MODULE 1
The Fundamentals
The Basics of Infertility | IVI RMA North America Nursing Education Department
Index
- "Normal" Menstrual Cycle
- Gonadotropins: FSH and LH
- HPO Axis
- Follicular Cells: Theca & Granulosa
- Estrogen and Progesterone
- Window of Implantation
- Reproductive Anatomy of Individuals Assigned Female at Birth
- Ovary
- Follicular & Occyte Development
- Oocyte Cohorts
- The Uterus
Lesson 1
Lesson 2
Female Reproductive Anatomy
The Menstrual Cycle & HPO Axis
LESSON 2 | The Menstrual Cycle & HPO Axis
LESSON 2
What is a "Normal" Menstrual Cycle
Gonadotropins: FSH and LH
HPO Axis
Follicular Cells: Theca & Granulosa
The Menstrual Cycle & HPO Axis
Ovarian Hormones: Estrogen and Progesterone
Window of Implantation
LESSON 2 | The Menstrual Cycle & HPO Axis
Follicular phase
Luteal phase
Hormones
Follicles
Endometrium lining
Days
Menstruation
Profilerative phase
Secretory phase
14 Days
Ovulation
LESSON 2 | Test your Knowledge of the HPO Axis
Drag and drop each hormone into its position
Anterior Pituitary
Congratulations!
You've done it perfectly!
Continue
Hypothalamus
Estradiol
Progesterone
GNRH
FSH
hCG
LH
ovaries
LESSON 2 | Uterine and Tubal Factors
Congenital Uterine Anomalies
Normal uterus
Uterine hypoplasia
Unicornuate uterus
Uterus didelphys
Diethylstillbestrol drug related
Bicornuate uterus
Septate uterus
Arcuate uterus
MODULE 3
Brief Overview of Male Infertility
The Basics of Infertility | IVI RMA North America Nursing Education Department
LESSON 1 | The Male Reproductive Anatomy & HPG Axis
LESSON 1
Reproductive Anatomy of Individuals Assigned Male at Birth
Accessory Glands to Aid in Sperm Transport
The Testis
The Male Reproductive Anatomy & HPG Axis
Seminiferous Tubules
Spermatogenesis
Sertoli Cell / Leydig Cells
HPG Axis
LESSON 1 | The Male Reproductive Anatomy & HPG Axis
HPG Axis
GnRH
GnRH: released by hypothalamus
- Causes FSH/LH to be released by pituitary
FSH: binds to Sertoli cells to facilitate sperm development
Testes
FSH
LH
LH: binds to Leydig cells to stimulate testosterone production
Central Nervous System
Testosterone: essential for sperm production
- Regulates FSH/LH secretion
- Inhibin reduces FSH release
Testosterone
Sertoli cells
Sperm =
LH
Leydig cells
LESSON 1 | Female Reproductive Anatomy
LESSON 1
Reproductive Anatomy of Individuals Assigned Female at Birth
Ovary
Follicular & Oocyte Development
Oocyte Cohors
Female Reproductive Anatomy
Fallopian Tubes
The Uterus
LESSON 1 | Female Reproductive Anatomy
Male/female indifferent stage
In the Begining...
An undifferentiated gonad is present in all fetuses:
Ovum: X
Sperm: X or Y
Zigote: XX or XY
Female
Male
Testicular Determining Factor (TDF) present at ~ 7 wks
SRY Gene
- TDF also known as sex-determining region (SRY) protein, is located on the Y chromosome
- Ovary begins to develop after the 13th week of gestation if TDF not expressed
LESSON 1 | Female Reproductive Anatomy
Reproductive Anatomy of Individuals Assigned Female at Birth
LESSON 1
Click on the green bullets to know more
LESSON 1 | Female Reproductive Anatomy
Ovary
Primary follicle
Developing follicles
Mature follicle
Primordial follicle
LESSON 1
Responsible for:
Store and Develop oocytes
Produce Estrogen
Blood vessels
Produce Progesterone
Ruptured follicle
Corpus albicans
Early corpus luteum
Corpus luteum
Liberated ovum
LESSON 1 | Female Reproductive Anatomy
Follicular Development
LESSON 1
Follicles
fsh
The follicle responds to FSH in the first half of the cycle by growing and preparing for ovulation.
A follicle is a fluid filled sac that contains the oocyte.
A group of immature oocytes is recruited monthly to develop = Cohort
Only ONE oocyte from each monthly cohort will develop to maturity
LESSON 1 | Female Reproductive Anatomy
Oocyte Development
46
23
Before birth
Childhood- Ovary inactive
From puberty to menopause
Primordial follicle
LESSON 1 | Female Reproductive Anatomy
Oocyte Cohorts
Follicles
Each month the ovary recruits a cohort, or group, of oocytes
Eggs are recruited from a determined number of eggs they have had since birth
ONE follicle will grow and ovulate - the rest will degenerate
Eggs that are not ovulated, will be ‘lost’ every month
LESSON 1 | Female Reproductive Anatomy
Fallopian Tubes
A pair of Fallopian tubes connect the ovaries to the uterus.
The fimbriae at the end pick up the oocyte after ovulation.
They provide space for the sperm to fertilize the oocyte
Small, hair-like structures, called Cilia, propel the fertilized embryo to the uterus.
Click on the green bullets to know more
LESSON 1 | Female Reproductive Anatomy
The Uterus
An organ the size of your fist that responds to hormones and accommodates a developing fetus until birth.
Uterus
Embryo attaches and implants to the endometrium – the inner lining of the uterus
Cervix
During pregnancy, glands and blood vessels in the endometrium work to support the developing embryo through the placenta.
Click on the green bullets to know more
Vagina
LESSON 1 | Fill in the sentence
The _________ pick up the oocyte right after ovulation.
LESSON 1 | Fill in the sentence
The fundamental unit of an ovary is a ____________.
MODULE 1 | The fundamentals
Congratulations! You have completed the Module 1
We are here to help you. If something was not clear or you want to delve deeper into any topic, don’t hesitate to contact us. Your curiosity is also part of the learning process.
CLOSE
The Basics of Infertility | IVI RMA North America Nursing Education Department
LESSON 1 | Fill in the sentence
The layer of the uterus that the embryo implants in is the _______.
LESSON 2 | The Menstrual Cycle & HPO Axis
What is a “Normal” Menstrual Cycle?
Purpose: Mature and release an oocyte
Normal values:
Provide an appropriate environment to:
Duration: 28 (+ - ) 7d
Select and transport of the sperm
Flow: 4 (+ - ) 2d
Fertilize of the oocyte
Transport of the zygote
Implant the blastocyst
LH
fsh
Follicular phase
Luteal phase
LESSON 2 | The Menstrual Cycle & HPO Axis
Gonadotropins: FSH and LH
FSH stimulations the follicle to grow
Increases estrogen and inhibin
LH
Aids in follicular growth
Causes ovulation to occur
Causes the corpus luteum to secrete progesterone
Increases Androgens
LH
FSH
LESSON 2 | The Menstrual Cycle & HPO Axis
HPO Axis
GnRH
Hypothalamus sends GnRH (Gonadotropin Releasing Hormone) to the Anterior Pituitary
Anterior Pituitary Gland send Gonadotropins (FSH & LH) to the ovarian follicles
- Follicle Stimulation Hormone (FSH): Stimulate follicles to grow
- Luteinizing Hormone (LH): Final maturation and ovulation
Estrogen
Progesterone
FSH
ovaries
LH
Inhibin
- Estradiol is produced by the growing follicle prior to ovulation
- Progesterone is produced by the ovulated follicle (corpus luteum)
- Inhibin (attaches to Estrogen and Progesterone to inhibit FSH)
hCG
UTERUS
Placenta produces Human Chorionic Gonadotropin (hCG)
LESSON 2 | The Menstrual Cycle & HPO Axis
Follicular Cells: Theca and Granulosa
Androgens
Estrogens
GnRH
FSH
LH
FSH
LH
Androgen precursor
Ovary
Granulosa cells located inside the follicle, respond to FSH by growing and multiplying, and they convert androgens (coming from theca cells) to estradiol (estrogen).
Theca Cells surround the outside of the follicle and produce androgens in response to LH.
LESSON 2 | The Menstrual Cycle & HPO Axis
Ovarian Hormones: Estrogen and Progesterone
Estrogen is made by the granulosa cells in the follicle
Stops menstrual bleeding
LH
Aids in follicular growth
Causes ovulation to occur
Causes the corpus luteum to secrete progesterone
Increases Androgens
Stimulates growth of the endometrium
Profilerative phase
Menstruation
Secretory phase
Ovulation
Feeds back to Hypothalamus and Pituitary to regulate GnRH, FSH and LH secretion
Progesterone
Stops endometrial growth
Induces a secretory state in the endometrium
Inhibin accompanies Estrogen and Progesterone back to the pituitary to inhibit FSH secretion
Secretory phase
Profilerative phase
LESSON 2 | The Menstrual Cycle & HPO Axis
Progesterone
Secreted in small amounts by the growing follicle
At Ovulation: Ruptured follicle becomes the corpus luteum (CL) or “yellow body”
LH
Aids in follicular growth
Causes ovulation to occur
Causes the corpus luteum to secrete progesterone
Increases Androgens
CL secretes progesterone
Stops growth of endometrium and causes it to secrete substances necessary to support an early pregnancy
Support continues until placenta takes over at about 10 weeks gestation
If no pregnancy detected after 14 days, progesterone levels drop and uterus sheds the endometrium, and day 1 of a menstrual cycle starts
LESSON 2 | Putting it all together
Luteal Phase
Follicular Phase
From Ovulation to next Day 1
From Day 1 to Ovulation
GnRH causes release of FSH/LH
LH luteinizes the granulosa cells and stimulates progesterone secretion
FSH stimulates
- Follicle growth
- Estrogen and inhibin secretion
The Corpus Luteum has a finite lifespan (14 days) unless rescued by hCG
Estrogen modulates gonadotropin secretion (mainly at pituitary)
Estrogen and Progesterone start to drop 7 days prior to menses
LH
Aids in follicular growth
Causes ovulation to occur
Causes the corpus luteum to secrete progesterone
Increases Androgens
- Inhibin decreases FSH secretion
Menses starts ~3d after Progesterone < 1 ng/ml
Estrogen threshold:
150-200 pg/ml for >36h results in LH surge
38–40h after LH surge onset
Ovulation occurs:
Follicular Phase
Luteal Phase
Menstruation
Profilerative phase
Ovulation
Secretory phase
LESSON 2 | The Menstrual Cycle & HPO Axis
Window of Implantation
Short interval during the mid-luteal phase, when endometrium is most receptive to embryo implantation
Provides the embryo the opportunity to attach and develop
Window of Implantation
The endometrium has been primed by estrogen and progesterone
5-7 days progesterone
LESSON 2 | List the words or sentences in the correct order
Place the following steps in the correct order to show how theca cells and granulosa cells work together to produce estrogen during the menstrual cycle.
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Transcript
MODULE 1
The Fundamentals
The Basics of Infertility | IVI RMA North America Nursing Education Department
Index
Lesson 1
Lesson 2
Female Reproductive Anatomy
The Menstrual Cycle & HPO Axis
LESSON 2 | The Menstrual Cycle & HPO Axis
LESSON 2
What is a "Normal" Menstrual Cycle
Gonadotropins: FSH and LH
HPO Axis
Follicular Cells: Theca & Granulosa
The Menstrual Cycle & HPO Axis
Ovarian Hormones: Estrogen and Progesterone
Window of Implantation
LESSON 2 | The Menstrual Cycle & HPO Axis
Follicular phase
Luteal phase
Hormones
Follicles
Endometrium lining
Days
Menstruation
Profilerative phase
Secretory phase
14 Days
Ovulation
LESSON 2 | Test your Knowledge of the HPO Axis
Drag and drop each hormone into its position
Anterior Pituitary
Congratulations!
You've done it perfectly!
Continue
Hypothalamus
Estradiol
Progesterone
GNRH
FSH
hCG
LH
ovaries
LESSON 2 | Uterine and Tubal Factors
Congenital Uterine Anomalies
Normal uterus
Uterine hypoplasia
Unicornuate uterus
Uterus didelphys
Diethylstillbestrol drug related
Bicornuate uterus
Septate uterus
Arcuate uterus
MODULE 3
Brief Overview of Male Infertility
The Basics of Infertility | IVI RMA North America Nursing Education Department
LESSON 1 | The Male Reproductive Anatomy & HPG Axis
LESSON 1
Reproductive Anatomy of Individuals Assigned Male at Birth
Accessory Glands to Aid in Sperm Transport
The Testis
The Male Reproductive Anatomy & HPG Axis
Seminiferous Tubules
Spermatogenesis
Sertoli Cell / Leydig Cells
HPG Axis
LESSON 1 | The Male Reproductive Anatomy & HPG Axis
HPG Axis
GnRH
GnRH: released by hypothalamus
FSH: binds to Sertoli cells to facilitate sperm development
Testes
FSH
LH
LH: binds to Leydig cells to stimulate testosterone production
Central Nervous System
Testosterone: essential for sperm production
Testosterone
Sertoli cells
Sperm =
LH
Leydig cells
LESSON 1 | Female Reproductive Anatomy
LESSON 1
Reproductive Anatomy of Individuals Assigned Female at Birth
Ovary
Follicular & Oocyte Development
Oocyte Cohors
Female Reproductive Anatomy
Fallopian Tubes
The Uterus
LESSON 1 | Female Reproductive Anatomy
Male/female indifferent stage
In the Begining...
An undifferentiated gonad is present in all fetuses:
Ovum: X
Sperm: X or Y
Zigote: XX or XY
Female
Male
Testicular Determining Factor (TDF) present at ~ 7 wks
SRY Gene
LESSON 1 | Female Reproductive Anatomy
Reproductive Anatomy of Individuals Assigned Female at Birth
LESSON 1
Click on the green bullets to know more
LESSON 1 | Female Reproductive Anatomy
Ovary
Primary follicle
Developing follicles
Mature follicle
Primordial follicle
LESSON 1
Responsible for:
Store and Develop oocytes
Produce Estrogen
Blood vessels
Produce Progesterone
Ruptured follicle
Corpus albicans
Early corpus luteum
Corpus luteum
Liberated ovum
LESSON 1 | Female Reproductive Anatomy
Follicular Development
LESSON 1
Follicles
fsh
The follicle responds to FSH in the first half of the cycle by growing and preparing for ovulation.
A follicle is a fluid filled sac that contains the oocyte.
A group of immature oocytes is recruited monthly to develop = Cohort
Only ONE oocyte from each monthly cohort will develop to maturity
LESSON 1 | Female Reproductive Anatomy
Oocyte Development
46
23
Before birth
Childhood- Ovary inactive
From puberty to menopause
Primordial follicle
LESSON 1 | Female Reproductive Anatomy
Oocyte Cohorts
Follicles
Each month the ovary recruits a cohort, or group, of oocytes
Eggs are recruited from a determined number of eggs they have had since birth
ONE follicle will grow and ovulate - the rest will degenerate
Eggs that are not ovulated, will be ‘lost’ every month
LESSON 1 | Female Reproductive Anatomy
Fallopian Tubes
A pair of Fallopian tubes connect the ovaries to the uterus.
The fimbriae at the end pick up the oocyte after ovulation.
They provide space for the sperm to fertilize the oocyte
Small, hair-like structures, called Cilia, propel the fertilized embryo to the uterus.
Click on the green bullets to know more
LESSON 1 | Female Reproductive Anatomy
The Uterus
An organ the size of your fist that responds to hormones and accommodates a developing fetus until birth.
Uterus
Embryo attaches and implants to the endometrium – the inner lining of the uterus
Cervix
During pregnancy, glands and blood vessels in the endometrium work to support the developing embryo through the placenta.
Click on the green bullets to know more
Vagina
LESSON 1 | Fill in the sentence
The _________ pick up the oocyte right after ovulation.
LESSON 1 | Fill in the sentence
The fundamental unit of an ovary is a ____________.
MODULE 1 | The fundamentals
Congratulations! You have completed the Module 1
We are here to help you. If something was not clear or you want to delve deeper into any topic, don’t hesitate to contact us. Your curiosity is also part of the learning process.
CLOSE
The Basics of Infertility | IVI RMA North America Nursing Education Department
LESSON 1 | Fill in the sentence
The layer of the uterus that the embryo implants in is the _______.
LESSON 2 | The Menstrual Cycle & HPO Axis
What is a “Normal” Menstrual Cycle?
Purpose: Mature and release an oocyte
Normal values:
Provide an appropriate environment to:
Duration: 28 (+ - ) 7d
Select and transport of the sperm
Flow: 4 (+ - ) 2d
Fertilize of the oocyte
Transport of the zygote
Implant the blastocyst
LH
fsh
Follicular phase
Luteal phase
LESSON 2 | The Menstrual Cycle & HPO Axis
Gonadotropins: FSH and LH
FSH stimulations the follicle to grow
Increases estrogen and inhibin
LH
Aids in follicular growth
Causes ovulation to occur
Causes the corpus luteum to secrete progesterone
Increases Androgens
LH
FSH
LESSON 2 | The Menstrual Cycle & HPO Axis
HPO Axis
GnRH
Hypothalamus sends GnRH (Gonadotropin Releasing Hormone) to the Anterior Pituitary
Anterior Pituitary Gland send Gonadotropins (FSH & LH) to the ovarian follicles
Estrogen
Progesterone
FSH
ovaries
LH
Inhibin
hCG
UTERUS
Placenta produces Human Chorionic Gonadotropin (hCG)
LESSON 2 | The Menstrual Cycle & HPO Axis
Follicular Cells: Theca and Granulosa
Androgens
Estrogens
GnRH
FSH
LH
FSH
LH
Androgen precursor
Ovary
Granulosa cells located inside the follicle, respond to FSH by growing and multiplying, and they convert androgens (coming from theca cells) to estradiol (estrogen).
Theca Cells surround the outside of the follicle and produce androgens in response to LH.
LESSON 2 | The Menstrual Cycle & HPO Axis
Ovarian Hormones: Estrogen and Progesterone
Estrogen is made by the granulosa cells in the follicle
Stops menstrual bleeding
LH
Aids in follicular growth
Causes ovulation to occur
Causes the corpus luteum to secrete progesterone
Increases Androgens
Stimulates growth of the endometrium
Profilerative phase
Menstruation
Secretory phase
Ovulation
Feeds back to Hypothalamus and Pituitary to regulate GnRH, FSH and LH secretion
Progesterone
Stops endometrial growth
Induces a secretory state in the endometrium
Inhibin accompanies Estrogen and Progesterone back to the pituitary to inhibit FSH secretion
Secretory phase
Profilerative phase
LESSON 2 | The Menstrual Cycle & HPO Axis
Progesterone
Secreted in small amounts by the growing follicle
At Ovulation: Ruptured follicle becomes the corpus luteum (CL) or “yellow body”
LH
Aids in follicular growth
Causes ovulation to occur
Causes the corpus luteum to secrete progesterone
Increases Androgens
CL secretes progesterone
Stops growth of endometrium and causes it to secrete substances necessary to support an early pregnancy
Support continues until placenta takes over at about 10 weeks gestation
If no pregnancy detected after 14 days, progesterone levels drop and uterus sheds the endometrium, and day 1 of a menstrual cycle starts
LESSON 2 | Putting it all together
Luteal Phase
Follicular Phase
From Ovulation to next Day 1
From Day 1 to Ovulation
GnRH causes release of FSH/LH
LH luteinizes the granulosa cells and stimulates progesterone secretion
FSH stimulates
The Corpus Luteum has a finite lifespan (14 days) unless rescued by hCG
Estrogen modulates gonadotropin secretion (mainly at pituitary)
Estrogen and Progesterone start to drop 7 days prior to menses
LH
Aids in follicular growth
Causes ovulation to occur
Causes the corpus luteum to secrete progesterone
Increases Androgens
Menses starts ~3d after Progesterone < 1 ng/ml
Estrogen threshold:
150-200 pg/ml for >36h results in LH surge
38–40h after LH surge onset
Ovulation occurs:
Follicular Phase
Luteal Phase
Menstruation
Profilerative phase
Ovulation
Secretory phase
LESSON 2 | The Menstrual Cycle & HPO Axis
Window of Implantation
Short interval during the mid-luteal phase, when endometrium is most receptive to embryo implantation
Provides the embryo the opportunity to attach and develop
Window of Implantation
The endometrium has been primed by estrogen and progesterone
5-7 days progesterone
LESSON 2 | List the words or sentences in the correct order
Place the following steps in the correct order to show how theca cells and granulosa cells work together to produce estrogen during the menstrual cycle.