1. Learning question: Why do we age and how does it affect fertility? Title: The effects of aging on the reproductive system Homework: You have your class test next week – study! 08 June 2016

2. Learning Objectives Candidates should be able to: (a)describe the effects of ageing on the reproductive system; (b) describe the changes in physiology associated with the menopause;

3. Key words Menopause Oocyte FSH Testosterone Ejaculate Cholesterol LDL HDL Coronary heart disease Osteoporosis HRT

4. What is aging? Aging is the deterioration over time, including: – Increased weakness; – Susceptibility to disease and adverse environmental conditions; – Loss of mobility and agility; – Age-related physiological changes; – Reduced reproductive capacity.

6. Aging and reproduction The impact of aging and fertility is becoming more of an issue as many women are opting to have a family later in life than previous generations. 50% of infertility treatment is because of reproductive aging.

7. Aging and reproduction A woman’s reproductive potential decreases with age. The decline begins around the age of 30, despite the continuation of the menstrual cycle until menopause. The reproductive potential may have been lost before menopause.

8. Aging and reproduction One third of women aged 35 and over will have problems conceiving, while fewer than 30% of women aged 40 and over are able to conceive naturally. The chances of having a miscarriage also increases with age. This is because of several factors including: Quality of oocyte (declines with age) – this is the immature egg FSH (follicle stimulating hormone) increases with age – difficulty conceiving. If they do, miscarriage is likely.

9. Menopause Changes in reproductive organs and genitalia occur rapidly. Menstrual cycle stops and ovaries stop producing oestrogen. Atrophy (thinning) of tissues in the labia minora, clitoris, vagina and urethra occur. Can result in chronic dryness, irritation and discharge from the vagina. Vaginal infections are more likely to develop. Also, after menopause the uterus, fallopian tubes and ovaries become smaller.

10. Male fertility The impact of aging is not as severe as it is for women! Number, motility and percentage of sperm decrease slightly If a male partner is >50 years, fertility decreases and rate of miscarriage increases

11. Oldest father in the world, 96 years “Despite the fact that some men can become fathers at the age of 80 or older, couples should consider the effects of aging in both partners when planning to become parents.”

12. Males and reproduction Aging causes a gradual change in male sexual function – Levels of testosterone decrease – Results in loss of libido – Blood flow to penis decreases – Decreased sensitivity of penis and volume of ejaculate

13. Exception to the rule…

14. Changes in physiology associated with the menopause Menopause, also known as the “change of life” – women’s body slowly produces less progesterone and oestrogen. Often occurs between 45-55 years, although can happen earlier (35) or later (60) There are 3 phases of menopause: – Peri-menopausal – Menopausal – Post-menopausal

15. Peri-menopausal period Regular cycle of menstruation disrupted Menstruation becomes irregular Can last from 6 months to one year Oestrogen production decreases and eventually stops

16. Menopausal and post menopausal period Defined as the ending of the menstrual period Women are described as post-menopausal when they have gone one year without a period.

17. Decrease of ovarian hormones Coronary heart disease (CHD) risk increases due to elevated levels of cholesterol and LDL (low density lipoprotein) cholesterol Oestrogen prevents high levels of blood cholesterol and maintains activity of oestrogen receptors This helps to prevent CHD

18. Decrease of ovarian hormones Ca loss increases in 5 years leading up to menopause Loss of bone density Tapers off then accelerates again at about 75 years Older women much more likely to suffer from osteoporosis and bone fractures

19. Decrease of ovarian hormones Body composition changes Increased percentage of body fat, decreased percentage of muscle mass Increase in body fat is partly due to decreased physical activity

20. Questions Complete questions 1 -4 on page 263 Read the green box on HRT to help you answer question 4 Use the mark scheme at the back of your book to assess how well you have learned this topic.

21. Past paper question Do January 2011 question 2 Use your notes to help answer this question thoroughly!