Urghh hate doing this! Why! Pointless! 2Back One white board between you 1s faces board 2s away from board No cheating! Now 1’s DESCRIBE what you see [3] 2s can you see what it is yet? Urghh hate doing this! Why! Pointless! Great data handling skill in the exam – many of you FAILED to score an easy 2 marks in the NAB. Make sure you describe each part

Luteinising hormone! One actual patient – so not exact 1 mark - steadily increases from day 1 to 12 +/- 1 day 1 mark – peaks day 13+/- 1 day at 18 IU/L 1 mark - EITHER – decreases to 2 IU/L but then increases on day 16 up to 6 IU/L OR - sharp decrease from 5.5 IU/L to 1 IU/L on day 22. NOW SWAP OVER !

Progesterone hormone One actual patient – so days may be out etc. 1 mark - Remains very low, just over 0ng/mL for first 9 days 1 mark – Rises from day 10 to 18 up to peak of 24 ng/mL 1 mark - Decreases back to baseline from day 19 to 27.

Apply the principles of the biology fertilisation in; Learning Outcomes Examine the fertile period in females (cyclical) compared with continuous fertility in males Apply the principles of the biology fertilisation in; Treatments for infertility Methods of contraception Compare and contrast contraception methods

My cycle is just once a year – whereas humans are twelve times that ! Fertile Period Men are continuously fertile as they maintain a relatively steady level of testosterone, which means they regularly secrete sperm. However women are only fertile cyclically, 1-2 days after ovulation Not so different now! My cycle is just once a year – whereas humans are twelve times that !

Calculation of the fertile period 3 main ways ; Temperature Temperature increases by 0.2 – 0.5oC ~ 1 day after ovulation and remains high during the luteal phase Fertile for ~ 3 days after this rise in temp Cervical Mucus Becomes less viscous during fertile period Increases in viscosity due to progesterone after Rhythm Methods of contraception Avoiding sexual intercourse based on temperature and mucus viscosity to indicate fertile period Not reliable because cycle period varies

TEMPERATURE AND OVULATION Body temperature rises by about 0.5oC one day after ovulation (under the action of progesterone) and remains high during the luteal phase

CERVICAL MUCUS High levels of oestrogen prior to ovulation stimulate the cervix to produce a watery mucus making it easier for the sperm to swim through. Chance of fertilisation is increased

Rainbow 4’s Activity Get yourselves into groups of 4s. Choose a colour – red or orange or green or blue Research your the category 2 using books. 2 using computers Compare the pros and cons of each method of research.

Infertility - disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual activity (WHO)

Treatments for infertility 4 main ones we will examine; Stimulating ovulation Hormone treatment for ovulation Artificial insemination Low sperm count treated by introducing several samples into reproductive tract. In vitro fertilisation (IVF) + PGS/PGD  Counteracts oviduct blockage by fusion of gametes outside body, then once into 8 cells+ reinsert into womb Intracytoplasmic sperm injection If sperm inactive directly fuse in IVF

Contraceptive Methods Contraception is the intention of prevention of conception/pregnancy by natural or artificial means. 2 categories of contraception; Physical Chemical PHYSICAL CHEMICAL Pill containing combination hormones Morning after pill Mini Pills Barrier method Inter-uterine devices (IUD) Sterilisation procedures

Rainbow 4’s Activity 10 minutes of research Books Computers 10 minutes of research Come back together and share/disseminate what you have found out.

Rainbow 4’s Activity 10 minutes of research Books p131-2, p136 and p137 Computers Books p133-134 and p136 10 minutes of research Come back together and share/disseminate what you have found out.

Research Review Criterias Books Computers Access of resources Research method used Information gained Reliability check OVERALL SCORE Online difficulties? Logon ok? Enough books? Content/index? Ask Jeeves/Yahoo answer? Keyword/phase search? Did you understand it? Over your head? Too simple? Multiple sources? What gives you confidence the information you are giving to others? Checked? Other website? So which is better for this type of task? A place for both

You are a fertility doctor Couples will come up with a problem they have You must explain how to intervene and treat the problem.

Choose Your Causes of Infertility Infertility could be due to one or a combination of factors. Infertility is usually treated by returning hormones to the natural level. Infertility in Females failure to ovulate blockage of oviduct(s) failure of implantation Infertility in Males low sperm count

Infertility in Women Causes Failure to ovulate Blockage of uterine tubes (oviducts) Failure of implantation

Failure to Ovulate Causes Inadequate supply of FSH or LH Prolonged use of contraceptive pill Emotional stress Poor health Treatments Fertility Drugs to stimulate FSH, LH production Injections of FSH, LH (extracted from fertile placentas or menopausal women)

Blockage of Oviducts Causes Tissue growth (e.g. tumours) Infections Treatments Clear blockage (laser treatment) IVF (in vitro fertilisation)

Failure of Implantation Causes Hormone imbalance Treatments  Fertility Drugs to stimulate FSH and LH production & restore normal cycle

Infertility in Men Low Sperm Count Causes Failure of pituitary gland to produce adequate quantities of gonadotrophic hormones (FSH and ICSH) Ill health Emotional stress Treatments Drugs to stimulate FSH and ICSH production IVF AI (artificial insemination)

Remaining embryos frozen in case a second attempt is needed In vitro fertilisation (IVF) Fertilised eggs incubated in nutrient agar to allow cell division 6 Remaining embryos frozen in case a second attempt is needed

Artificial insemination Insemination is the introduction of semen into the female reproductive tract. This occurs naturally during sexual intercourse. However, due to infertility, scientists have developed artificial ways to inseminate the female. Men with low sperm count – semen is frozen and used when the women is at her most fertile.

Contraception ….intentional prevention of conception either naturally or artificially. Indicators of fertile period Temperature – immediately after ovulation body temperature rises by 0.5°C and stays high during the luteal phase. The infertile period resumes after the 3rd daily recording of the higher temperature due to the disintegration of the unfertilised egg. Mucus – During the fertile period the cervical mucus is thin and watery, after ovulation the mucus becomes more viscous showing the return of the infertile phase

This method is unreliable! Contraception Rhythm methods Women can use temperature and cervical mucus to calculate the fertile period. This is useful: as a natural method of contraception – by avoiding sexual intercourse when the female is fertile. This method is unreliable! for couples who are trying to conceive and want to know when sexual intercourse is likely to be most successful

Contraception: Hormonal methods Hormonal methods of contraception alter the normal sequence of events in the menstrual cycle to prevent ovulation. Contraceptive implants Contraceptive pill Contraceptive injection Nowadays, hormonal contraception is also available for men. View the BBC article: http://news.bbc.co.uk/1/hi/health/3167090.stm Image source: www.fpa.org.uk

Contraceptive Pill Oral contraceptive pills – contain synthetic progesterone, sometimes combined with oestrogen. Pill taken daily for 3 weeks from the final day of previous menstrual period. Sometimes dummy (placebo) pills are taken in the 4th week to allow the levels of oestrogen + progesterone to drop & menstruation to occur.

Vasectomy Permanent method of contraception in men also known as male sterilisation. View the animation http://hcd2.bupa.co.uk/fact_sheets/html/Vasectomy.html

Hysterectomy A hysterectomy is an operation to remove a woman's uterus (womb) as a permanent method of contraception.

Hysterectomy There are several types:

The Cap or Diaphragm A barrier method Image source: cks.library.nhs.uk Diaphragms and caps prevent sperm meeting an egg. They fit inside the vagina and cover the cervix. They're made of latex (rubber) or polyurethane (plastic). They come in different shapes and sizes. www.bbc.co.uk

The Coil or Intra Urine Device (IUD) A barrier method

Spermicide Spermicides are chemical contraceptive gels, foams or jellys which destroy sperms. But they're not effective enough to use on their own. If you use them by themselves, there's a high chance that sperm will get through sometimes - and cause pregnancy. Such chemical contraception should only be used in combination with a 'barrier method' - such as a condom, diaphragm or a cap.

IVF After hormone treatment to stimulate multiple ovulations, ova are harvested. Sperm are collected. Ova and sperm are mixed to fertilise the ova. Embryos are grown then 2 or 3 are implanted in the uterus.

Artificial Insemination In Vitro Fertilisation Insertion of semen into female by some other means other than by sexual intercourse

Treatment of Infertility Which types of infertility could be helped by in vitro fertilisation? Which types of infertility could be helped by artificial insemination? Which type of infertility could be helped by laser treatment? Which types of infertility could be helped by hormone (fertility) drugs?

Contraception Contraception is the deliberate prevention of fertility / conception

Condoms 85 – 98% effective- Prevent STIs No prescription Advantages Prevent STIs No prescription No hormonal side effects May decrease incidence of cervical cancer Disadvantages Can burst/leak Possible allergic reaction Decreased sensation

Diaphragm 86 – 94% effective Rubber dome with a springy & flexible rim  fits over the cervix & is held in place by vaginal muscles Holds spermicide over the cervix (kills sperm) Leave in place for 6-8 hours

Diaphragm Can be inserted 2 hours before intercourse Comfortable Advantages Can be inserted 2 hours before intercourse Comfortable Doesn’t alter menstrual cycles Doesn’t affect future fertility Disadvantages No protection against STIs Possible allergic reaction Requires fitting in a clinic Increased risk of bladder infections

IUD (intra-uterine device) 99.2-99.9% effective Inserted through cervix and placed in uterus Can last 1- 10 years Changes lining of uterus and fallopian tubes affecting movement of eggs and sperm  prevents fertilisation

IUD Requires no daily attention Immediately effective Long lasting Advantages Requires no daily attention Immediately effective Long lasting Disadvantages No protection against STIs Requires clinic visits Can cause very difficult menstruation Above average risk of infection Possible risk to future fertility

Contraceptive Implant

Contraceptive Implant Soft capsules - ~ 2 inches long are placed under the skin in the upper arm Constantly release progestin  thickens cervical mucus and stops ovulation

Contraceptive Implant Advantages Can be worn for 3-5 years Easy to use No Menstruation Disadvantages No protection against STIs Increased risk of heart attack or stroke Requires prescription

Sterilisation - Males

Sterilisation - Females

Sterilisation 99.5% effective Male – cut vas deferens so sperm cannot mix with semen Female – Cut fallopian tubes – still get ovulation but eggs are reabsorbed by the body

Sterilisation Permanent contraception Advantages Permanent contraception Immediately effective (in females) No daily attention Disadvantages No protection against STIs Requires surgery – risks Not reversible Not immediately effective (in males)

Contraceptive Pill The “pill” contains progesterone (and oestrogen) which inhibits release of FSH (maturation of follicles inhibited-ovulation inhibited) Highly reliable

Other hormonal methods Implants and injections work on the same principle as the contraceptive pill Implants allow slow controlled release of synthetic hormones (avoids the need to remember to take the pill daily) Prolonged use of these can lead to temporary infertility when discontinued

Natural Contraception Uses body temperature and vaginal mucus texture to identify fertile periods and safe periods Very unreliable