temperature rises by about 0.5ooC one C one day after ovulation (under the action of day after ovulation (under the action of progesterone) and remains high during the progesterone) and remains high during the luteal phaseluteal phase

CERVICAL MUCUSCERVICAL MUCUS

• High levels of oestrogen prior to ovulation stimulate the cervix to produce a watery mucus making it easier for the sperm to swim through.Chance of fertilisation is increasedChance of fertilisation is increased

Rainbow 4’s Activity

•Get yourselves into groups of 4s.

•Choose a colour – red or orange or green or blue

•Research your the category • 2 using books. • 2 using computers • Compare the pros and cons of each method of research.

Infertility - disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual activity (WHO)

Treatments for infertility

4 main ones we will examine;Stimulating ovulationHormone treatment for ovulationArtificial inseminationLow sperm count treated by introducing several samples into reproductive tract.

In vitro fertilisation (IVF) + PGS/PGD Counteracts oviduct blockage by fusion of gametes outside body, then once into 8 cells+ reinsert into womb

Intracytoplasmic sperm injectionIf sperm inactive directly fuse in IVF

Contraceptive MethodsContraception is the intention of prevention of conception/pregnancy by natural or artificial means. 2 categories of contraception;

•Physical •Chemical

PHYSICAL

• Barrier method• Inter-uterine devices (IUD)

• Sterilisation procedures

CHEMICAL

• Pill containing combination hormones

• Morning after pill• Mini Pills

Rainbow 4’s Activity

•10 minutes of research•Come back together and share/disseminate what you have found out.

• Books• Computers• Books• Computers

Rainbow 4’s Activity

•10 minutes of research•Come back together and share/disseminate what you have found out.

• Books p131-2, p136 and p137

• Computers• Books p133-134 and p136• Computers

Research ReviewResearch Review

Criterias Books ComputersAccess of resourcesResearch method usedInformation gainedReliability checkOVERALL SCORE

Online difficulties? Logon ok? Enough books?

Content/index? Ask Jeeves/Yahoo answer? Keyword/phase search?

Did you understand it? Over your head? Too simple? Multiple sources?

What gives you confidence the information you are giving to others? Checked? Other website?

So which is better for this type of task? A place for both

• Couples will come up with a problem they have

• You must explain how to intervene and treat the problem.

You are a fertility doctor

Choose Your Causes of InfertilityChoose Your Causes of InfertilityInfertility could be due to one or a combination of factors. Infertility is usually treated by returning hormones to the natural level.

Infertility in Females

• failure to ovulate

• blockage of oviduct(s)

• failure of implantation

Infertility in Males

• low sperm count

Infertility in Women

CausesFailure to ovulateBlockage of uterine tubes (oviducts)Failure of implantation

Failure to Ovulate

CausesInadequate supply of FSH or LHProlonged use of contraceptive pillEmotional stressPoor healthTreatmentsFertility Drugs to stimulate FSH, LH productionInjections of FSH, LH (extracted from fertile

placentas or menopausal women)

Blockage of Oviducts

CausesTissue growth (e.g. tumours) Infections

TreatmentsClear blockage (laser treatment)IVF (in vitro fertilisation)

Failure of Implantation

CausesHormone imbalance

Treatments Fertility Drugs to stimulate FSH and LH production & restore

normal cycle

Infertility in Men

Low Sperm CountCausesFailure of pituitary gland to produce adequate

quantities of gonadotrophic hormones (FSH and ICSH)

Ill healthEmotional stressTreatmentsDrugs to stimulate FSH and ICSH productionIVFAI (artificial insemination)

In vitroIn vitro fertilisation (IVF) fertilisation (IVF)Remaining embryos frozen in

case a second attempt is needed

Fertilised eggs incubated in nutrient agar to allow cell division

6

Insemination is the introduction of semen into the female reproductive tract.

Artificial insemination Artificial insemination

This occurs naturally during sexual intercourse. However, due to infertility, scientists have developed artificial ways to inseminate the female.

Men with low sperm count – semen is frozen and used when the women is at her most fertile.

ContraceptionContraception….intentional prevention of conception either naturally or artificially.

Indicators of fertile period

• Temperature – immediately after ovulation body temperature rises by 0.5°C and stays high during the luteal phase. The infertile period resumes after the 3rd daily recording of the higher temperature due to the disintegration of the unfertilised egg.

• Mucus – During the fertile period the cervical mucus is thin and watery, after ovulation the mucus becomes more viscous showing the return of the infertile phase

ContraceptionContraceptionRhythm methods

Women can use temperature and cervical mucus to calculate the fertile period.

This is useful:

for couples who are trying to conceive and want to know

when sexual intercourse is likely

to be most successful

as a natural method of

contraception – by avoiding sexual

intercourse when the female is fertile.

This method is unreliable!

Contraception: Hormonal methodsContraception: Hormonal methodsHormonal methods of contraception alter the normal sequence of events in the menstrual cycle to prevent ovulation.

Nowadays, hormonal contraception is also available for

men. View the BBC article:

http://news.bbc.co.uk/1/hi/health/3167090.stm

Contraceptive injection

Image source: www.fpa.org.uk

Contraceptive implantsContraceptive

pill

Oral contraceptive pills – contain synthetic progesterone, sometimes combined with oestrogen.

Contraceptive PillContraceptive Pill

Pill taken daily for 3 weeks from the final day of previous menstrual period. Sometimes dummy (placebo) pills are taken in the 4th week to allow the levels of oestrogen + progesterone to drop & menstruation to occur.

VasectomyVasectomyPermanent method of contraception in men also known as male sterilisation.

View the animationhttp://hcd2.bupa.co.uk/fact_sheets/

html/Vasectomy.html

HysterectomyHysterectomyA hysterectomy is an operation to remove a woman's uterus (womb) as a permanent method of contraception.

HysterectomyHysterectomyThere are several types:

Image source: cks.library.nhs.uk

The Cap or DiaphragmThe Cap or DiaphragmA barrier methodA barrier method

Diaphragms and caps prevent sperm meeting an egg. They fit inside the vagina and cover the cervix. They're made of latex (rubber) or polyurethane (plastic). They come in different shapes and sizes.

www.bbc.co.uk

The Coil or Intra Urine Device The Coil or Intra Urine Device (IUD)(IUD)

A barrier methodA barrier method

SpermicideSpermicideSpermicides are chemical contraceptive gels, foams or jellys which destroy sperms. But they're not effective enough to use on their own. If you use them by themselves, there's a high chance that sperm will get through sometimes - and cause pregnancy.

Such chemical contraception should only be used in combination with a 'barrier method' - such as a condom, diaphragm or a cap.

IVFIVF

After hormone After hormone treatment to stimulate treatment to stimulate multiple ovulations, ova multiple ovulations, ova are harvested.are harvested.

Sperm are collected.Sperm are collected. Ova and sperm are Ova and sperm are

mixed to fertilise the mixed to fertilise the ova.ova.

Embryos are grown Embryos are grown then 2 or 3 are then 2 or 3 are implanted in the uterus.implanted in the uterus.

•Insertion of semen into female by some other means other than by sexual intercourse

Artificial Insemination In Vitro Fertilisation

Treatment of Infertility

• Which types of infertility could be helped by in vitro fertilisation?

• Which types of infertility could be helped by artificial insemination?

• Which type of infertility could be helped by laser treatment?

• Which types of infertility could be helped by hormone (fertility) drugs?

Contraception• Contraception is the deliberate prevention of fertility /

conception

Condoms

•85 – 98% effective-AdvantagesPrevent STIsNo prescriptionNo hormonal side effectsMay decrease incidence of cervical cancer

DisadvantagesCan burst/leakPossible allergic reactionDecreased sensation

Diaphragm

• 86 – 94% effective• Rubber dome with a springy & flexible rim fits over

the cervix & is held in place by vaginal muscles• Holds spermicide over the cervix (kills sperm)• Leave in place for 6-8 hours

Diaphragm

AdvantagesCan be inserted 2 hours before intercourse

ComfortableDoesn’t alter menstrual cyclesDoesn’t affect future fertilityDisadvantagesNo protection against STIsPossible allergic reactionRequires fitting in a clinic Increased risk of bladder infections

IUD (intra-uterine device)

• 99.2-99.9% effective• Inserted through cervix and placed in uterus• Can last 1- 10 years• Changes lining of uterus and fallopian tubes affecting

movement of eggs and sperm prevents fertilisation

IUD

AdvantagesRequires no daily attentionImmediately effectiveLong lastingDisadvantagesNo protection against STIsRequires clinic visitsCan cause very difficult menstruationAbove average risk of infectionPossible risk to future fertility

Contraceptive Implant

Contraceptive Implant

• Soft capsules - ~ 2 inches long are placed under the skin in the upper arm

• Constantly release progestin thickens cervical mucus and stops ovulation

Contraceptive Implant

AdvantagesCan be worn for 3-5 yearsEasy to useNo Menstruation

DisadvantagesNo protection against STIsIncreased risk of heart attack or strokeRequires prescription

Sterilisation - Males

Sterilisation - Females

Sterilisation

• 99.5% effective• Male – cut vas deferens so sperm cannot mix with semen• Female – Cut fallopian tubes – still get ovulation but eggs are

reabsorbed by the body

Sterilisation

Advantages

Permanent contraceptionImmediately effective (in females)No daily attentionDisadvantages

No protection against STIsRequires surgery – risksNot reversibleNot immediately effective (in males)

Contraceptive Pill

The “pill” contains progesterone (and oestrogen) which inhibits release of FSH (maturation of follicles inhibited-ovulation inhibited)

Highly reliable

Other hormonal methods

• Implants and injections work on the same principle as the contraceptive pill

• Implants allow slow controlled release of synthetic hormones (avoids the need to remember to take the pill daily)

• Prolonged use of these can lead to temporary infertility when discontinued

Natural Contraception

Uses body temperature and vaginal mucus texture to identify fertile periods and safe periods

Very unreliable