INTRODUCTION

 Reproduction is an essential function of life.

 Sexual reproduction is a process where genes from two individuals combine in
random and new ways with each new generation and offers an advantage of
introducing great variability into a population.
 The primary reproductive organs are called the gonads.
 In females they are called the ovaries and in males the testes.
 The differentiation of the gonads into testes or ovaries is genetically
determined in humans by sex chromosomes.
 These are the X and Y chromosomes. The Y chromosome is necessary and
sufficient for the development of the testes and its absence causes the
development of the ovaries.
 Male cells contain an X and Y chromosome (X, Y pattern), while female cells contain 2 X
chromosome (X, X pattern).
 In sexual reproduction, germ cells or gametes (sperm and ova) are formed within the gonads
by meiosis (reduction division).
 During this type of cell division, the normal number of chromosome is halved so that each
gamete receives twenty three chromosomes Fusion of a sperm cell and ovum in the act of
fertilisation results in the restoration of the original chromosome number of forty six (diploid)
in the zygote (fertilised egg). I.e. each zygote inherits twenty three chromosomes from its
mother and twenty three from its father.
 This does not produce forty six different chromosomes but rather twenty three homologous
pairs of chromosomes.
 The members of a homologous pair, with the exception of the sex chromosomes, look like each
other and contain similar genes. Each cell that contains forty-six chromosomes (diploid) has
the first twenty-two pairs as autosomes and the twenty third pair as sex chromosomes.
 In a female, the sex chromosomes consists of two X chromosomes, whereas in a male, there is
 one X and one Y chromosomes. The X and Y chromosomes look different
and contain different genes.

 When a diploid cell undergoes meiotic division, its daughter cells receive
only one chromosome from each homologous pair of chromosomes.

 The gametes are therefore said to be haploid (i.e. they contain only half of
the number of chromosomes in the diploid parent cell.

 Each sperm cell will receive only one chromosome of the homologous
chromosome (X,Y), so that approximately half of the sperm produced will
contain an X and approximately half will contain a Y chromosome.

 Which of the two chromosomes, i.e. maternal or paternal ends up in a

given cell is completely random.
 Similarly the egg cells (ova) in females will receive a similar random
assortment of maternal and paternal chromosomes and all of the above will
normally contain one X chromosome (haploid).

 Because all ova contain one X chromosome, whereas some sperm are X-
bearing and others Y- bearing, the chromosomal sex of the zygote is
determined by the fertilising sperm cell.

 If a Y-bearing sperm cell fertilizes the ovum, the zygote will be X, Y and male,
if an X bearing sperm cell fertilizes the ovum, the zygote will be X, X and
female.
 Although each diploid cell in a woman’s body inherits two X chromosomes, it
appears that only one of each pair of the X chromosome remains active.

 In abnormal individuals with more than two X chromosomes, only one remains
active.

 The process that is normally responsible for inactivation is initiated in an X-

inactivation center in the chromosome, probably via a gene called Xist that
produces a non-coding mRNA which brings about the inactivation.
 The choice of which chromosome remains active is random. So
normally one X chromosome remains active in approximately half
of the cells and the other X chromosome is active in the other
half.

 The active chromosome forms a clump of heterochromatin called

the Barr body and usually seen in cheek cells. This provides a
convenient test for chromosomal sex.

 Also, some of the nuclei in the neutrophils (1-15%) of the females

have a drumstick appendage not seen in neutrophils from males.
Development of the gonads

Testes /Ovaries
 At about the 4th week of gestation (development), the primitive gonads develops from
the genital ridge, near the adrenal gland.

 At this stage, the morphology is indeterminate, and further development depends on

the chromosomal complement i.e. the presence of the Y chromosome (X Y) induces
development of the testes and the absence of the Y-chromosome (X X) leads to the
development of the ovaries.
Development of the Accessory Sex Organs and external genitalia;
 In addition to testes and ovaries, various internal accessory sex organs are needed for reproduc
functions.

 These are derived from two systems of embryonic ducts. Male accessory organs are derived f
the Wolfian ducts and female accessory organs from the Mullerian ducts.

 The Wolfian ducts develop to form the epididymis, ductus deferens (vas deferens), sem
vesicles, and ejaculatory ducts.

 In females, the Mullerian duct gives rise to the uterus and fallopian tubes.

 The external genitalia of males and females are essentially identical during the first six week
development sharing a common urogenital sinus, genital tubercle urethral folds and a pa
labioscrotal swellings.
 The presence of a functional testes produces secretions that masculinizes these
structures.

 The Leydig cells of the fetal testes secretes testosterone and the Sertorli cells secretes
mullerian inhibiting substance (MIS).

 MIS and testosterone act unilaterally.

 Testosterone stimulates the Wolfian ducts to form the penis and urethra, prostate and
scrotum,

 while the MIS causes the regression of the mullerian ducts.

 In the absence of testosterone, the clitoris is formed and the labioscrotal swellings form
the labia majora in females.
Sex differentiation from the
mesonephric (wolffian) and
paramesonephric (müllerian) ducts:
In females, the mesonephric ducts
regress while the paramesonephric
ducts persist. The paramesonephric
ducts remain open to the
intraembryonic coelom (the eventual
peritoneal cavity) near the gonads, and
the inferior/medial ends fuse into a
common body in the midline, forming
the uterus and upper vagina.
In males, the mesonephric ducts are
closely associated with the gonads;
they enter the urogenital sinus
separately on each side becoming parts
of the ejaculatory system, while the
urogenital sinus becomes the bladder
and prostate.
Image by Lecturio. License:
Sex differentiation from the mesonephric (wolffian) and paramesonephric (müllerian) ducts:

In females, the mesonephric ducts regress while the paramesonephric ducts persist. The
paramesonephric ducts remain open to the intraembryonic coelom (the eventual peritoneal cavity)
near the gonads, and the inferior/medial ends fuse into a common body in the midline, forming the
uterus and upper vagina.

In males, the mesonephric ducts are closely associated with the gonads; they enter the urogenital
sinus separately on each side becoming parts of the ejaculatory system, while the urogenital sinus
becomes the bladder and prostate.
Disorders of sex development (DSD) –
Intersex conditions
1. Chromosomally related differences
 Turner syndrome 45 X (XO),
 gonads are rudimentary,
 female external genitalia develops,
 short stature, no maturation occurs at puberty,
 other congenital abnormalities are often present.

 Klinefelter Syndrome i.e. 47 XXY very common,

 men with an extra X,
 low production of testosterone – feminising influences,
 seminiferous tubules are abnormal, there is a high incidence of mental
retardation.
 XXX (Supper female) pattern is second in frequency to the XXY pattern
Androgen (testosterone) related
 Testosterone Biosynthetic defects
 Androgen Insensitivity Syndrome (AIS)  Partial AIS (PAIS)
 Gonadal Reductase Deficiency
 5-alpha reductase deficiency
 Micropenis
 Congenital Adrenal hyperplasia
Klinefelter syndrome

 Chromosomal anomaly characterized by 1 or more X

chromosomes in a male karyotype

 Most commonly 47,XXY

 Other possible karyotypes: 48,XXXY and 48,XXYY

 ↓ Testosterone and ↑ estrogen compared to typical levels

in men
 Phenotypic male genitalia

 Wolffian structures present

 Müllerian structures absent

 Presents in adolescence with small testes, ↓ body hair, gynecomastia, and

infertility

 Most common cause of hypogonadism in men

Testosterone receptor defect on X
 Neither testosterone nor dihydrotesosterone can bind to receptors
 Body is ‘blind’ to testosterone
 External genitalia is female – testes in abdomen, no pubic hair, well developed breasts
 Gonads based on genetics so they are fixed
 Hormones acts as modifying agents
 The body cannot respond to the androgens they secrete
Complete androgen insensitivity syndrome
 Genetically male
 Phenotypically female but lacks uterus
Partial androgen insensitivity
5 alpha-reductase deficiency
 Are Genetically males (with normal X and Y)

 Lack enzyme that converts testosterone to dihydrotesosterone

 Testosterone masculinizes internal genitalia but development of penis and scrotum needs
DHT

 As puberty approaches, testosterone surge (acts on brain) – leads to development of penis

Endocrine Regulation of Reproduction;
 The testes during the first trimester of pregnancy (3 months) are active
endocrine glands secreting high amounts of testosterone needed to masculinize
the male embyro’s external genitalia and accessory sex organs.

 Ovaries on the other hand do not mature until the third trimester of pregnancy.

 Testosterone secretion declines during the second trimester so that both

gonads are inactive at the time of birth.

 Before puberty, there are also low concentrations of sex steroids (androgens
and oestrogens) in the blood in both males and females.
 During puberty, the anterior pituitary gland secretes two gonadotrophic
hormones, FSH and LH which stimulates the gonads of both sexes to secrete
increased amount of sex steroids.
 Besides sex hormone stimulation, gonadotropins also stimulate
spermatogenesis or oogenesis (formation of sperm or ova) and maintenance of
the structure of the gonads.

 LH and FSH secretion is stimulated by LHRH (luteinizing hormone-releasing

hormone) from the hypothalamus. Hormonal regulation via negative feedback
effects by
1). Inhibition of LHRH (GnRH) secretion from the hypothalamus and
2). Inhibition of the pituitary’s response to a given amount of LHRH.
These changes are accompanied by a growth spurt, which begins at an earlier age
in girls than boys.
 FEMALE REPRODUCTIVE SYSTEM

FEMALE REPRODUCTIVE ORGANS

Female reproductive system comprises of primary sex organs and accessory sex organs

PRIMARY SEX ORGANS

Primary sex organs are a pair of ovaries, which produce eggs or ova and secrete female sex
hormones, the estrogen and progesterone.

FUNCTIONAL ANATOMY OF OVARY

Ovaries are flattened ovoid bodies, with dimensions of 4 cm in length, 2 cm in width and 1 cm in
thickness. Each ovary is attached at hilum to the broad ligament, by means of mesovarium and
ovarian ligament.
Each ovary has two portions:
1. Medulla
2. Cortex.
MEDULLA
 Medulla or zona vasculosa is the central deeper portion of the ovary.

 It has the stroma of loose connective tissues.

 It contains blood vessels, lymphatics, nerve fibers and bundles of smooth muscle fibers near t
hilum.

CORTEX
 Cortex is the outer broader portion and has compact cellular layers.

 It is interrupted at the hilum, where the medulla is continuous with mesovarium.

 is lined by the germinal epithelium underneath a fibrous layer known as ‘tunica albuginea’.
 It consists of the following structures:

i. Glandular structures, which represent ovarian follicles at different stages

ii. Connective tissue cells

iii. Interstitial cells, which are clusters of epithelial cells with fine lipid granules formed mainly
from theca interna

Ovarian Follicles
 In the intrauterine life, the outer part of cortex contains the germinal epithelium, which is
derived from the germinal ridges.

 When the fetus develops, the germinal epithelium gives rise to a number of primordial ova
which moves towards the inner substance of cortex.

 A layer of spindle cells called granulose cells from the ovarian stroma surround the ova. Th
Primordial ovum along with granulosa cells is called the primordial follicle.
 At 7th or 8th month of intrauterine life, about 6 million primordial follicles are found in the
ovary. But at the time of birth, only 1 million primordial follicles are seen in both the ovaries
and the rest of the follicles degenerate.

 At the time of puberty, the number decreases further to about 300,000 to 400,000.

 After menarche, during every menstrual cycle, one of the follicles matures and releases its
ovum.

 During every menstrual cycle, only one ovum is released from any one of the ovaries, many of
the follicles degenerate.
 The degeneration of the follicles is called atresia and the degenerated follicles are known as
atretic follicles.

 The atretic follicles become fibrous and the fibrotic follicles are called the corpus fibrosa.

 Atresia occurs at all levels of follicles. Usually, the degenerated follicles disappear without
leaving any scar.
FIGURE of Ovarian follicles and corpus luteum
FUNCTIONS OF OVARIES

 Ovaries are the primary sex organs in females and their main functions
include:
1. Secretion of female sex hormones
2. Oogenesis
3. Menstrual cycle.

OVARIAN HORMONES
 Ovary secretes the female sex hormones estrogen and progesterone.

 Ovary also secretes few more hormones, namely inhibin, relaxin and small quantities of
androgens.
ESTROGEN
Source of Secretion

 In a normal non-pregnant woman, estrogen is secreted in large quantity by theca

interna cells of ovarian follicles and in small quantity by corpus luteum of the ovaries.

 Estrogen secretion is predominant at the later stage of follicular phase before

ovulation.
 It is derived from androgens, particularly androstenedione, which is secreted in theca
interna cells.
 Androstenedione migrates from the theca cells to the granulosa cells, where it is
converted into estrogen by the activity of the enzyme aromatase.
 A small quantity of estrogen is also secreted by adrenal cortex. In pregnant women, a
large amount of estrogen is secreted by the placenta.
FUNCTIONS
 Major function of estrogen is

 to promote cellular proliferation and tissue growth in the sexual organs and in other
tissues, related to reproduction.
 In childhood, the estrogen is secreted in small quantity.
 During puberty, the secretion increases sharply, resulting in changes in the sexual
organs. Effects of estrogen are:

1. Effect on Ovarian Follicles

Promotes the growth of ovarian follicles and,
It increases the secretory activity of theca cells.
2. Effect on Uterus
It produces the following changes in uterus:
i. Enlargement of the uterus to about double of its childhood size
ii. Increase in the blood supply to endometrium
iii. Deposition of glycogen and fats in endometrium
iv. Proliferation and dilatation of blood vessels of endometrium
v. Proliferation and dilatation of the endometrial glands, which become more tortuous with
increased blood flow
vi. Increase in the spontaneous activity of the uterine muscles and their sensitivity to oxytocin
vii. Increase in the contractility of the uterine muscles. All these changes prepare uterus for
pregnancy.
3. Effect on Fallopian Tubes
i. Acts on the mucosal lining of the fallopian tubes and increases the
number and size of the epithelial cells, especially the ciliated
epithelial cells lining the fallopian tubes

ii. Increases the activity of the cilia, so that the movement of ovum in
the fallopian tube is facilitated

iii. Enhances the proliferation of glandular tissues in fallopian tubes.

All these changes are necessary for the fertilization of ovum.
4. Effect on Vagina
i. Changes the vaginal epithelium from cuboidal into stratified type
ii. Increases the layers of the vaginal epithelium
iii. Reduces the pH of vagina, making it more acidic.

5. Effect on Secondary Sexual Characters

Estrogen is responsible for the development of secondary
sexual characters in females.
Secondary sexual characters in female
i. Hair distribution: Hair develops in the pubic and axillary region.
ii. Skin: Skin becomes soft and smooth.
iii. Vascularity of skin also increases
iv. Body shape: Shoulders become narrow, hip broadens, thighs converge and the
arms diverge. Fat deposition increases in breasts and buttocks
v. Pelvis:
a. Broadening of pelvis with increased transverse diameter
b. Round or oval shape of pelvis
c. Round or oval shaped pelvic outlet.

Thus, pelvis in females is different from that of

males, which is funnel shaped.

vi. Voice: Larynx remains in prepubertal stage,

which produces high-pitch voice

6. Effect on Breast
Estrogen causes:
i. Development of stromal tissues of breasts
ii. Growth of an extensive ductile system
iii. Deposition of fat in the ductile system.
All these effects prepare the breasts for lactation.
Estrogen causes development of lobules and alveoli of the breasts, to some extent.
7. Effect
on Bones
 increases osteoblastic activity. So, at the time of puberty, the
growth rate increases enormously. But, at the same time, estrogen
causes early fusion of the epiphysis with the shaft.
 This effect is much stronger in females than the similar effect of
testosterone in males. As a result, the growth of the females
usually cease a few years earlier than in the males.

 In old age, the estrogen is not secreted or it becomes scanty. It

leads to osteoporosis, in which the bones become extremely weak
and fragile. Because of this, the bones are highly susceptible to
fractures.
8. Effecton Metabolism
i. On protein metabolism
 induces anabolism of proteins, by which it increases the total body protein.

ii. On fat metabolism

 causes deposition of fat in the subcutaneous tissues, breasts, buttocks and
thighs.

 The overall specific gravity of the female body is considerably lesser than
that of males because of fat deposit
PROGESTERONE
Source of Secretion
 In non-pregnant woman, a small quantity of progesterone is secreted by theca
interna cells of ovaries during the first half of menstrual cycle, i.e. during
follicular stage.

 But, a large quantity of progesterone is secreted during the latter half of each
menstrual cycle, i.e. during secretory phase by the corpus luteum.

 Small amount is secreted also from adrenal cortex also.

 In pregnant woman, large amount of progesterone is secreted by the corpus

luteum in the first trimester. In the second trimester, corpus luteum
degenerates.
 Placenta secretes large quantity of progesterone in second and
third trimesters.
 Progesterone is a C21 steroid.

FUNCTIONS OF PROGESTERONE
 Progesterone is concerned mainly with the final preparation of
the uterus for pregnancy and the breasts for lactation. The
effects of progesterone are:

1. Effect on Fallopian Tubes

 Progesterone promotes the secretory activities of mucosal lining
of the fallopian tubes.
 Secretions of fallopian tubes are necessary for nutrition of the
fertilized ovum, while it is in fallopian tube before implantation.
Effect on the Uterus
 Progesterone promotes the secretory activities of uterine endometrium during the
secretory phase of the menstrual cycle. Thus, the uterus is prepared for implantation of
the fertilized ovum.
 Progesterone:
i. Increases the thickness of the endometrium
ii. Increases the size of uterine glands and these glands become more tortuous

iii. Increases the secretory activities of epithelial cells of uterine glands

iv. Increases the deposition of lipid and glycogen in the stromal cells of endometrium

v. Increases the blood supply to endometrium. It is due to increase in size of the vessels
and vasodilatation

vi. Decreases the frequency of uterine contractions during pregnancy. Because of this, the
expulsion of the implanted ovum is prevented
3. Effect on Cervix
Progesterone increases the thickness of cervical mucosa and thereby
inhibits the transport of sperm into uterus. This effect is utilized in the
contraceptive actions of minipills.

4. Effect on the Mammary Glands

 Progesterone promotes the development of lobules and alveoli of
mammary glands by proliferating and enlarging the alveolar cells.

 It also makes the breasts secretory in nature. It makes the breasts to

swell by increasing the secretions in the subcutaneous tissue.
5. Effect on Hypothalamus
 Progesterone inhibits the release of LH from hypothalamus
through feedback effect.

6. Thermogenic Effect
 Progesterone increases the body temperature after ovulation. The
mechanism of thermogenic action is not known. It is suggested that
progesterone increases the body temperature by acting on hypothalamic
centers for temperature regulation.

7. Effect on Electrolyte Balance

 Progesterone increases the reabsorption of sodium and water from the renal
tubules.

 However, in large doses, it is believed to cause excretion of sodium and water.

This may be due to an indirect effect, i.e. progesterone combines with the
same receptors, which bind with aldosterone. So, the action of aldosterone is
blocked, leading to the excretion of sodium and water.
ACCESSORY SEX ORGANS
Accessory sex organs in females are:
1. A system of genital ducts: Fallopian tubes, uterus,
cervix and vagina

2. External genitalia: Labia majora, labia minora and

clitoris.
FUNCTIONAL ANATOMY OF ACCESSORY SEX ORGANS
Uterus
 Uterus is otherwise known as womb.

 It lies in the pelvic cavity, in between the rectum and urinary bladder.
 is a hollow muscular organ with a thick wall.
 It has a central cavity, which opens into vagina through cervix.
 On either side at its upper part, the fallopian tubes open.
 communicates with peritoneal cavity through fallopian tubes.
 Virgin uterus is pyriform in shape and is flattened anteroposteriorly.
 It measures about 7.5 cm in length, 5 cm in breadth at its upper part and about
2.5 cm in thickness.
 There is a constriction almost at the middle of uterus called isthmus.
Divisions of uterus
Uterus is divided into three portions:
1. Fundus (above the entrance points of fallopian tubes)
2. Body (between fundus and isthmus)
3. Cervix (below isthmus).

Structure of the uterus

Uterus is made up of three layers:
1. Serous or outer layer
2. Myometrium or middle muscular layer
3. Endometrium or inner mucus layer.

1. Serous or outer layer

 is the covering of uterus derived from peritoneum. Anteriorly, it covers the
uterus completely, but posteriorly it covers only up to the isthmus.
2. Myometrium or middle muscular layer
Is the thickest layer of uterus and it is made up of smooth muscle fibers. The
smooth muscle fibers are arranged in three layers:
i. External myometrium with transversely arranged
muscle fibers

ii. Middle myometrium with muscle fibers arranged longitudinally, obliquely

and transversely

iii. Internal myometrium with circular muscle fibers.

Muscular layer is interdisposed with blood vessels, nerve fibers, lymphatic

vessels and areolar tissues.
3. Endometrium or inner mucus layer
 Endometrium is smooth and soft with pale red color.

 It is made up of ciliated columnar epithelial cells.

 Surface of the endometrium has minute orifices, through which tubular

follicles of endometrium open.

 The endometrium also contains connective tissue in which the uterine

glands are present. Uterine glands are lined by ciliated columnar epithelial
cells.
The female reproductive organs and other organs of the
reproductive system
Changes in uterus:
The Uterus changes its size, structure and function in different phases of sexual
life.

 Just before menstruation; uterus is enlarged, becomes more vascular. The

endometrium thickens with more blood supply. This layer is desquamated
during menstruation and reformed after menstrual period.

 During pregnancy; uterus is enlarged very much with increase in weight.

 After parturition (delivery), it comes back to its original size but the cavity
remains larger.
 In old age, uterus is atrophied.
Cervix:
The Cervix is the lower constricted part of uterus. It is divided
into two portions:

1. The Upper supravaginal portion, which communicates with body of

uterus through internal os (orifice) of cervix. Mucus membrane of this
portion has glandular follicles, which secrete mucus.

2. The Lower vaginal portion, which projects into the anterior wall of
the vagina and it communicates with the vagina through external os
(orifice) of cervix. The mucus membrane of this portion is formed by
stratified epithelial cells.

Vagina:
Vagina is a short tubular organ. It is lined by mucus
membrane, which is formed by stratified epithelial cells.
 MENSTRUAL CYCLE
DEFINITION
 The menstrual cycle is a cyclic set of events in the female which starts with
bleeding.
 The duration is usually 28 days but could last from 20 to even 45days in normal
females.
 The first day of menstruation is usually labelled “day one” of the cycle
 Menstrual cycle starts at the age of 12 to 15 years, which marks the onset of
puberty.
 The commencement of menstrual cycle is called menarche.
 ceases at the age of 45 to 50 years.
 Permanent cessation of the menstrual cycle in old age is called menopause
CHANGES DURING THE MENSTRUAL CYCLE

During each menstrual cycle, series of changes occur in the ovary and
accessory sex organs.

These changes are divided into 4 groups:

1. Ovarian changes
2. Uterine changes
3. Vaginal changes
4. Changes in cervix.
All these changes take place simultaneously
OVARIAN CHANGES DURING MENSTRUAL CYCLE
Changes in the ovary during each menstrual cycle occur in two phases:
A. Follicular phase
B. Luteal phase.
Ovulation occurs in between these two phases.

THE FOLLICULAR PHASE

 extends from the 5th day of the cycle until the time of ovulation, which takes
place on 14th day.

 It is marKed by the maturation of the ovum with development of ovarian follicles.

Ovarian Follicles
Ovarian follicles are glandular structures present in the cortex of ovary.
Each follicle consists of the ovum surrounded by epithelial cells, namely
granulosa cells. The follicles gradually grow into a matured follicle
through various stages.

Different follicles:
1. Primordial follicle
2. Primary follicle
3. Vesicular follicle
4. Matured follicle or graafian follicle.
1. PrimordialFollicle
 At the time of puberty, both the ovaries contain about 400,000 primordial
follicles.
 Diameter of the primordial follicle is about 15 to 20 μ and that of ovum is
about 10 μ.
 Each primordial follicle has an ovum, which is incompletely surrounded by the
granulosa cells. These cells provide nutrition to the ovum during childhood.

 All the ova present in the ovaries are formed before birth.

 No new ovum is developed after birth.

 At the onset of puberty, under the influence of FSH and LH the primordial
follicles start growing through various stages.
2. Primary Follicle
 Primordial follicle becomes the primary follicle, when ovum is completely
surrounded by the granulosa cells.

 During this stage, the follicle and the ovum increase in size.

 Diameter of the follicle increases to 30 to 40 μ and that of ovum increases to

about 20 μ.

 Primary follicles develop into vesicular follicles.

3. Vesicular Follicle
 Under the influence of FSH, about 6 to 12 primary follicles
start growing and develop into vesicular follicles.
Changes taking place during the development of
vesicular follicle.

i. The granulosa cells first, proliferate.

 a cavity called follicular cavity or antrum is formed in between
the granulosa cells.
 The Antrum is filled with a serous fluid called the liquor
folliculi. With continuous proliferation of granulosa cells, the
follicle increases in size. The Antrum with its fluid also
increases in size.
 The Ovum is pushed to one side and it is surrounded by
granulosa cells, which forms the germ hill or cumulus
oophorus
 The Granulosa cells, which line the antrum form membrana
granulosa and the cells of germ hill become columnar and
form corona radiata.
ii. Changes in ovum
 First, the ovum increases in size and its diameter increases to 100 to 150 μ.
 The nucleus becomes larger and vesicular,
 the cytoplasm becomes granular and a thick membrane is formed around the
ovum called the zona pellucida.
 A narrow cleft appears between ovum and zona pellucida. This cleft is called
perivitelline space.

iii. Formation of capsule.

 Spindle cells from the stroma of ovarian cortex are modified and form a
covering sheath around the follicle. The covering sheath is known as follicular
sheath or theca folliculi.
 The Theca folliculi divides into two layers:
a. Theca interna
b. Theca externa.
 Theca interna is the inner vascular layer with loose connective tissue.
 This layer also contains special type of epithelial cells with lipid granules and
some delicate collagen fibers.

 Epithelial cells become secretory in nature and start secreting the female sex
hormones, especially estrogen.

Theca externa
 is the outer layer of follicular capsule and consists of thickly packed fibers and
spindle shaped cells.

 After about the 7th day of the menstrual cycle, one of the vesicular follicles
outgrows others and becomes the dominant follicle. It develops further to form
graafian follicle. Other vesicular follicles degenerate and become
atretic by means of apoptosis.
4. Graafian Follicle
 Graafian follicle is the matured ovarian follicle with maturing ovum. It is
named after the Dutch physician and anatomist, Regnier De Graaf.
Changes taking place during the development of graafian follicle
 The Size of the follicle increases to about 10 to 12 mm.
 It extends through the whole thickness of the ovarian cortex.
 At one point, the follicle encroaches upon the tunica albuginea and
protrudes upon surface of the ovary. T
 his protrusion is called stigma.
 At the stigma, the tunica albuginea becomes thin
 The Follicular cavity becomes larger and distended with fluid and the ovum
attains its maximum size,
 the Zona pellucida becomes thick,
 the Corona radiata becomes prominent and small spaces filled with fluid
appear between the cells of germ hill, outside the corona radiata.
 These spaces weaken the attachment of the ovum to the follicular
wall.
 The Theca interna becomes prominent. Its thickness becomes
double with the formation of rich capillary network.

 On the 14th day of menstrual cycle, the graafian follicle is ready for
the process of ovulation.
Ovulation is the process by which the graafian follicle ruptures leading to
the discharge of ovum into the abdominal cavity.

 It is influenced by LH

 occurs on the 14th day of menstrual cycle in a normal cycle of 28 days.

 From abdominal cavity, the ovum enters the fallopian tube through the
fimbriated end.

 The Ovum becomes haploid before or during ovulation by the formation

of polar bodies.

 After ovulation, the ovum is viable only for 24 to 48 hours.

 So it must be fertilized within that time.

 Fertilized ovum is called zygote.

 Zygote moves from the fallopian tube and reaches the uterus on the 3rd
day after ovulation. It is implanted in the uterine wall on 6th or 7th day.

 If fertilization does not occur, ovum degenerates. Generally, only one

ovum is released from one of the ovaries.
LUTEAL PHASE
Luteal phase extends between 15th and 28th day of menstrual cycle. During this
phase, corpus luteum is developed and hence this phase is called luteal phase

Corpus Luteum
 Is a glandular yellow body, developed from the ruptured graafian follicle after the
release of the ovum.
 It is also called yellow body.
 It is formed as follows; after the rupture of graafian follicle and release of the
ovum, the follicle is filled with blood.
 At this point, the follicle is called corpus hemorrhagicum. It does not
degenerate immediately. It is transformed into corpus luteum.
Follicular cavity closes gradually by the healing of
the wound.
Corpus luteum obtains a diameter
of 15 mm and remains in the ovary till the end of the cycle.
Structure of Corpus Luteum

 In the corpus luteum, granulosa cells and theca interna cells are transformed into lutein
cells called granulosa lutein cells and theca lutein cells.

 The process which transforms the granulosa and theca cells into lutein cells is called
luteinization.

 Granulosa lutein cells contain fine lipid granules and the yellowish pigment granules. The
yellowish pigment granules give the characteristic yellow color to corpus luteum.

 Theca lutein cells contain only lipid granules and not the yellow pigment. Follicular cavity
is greatly reduced with irregular outline. It is filled with the serous fluid and remnants of
blood clots.
Functions of Corpus Luteum
1. Secretion of hormones
Corpus luteum acts as a temporary endocrine gland. It secretes large quantity of
progesterone and small amount of estrogen.

2. Maintenance of pregnancy
If pregnancy occurs, corpus luteum remains active for about 3 months, i.e. until placenta
develops. Hormones secreted by corpus luteum during this period maintain the pregnancy.

The fate of corpus luteum depends upon whether the ovum is fertilized or not.
1. If the ovum is not fertilized
 the corpus luteum reaches the maximum size about one week after ovulation.

 During this period, it secretes large quantity of progesterone with small quantity of
estrogen.

 Then, it degenerates into the corpus luteum menstrualis or spurium. The cells decrease in
size and the corpus luteum becomes smaller and involuted.

 Afterwards, the corpus luteum menstrualis is transformed into a whitish scar called corpus
albicans. The process by which corpus luteum undergoes regression is called luteolysis.
2. If ovum is fertilized
If ovum is fertilized and pregnancy occurs,

 the corpus luteum persists and increases in size.

 It attains a diameter of 20 to 30 mm and it is transformed into corpus luteum

graviditatis (verum) or corpus luteum of pregnancy.

 It remains in the ovary for 3 to 4 months. During this period, it secretes large amount
of
Progesterone with small quantity of estrogen, which are essential for the maintenance
of pregnancy.

 After 3 to 4 months, placenta starts secreting these hormones and corpus luteum
degenerates.
UTERINE CHANGES DURING MENSTRUAL CYCLE

During each menstrual cycle, along with ovarian changes, uterine changes also
occur simultaneously.

Uterine changes occur in three phases:

1. Menstrual phase
2. Proliferative phase
3. Secretory phase.
MENSTRUAL PHASE
 After ovulation, if pregnancy does not occur, the thickened endometrium is shed or desquamated.

 This desquamated endometrium is expelled out through vagina along with blood and tissue fluid.

 The process of shedding and exit of uterine lining along with blood and fluid is called menstruation or
menstrual bleeding.

 It lasts for about 4 to 5 days. This period is called menstrual phase or menstrual period. It is also called
menses, emmenia or catamenia.

 The day when bleeding starts is considered as the first day of the menstrual cycle.

 Two days before the onset of bleeding, that is on 26th or 27th day of the previous cycle, there is a
sudden reduction in the release of estrogen and progesterone from ovary. Decreased level of these two
hormones is responsible for menstruation.
Changes in Endometrium during Menstrual Phase
 Lack of estrogen and progesterone causes sudden involution of endometrium which leads
to a reduction in the thickness of endometrium, (up to 65% of original thickness).

 During the next 24 hours, the tortuous blood vessels

in the endometrium undergo severe constriction.

 Endometrial vasoconstriction occurs because of Involution of endometrium actions of

vasoconstrictor substances like prostaglandin, released from tissues of involuted
endometrium and sudden reduction of estrogen and progesterone
(Which are vasodilators).

 Vasoconstriction leads to hypoxia, which results in necrosis of the endometrium.

 Necrosis causes rupture of blood vessels and oozing of blood the outer layer of the
necrotic endometrium is separated and passes out along with blood.

 This process is continued for about 24 to 36 hours.

 Within 48 hours after the reduction in the secretion of estrogen and progesterone, the
superficial layers of endometrium are completely desquamated.

 Desquamated tissues and the blood in the endometrial cavity initiate the contraction of
uterus.

 Uterine contractions expel the blood along with desquamated uterine tissues to the
exterior through the vagina.

 During normal menstruation, about 35 mL of blood along with 35 mL of serous fluid is

expelled. The blood clots as soon as it oozes into the uterine cavity.

 Fibrinolysin causes lysis of clot in uterine cavity itself, so that the expelled menstrual
fluid does not clot.
 However, in the pathological conditions involving uterus, the lysis of blood clot does not
occur. So the menstrual fluid comes out with blood clot.
Menstruation stops between 3rd and 7th day of the menstrual cycle. At the end of
menstrual phase, the thickness of endometrium is only about 1 mm. This is followed by the
PROLIFERATIVE PHASE
 Proliferative phase extends usually from 5th to 14th day of menstruation, i.e.
between the day when menstruation stops and the day of ovulation.

 It corresponds to the follicular phase of ovarian cycle.

 At the end of menstrual phase, only a thin layer (1 mm) of endometrium remains,
as most of the endometrial stroma is desquamated.
Changes in Endometrium during
Proliferative Phase
 Endometrial cells proliferate rapidly and epithelium reappears on the surface of
endometrium within the first 4 to 7 days.

 The Uterine glands start developing within the endometrial stroma and blood vessels
appear in the stroma.

 Proliferation of endometrial cells occurs continuously, so that the endometrium reaches

the thickness of 3 to 4 mm at the end of proliferative phase.
 All these uterine changes during proliferative phase occur because of the influence of
estrogen released from the ovary.

 On the 14th day, ovulation occurs under the influence of LH. This is followed by the
secretory phase.
SECRETORY PHASE
 phase extends between 15th and 28th day of the menstrual cycle, i.e. between
the day of ovulation and the day when menstruation of next cycle commences.

 After ovulation, corpus luteum is developed in the ovary. It secretes a large

quantity of progesterone along with a small amount of estrogen.

 Estrogen causes further proliferation of cells in uterus, so that the endometrium

becomes thicker.
 Progesterone causes further enlargement of endometrial stroma and further
growth of glands.
 Under the influence of progesterone, the endometrial glands commence their
secretory function.
 Many changes occur in the endometrium before commencing the secretory
function i.e.
i. the glands become more tortuous to get accommodated within the endometrium
ii. Cytoplasm of stromal cells increases because of the deposition of glycogen and
lipid
iii. Many new blood vessels appear within endometrial stroma.
iv. The blood vessels also become tortuous
v. The blood supply to endometrium increases
vi. Thickness of endometrium increases up to 6 mm.
Actually, secretory phase is the preparatory period, during which the uterus is
prepared for implantation of an ovum. All these uterine changes during secretory
phase occur due to the influence of estrogen and progesterone.
 Estrogen is responsible for repair of damaged endometrium and growth of the
glands and

 Progesterone is responsible for further growth of these structures and secretory

activities in the endometrium.

 If a fertilized ovum is implanted during this phase and if the implanted ovum
starts developing into a fetus, then further changes occur in the uterus for the
survival of the developing fetus.

 If the implanted ovum is unfertilized or if pregnancy does not occur,

menstruation occurs after this phase and a new cycle begins.
CHANGES IN CERVIX AND VAGINA DURING MENSTRUAL CYCLE

CERVIX
Mucus membrane of the cervix also shows cyclic changes during different phases of the
menstrual cycle.

Proliferative Phase
During the proliferative phase, the mucus membrane of cervix becomes thinner and more
alkaline due to the influence of estrogen. It helps in the survival and motility of
spermatozoa.

Secretory Phase
During the secretory phase, the mucus membrane of the cervix becomes more thick and
adhesive because of the actions of progesterone.
VAGINAL CHANGES
Proliferative Phase
Epithelial cells of vagina are cornified. Estrogen is responsible for this.

Secretory Phase
 Vaginal epithelium proliferates due to the actions of progesterone.

 It is also infiltrated with leukocytes. These two changes increase the

resistance of vagina for infection.
APPLIED PHYSIOLOGY – ABNORMAL MENSTRUATION
MENSTRUAL SYMPTOMS
 Menstrual symptoms are the unpleasant symptoms with discomfort,
which appear in many women during menstruation.
 These symptoms are due to hormonal withdrawal, leading to cramps in
uterine muscle before or during menstruation.
Common Menstrual Symptoms
1. Abdominal pain
2. Dysmenorrhea (menstrual pain)
3. Headache
4. Occasional nausea and vomiting
5. Irritability
6. Depression
7. Migraine (neurological disorder, characterized by intense headache causing
disability).
PREMENSTRUAL SYNDROME
Premenstrual syndrome (PMS) is the symptom of stress
that appears before the onset of menstruation. It is also
called premenstrual stress syndrome, premenstrual
stress or premenstrual tension. It lasts for about 4 to
5 days prior to menstruation. Symptoms appear due to
salt and water retention caused by estrogen.
Common Features
1. Mood swings
2. Anxiety
3. Irritability
4. Emotional instability
5. Headache
6. Depression
7. Constipation
8. Abdominal cramping
9. Bloating (abdominal swelling).
ABNORMAL MENSTRUATION

1. Amenorrhea: Absence of menstruation

2. Hypomenorrhea: Decreased menstrual bleeding
3. Menorrhagia: Excess menstrual bleeding
4. Oligomenorrhea: Decreased frequency of menstrual
bleeding
5. Polymenorrhea: Increased frequency of
menstruation
6. Dysmenorrhea: Menstruation with pain
7. Metrorrhagia: Uterine bleeding in between
menstruations.
ANOVULATORY CYCLE
Anovulatory cycle is the menstrual cycle in which ovulation does not occur. The
menstrual bleeding occurs but the release of ovum does not occur. It is common during
puberty and few years before menopause. When it occurs before menopause, it is called
perimenopause.
If it occurs very often during childbearing years, it leads
to infertility.
Common Causes
1. Hormonal imbalance
2. Prolonged strenuous exercise program
3. Eating disorders
4. Hypothalamic dysfunctions
5. Tumors in pituitary gland, ovary or adrenal gland
6. Long-term use of drugs like steroidal oral
contraceptives.
OVULATION

INTRODUCTION
 Ovulation is the process by which the graafian follicle in the ovary ruptures and the ovum
is released into the abdominal cavity.

 Ovulation occurs on the 14th day of the menstrual cycle in a normal cycle of 28 days.

 The ovum, which is released into the abdominal cavity, enters the fallopian tube through
the fimbriated end of the tube. Usually, only one ovum is released from any one of the
ovaries.
 LH is responsible for ovulation.

PROCESS OF OVULATION
Prior to ovulation, large amount of LH is secreted (luteal surge). This causes changes in the
graafian follicle leading to ovulation
Stages of Ovulation
1. Graafian follicle moves towards the periphery of the ovary
2. New blood vessels are formed in the ovary by the actions of LH and progesterone
3. These blood vessels protrude into the wall of the follicle
4. This increases the blood flow to the follicle
5. Now, prostaglandin is released from granulosa cells of the follicle
6. It causes leakage of plasma into the follicle
7. Just before ovulation the follicle swells and protrudes against the capsule of the
ovary. This protrusion is called stigma
8. Then, progesterone activates the proteolytic enzymes present in the cells of theca
interna.
9. These enzymes weaken the follicular capsule and cause degeneration of the
stigma
10. After about 30 minutes, fluid begins to ooze from the follicle through the stigma
11. It decreases the size of the follicle causing rupture of stigma
12. Now, ovum is released from the follicle along with fluid and plenty of small
granulosa cells into the abdominal cavity.
HORMONAL REGULATION OF OVULATION
 LH is important for ovulation.

 Without LH, ovulation does not occur even with a large quantity of FSH.

 The need for excessive secretion of LH for ovulation is known as ovulatory surge for LH or
luteal surge.

 Prior to ovulation, a large quantity of LH is secreted due to positive feedback effect of

estrogen on GnRH,
DETERMINATION OF OVULATION TIME
Various methods are available to determine the ovulation time. In human
beings, usually indirect methods are adopted such as:
1. Determination of basal body temperature
2. Determination of hormonal excretion in urine
3. Determination of hormonal level in plasma
4. Ultrasound scanning
5. Cervical mucus pattern.

SIGNIFICANCE OF DETERMINING OVULATION TIME

Determination of ovulation time is helpful for family planning by rhythm
method