Female sex hormones

Progesterone

(21 C) It is secreted from: Corpus luteum. Placenta (after 10 weeks of pregnancy). It is also formed in the adrenal cortex as a precursor of C19 and C21 corticosteroids hormones .

 b)

Estrogens (18 C): - They are secreted from mature graffian follicle in ovaries. - synthesized by placenta and excreted in urine of o pregnant female

Estrogens (18 C):

They contain 18C, the first ring is completely unsaturated (aromatic) with no CH3 group at C10. There are 3 types: Estrone (E1), Estradiol (E2) and Estriol (E3) The most circulating one is E1 while the most active one is E 2

 Male

sex hormones (Androgens) 19C: Testosterone is the most potent one. It is synthesized in the testis.

Diagnosis of pregnancy

 Pregnancy

can be diagnosed by measuring Human chorionic gonadotropin(HCG) in blood or urine Detectable amounts ~ 5 IU/L Appears 8-11 days after conception and reach the peak(~ 100,000 IU/L) at 8-10 weeks pregnancy. In case of twin pregnancy, the amount of HCG is doubled.

 Serial

HCG can be used to determine abortion and ectopic pregnancy: In normal pregnancy, HCG doubles in 1.5 days in the first 5 weeks then every 2-3 days after 5 months In ectopic pregnancy or abortion HCG rises more slowly or even decreases

Infertility
Infertility

is defined as inability of a couple to conceive after at least 1 year of unprotected, well timed intercourse. This may be due to male, female or a combination of both causes.

Semen analysis

Semen is a grey opalescent fluid which is formed at ejaculation.It is composed of suspension of spermatozoa in seminal plasma. Semen is made up of the secretion of all the accessory glands of the male genital tract: Testes 5% Seminal vesicle 46-48% Prostate 13-33% Bulbourethral gland 2-5%.

Semen analysis

Physical properties Volume Colour pH Vicosity Specific gravity

Microscopic examination Concentration Morphology Motility Viability Non sperm cells

Biochemical tests Fructose Acid phosphatase ASA Acrosin Zinc L-carnitine Alpha glucosidase

PHYSICAL PROPERTIES OF SEMEN

Volume: Average volume is from 2-5 ml/ejaculation. Aspermia: Total absence of ejaculation (rare). Hypospermia: the seminal fluid volume is less than 2 ml. Hyperspermia: Increased volume of semen above 10 ml (rare).

Colour Greyish white.It is opalescent due to its high content of protein and the presence of more than 60 million sperms /ml. Other colours include: Urine produces pale yellow discolouration easily detected by the consistency of the semen and the urineferous odour. Blood (haematospermia) traces of fresh blood will colour semen pink, while large amounts of blood give bright red colour. Jaundice: bilirubin will also cause colouration of semen in deep jaundice. The semen may be a very bright yellow.

pH: Between 7.3-8.1 only recorded on fresh semen by using pH paper with a range of 7-9. Inflammatory conditions of the prostate or seminal vesicle may alter the pH of semen. Viscosity: Normal viscosity is that which allows semen to be poured drop by drop out of the container. It is measured the time taken by one drop to leave the standard pipette. Specific gravity: 1.028

MICROSCOPICAL EXAMINATION:
This

includes: Sperm count Sperm motility Sperm morphology Non-sperm cells

Sperm count

Total sperm count is the number of sperms in an ejaculation. It is obtained by multiplying the sperm concentration by the volume. Normally, it is 20 million/ml, i.e. about 60 millions/ejaculation.

How to conduct a sperm count

Hemacytometers

were developed for counting blood cells, but can also be used to count spermatozoa. A hemacytometer has two chambers and each chamber has a microscopic grid etched on the glass surface. The chambers are overlaid with a glass coverslip that rests on pillars exactly 0.1 mm above the chamber floor. Thus, the volume of fluid above each square of the grid is known with precision.

Loading the Hemacytometer:

At least two chambers should be counted, including at least 100 cells within each central counting area of each chamber.

 Azoospermia

means no spermatocytes

(male sterility). Oligozoospermia mean less than 20 million/ml less than 50 millions/ejaculation Polyzoospermia may reach 350 millions/ejaculation

 Motility: Percentage

motility (the percentage of sperms in the seminal fluid which are highly active) is performed soon after the production of the sample and is repeated after 1,2,3 and 6 hours after semen production. Normally, after one hour there must be over 80% active sperms.

 The

degree of sperm motility should be determined as soon as possible after liquefaction, which usually occurs 15 to 20 minutes after ejaculation..

W.H.O divided grades of motility into: ARapid forward progress motility BSlow or sluggish progressive motility CNonprogressive motility DImmotility. The cutoff value for normal is 50% grade A+B or 25% grade A motility. Asthenospermia: sperm motility less than the WHO cutoff levels

 Morphology

Normally,

the sperm count contains fewer than 20% abnormal forms e.g. bitailed, short tailed, 2 heads....etc.

Normal sperm

Examples of abnormal sperm morphology

Non-sperm cells RBCs:Normally, there are no RBCs. If present, this indicates haematospermia. WBCs: Normally there are very little number of WBCs which increase in cases of inflammation. Epithelial cells: always present in semen. Pus cells: 0- few number. Presence of large numbers of these cells indicates inflammation. Spermatocytes (germinal cells) : usually present in normal semen, but few in number.

BIOCHEMICAL TESTS

Fructose in semen: Secreted from the seminal vesicle (150-650 mg%). It is secreted for nutrition of sperm cells. It disappears in cases of: (a) absence of seminal vesicle (b) obstruction of ejaculatory duct (c) inflammation of seminal vesicle. (d) It is decreased in case of testosterone deficiency. So, fructose is used as fertility test. The used test is Seliwanoffs.

 Acid

phosphatase: Secreted from the prostate. The test is used as: 1) A marker of prostatic functions 2) In forensic laboratories as a test for the presence of semen.

Normal semen parameters

Test
Liquefaction Morphology Motility pH

Normal values
Within 20 minutes >70%normal,mature spermatozoa >60% >7.0 (average 7.7)

Sperm count Volume

White blood cell

>20 million sperm/ml 1.5-5.0 ml

< 1 million cell/ ml

Clinical cases

Case 1 : A 51 year old male with a history of 3 children in a prior marriage, an unremarkable medical history, and several (four) semen analyses that have revealed considerable variability in terms of sperm concentration (12 million per mL, 26 million per mL, 31 million per mL, and 94 million per mL). The semen collections were all thought to be complete and the other variables assessed in the semen analysis (including motility and morphology) were entirely normal. Question: What should be considered given this information?

Answer: There is a normal variability in sperm concentration for a normal fertile man. The sperm concentration occasionally is decreased even in the normal fertile male population. Therefore, the fact that most of the semen analyses report a normal concentration is encouraging. Also, the fact that this gentleman has proven fertility in the past is encouraging.

 Case

2: A 38 year old male with a history of 2 children, an unremarkable medical history, and a semen analysis that has revealed persistent pyospermia (an excess number of WBCs in the semen) Question: What should be considered given this information?

 Answer

Course

of (broad spectrum) antibiotic treatment should be given.