Notes

Oogenesis
- This is the female development of an ova used for fertilisation
- Ova develop from primordial follicles where during foetal development around 40,000 are present.
- After birth, the primoridal follicles undergo meiosis I, however they are arrested at prophase I as a primary follicle
- At puberty, when the menstrual cycle begins and FSH is released, the oocyte completes meiosis I and produces a daughter cell (secondary oocyte) and a polar body. The secondary oocyte takes all of the cytoplasm from the parent cell and the polar body has no cytoplasm. The polar body can either divide into 2 polar bodies or die within the follicle
- The secondary oocyte is arrested in metaphase II until chemical changes during fertilisation allow the production of a fertile ova.

Fertility
- Definition of infertility - the inability to produce a foetus/achieve clinical pregnancy while having 12+ months of unprotected sex regularly

Primary infertility - unable to have a child or carry a live pregnancy (including miscarriage/still births)
Secondary infertility - unable to have a child or carry a live birth, following a successful pregnancy of a live child or the previous ability of being able to carry a live birth

Risk factors

Age - females lose fertility after menopause which can occur around mid-30s, male fertility stays intact forever but the quality of semen decreases in late age
Weight - obese or severely underweight can affect ovulation
Stress - reduce libido, affect relationship with partner
Alcohol - affect the development of a foetus and reduces semen quality
Smoking - "
Klinefelters syndrome - XXY causes more feminine qualities in males, causing infertility
Turners syndrome - Missing X in females, causing affects in ovulation
Polycystic ovary syndrome - This is caused by high levels of androgens as there is nothing to regulate GnRH, therefore causes increased FSH, increased follicular development all round --> multiple ruptures of follicles causing cysts to develop as there is no time for the ovary to heal


Rectouterine
Uterovesical

Ligaments of the female reproductive system
Broad ligmament - this is a sheet of peritoneum that lies on top of the uterus and uterine tubes
contains 3 mesenteries - mesovarium, mesometrium, mesosalpinx
Ovarian ligament - fibrous cord that connects the ovary to the uterus
Suspensory ligament - carries the ovarian artery and vein. The suspensory ligament runs from the lateral pelvis to the ovary

Ovarian artery - arises from aorta from the same level as the renal artery
Ovarian vein - right ovarian vein --> drains into IVC, left vein --> drains into left renal vein

Parts of the uterine tube
- Infundibulum - where the ovum enters the fallopian tube. It has finger-like projections called frimbae which 'suck' up ova into the uterine tube from the surrounding peritoneum
- Ampulla - where fertilisation usually occurs. uterine wall composed of ciliated epithelium which sweeps the ovum towards the uterus
- Isthmus - narrowest part of the uterine tube
- Uterine part - where the tube opens up to the uterus

Anteflexion - the position to describe the uterus bending over the cervix
Anteversion - the position to describe the whole uterus bending over the vagina at a right angle

20% of females show retroflexion/retroversion however, they present with no symptoms or problems

Uterine artery - branch of the internal iliac artery
Uterine vein - drains into the internal iliac vein
Lymphatics - body drains to para-aortic nodes, cervix drains to internal iliac nodes

7.5cm long, 5cm wide, 2.5cm thick - inverted pear shape

Histology of the uterus

Innermost layer - endometrium
- composed of simple columnar epithelium
- stratum functionalis - contains spiral arteries
- stratum basalis - where glands reside

Middle layer - myometrium
- composed of 3 layers of smooth muscle

Outermost
Perimetrium
- Simple squamous epithelium with areolar connective tissue

The vagina
- 8cm
- Composed of non-keratinised stratified squamous epithelium which is important as the vagina experiences a lot of wear and tear from sex and childbirth
- The vaginal layer is covered by a mucous membrane that is mainly produced by the glands of the uterus --> the mucous that is produced drips into the vagina
- Contains large stores of glycogen which break down to form organic acids. This produces an acidic environment to destroy/prevent growth of bacteria/microbes, however, sperm can counteract this mechanism due to their alkaline characteristics

Bicornuate uterus - double uterus that is capable of a double pregnancy
- internal os communicates with the cervix and uterus, whilst the external os communicates with the vagina and cervix
- The appearance of the 2 os are different in woman that have and have not bear children #

Skin
Dartos muscle and fascia
External spermatic fascia
Cremasteric fascia and cresmaster muscle
Internal spermatic fascia
Tunica vaginalis - visceral and parietal layer
Tunica albuginea

Seminiferous tubules --> tubulus rectus --> rete testis --> epididymis --> ductus vas deferens

The coiled tubules of the seminiferious tubules connect to a common point known as the ductus rectus, which are straight tubules. These straight tubules connect to a network of tubules called rete testis. Efferent ducts emerge from the rete testis and enter the epididymis. The epipdidymis has 3 main parts - head (caput epididymidis), body (corpus epididymidis) and tail (cauda epididymidis). This joins on to the ductus vas deferens

Epididymis
- 3 gross parts as the tubules are very tightly coiled
- pseudo-stratified columnar epithelium which has 2 functions - absorbed fluid and to monitor the fluid composition of semen, so if too bicarbonate-sugar is released and vice versa

Blood supply
Testicular artery - arises from abdominal aorta
Venous --> pampiniform plexus --> testicular vein --> drains into IVC on right and (left) renal vein on left

Ductus deferens

- 45cm long (as long as femur)
- It is contained in spermatic cord
- Lies of lateral pelvic wall and turns medially towards to bladder
- Accessory glands, like seminal vesicle, add substance to the semen.
- Seminal vesicles develop as out-pouchings of the vas deferens
- The seminal vesicles secrete an alkaline solution which help the sperm survive in acidic vagina environemnt
- Also fructose is released - which can be used to regenerate ATP in sperm prostaglandins which aids motility of the sperm and causes contract