Female Physiology Part I 2013

Outline of the Lecture Once the estradiol peak is achieved, the LH surge is produced,
ovulation occurs.
I. Fertilization, transport and implantation of the ovum
II. Functions of the placenta Fertilization, Transport and Implantation of the Ovum
III. Hormonal Factors involved in pregnancy
IV. Maternal adaptations in pregnancy
V. Partutition (giving of birth)
VI. Lactation

Review

Despite the millions of sperms produced in an ejaculation, only one

sperm will reach the ovum and this is usually the fastest. So in the above
picture, you can see that the ovulated ovum can be fertilized by the sperm, and
the sperm traverses the whole cumulus oophorus and zona pelucida to meet
the ovum.

Q: Ovulation, stage of meiotic division?

A: Metaphase II

Meiosis II is not completed unless a sperm fertilizes it. You produce a

haploid ovum that is fertilized by the haploid sperm. Whatever the sperm
carries (X or Y), it produces the sex.

Despite the millions of sperms introduced into the vagina through

ejaculation, only 1 sperm can fertilize an ovum because of the following:

1. The fastest sperm can always reach the ovum first

A menstrual Cycle that is every 28 days can be divided into 2 phases by 2. Once the sperm has fertilized the ovum, the zona pelucida
ovulation which marks the midpoint. solidifies, preventing other sperms from entering the ovum

Q: Ovulation is caused by what?

A: LH surge T A K E N O T E
Q: LH surge is caused by?
A: Estradiol peak An ovum can only be fertilized by the same species.
Q: After ovulation, what remains inside the ovary is the corpus luteum
which secretes more?
A: Progesterone Transport of Ovum along the Fallopian Tube

But the secretion of progesterone is not that high so FSH and LH will It takes about 3-4 days.
decline. When the LH declines, the corpus luteum regresses to become the
corpus albicans. Q: What causes the unidirectional transport towards the uterus?
A:
Just to correlate it with the endometrial phase, the progesterone is - Fluid current towards the uterus
responsible for the secretory nature of the endometrium. When the corpus - Cilia of the fallopian tube beats toward the uterus
albicans is produced, progesterone declines and signals the onset of - Weak contractions of the tube propels the zygote inward into
menstruation. the uterus

Q: Day 1, level of FSH?

A: High
Q: They recruit how many number of pre-anthral follicles?
A: 6-12

And these pre-anthral follicles will grow but only one will become
dominant because of 2 reasons:

a. Contains the most number of receptors

b. Ongoing positive feedback effect

The growing follicle secreting estrogen will cause the endometrium to

proliferate and when it achieves the highest level of estradiol (because of the
tube-cell tube-gonadotrophin hypothesis)

Q: What kind of cells does the theca cells produce?

Once the zygote is fertilized, it divides into several stages until it
A: androgens
becomes the blastocyst. The blastocyst is composed of 2 cells: the inner cell
mass, and the outer cell mass. The inner cell mass will become the baby while
The androgens will go inside the granulosa cells to be converted to
the outer cell mass will become the placenta. The outer cell mass is otherwise
estrogen under the influence of the enzyme aromatase.
known as the trophoblastic cells.

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 Female Physiology Part I 2013
Implantation of Blastocyst in the Uterus

The blastocyst implants in the endometrium on about 5th-7th day after

ovulation. This is possible because the trophoblast cells are able to secrete
proteolytic enzymes that cause the digestion and liquefaction of the
endometrium.

T A K E N O T E
The implantation process is accompanied by bleeding.
When the blastocyst implants, bleeding can occur. Women usually
mistake this as their regular menstruation.

The first sperm to arrive is the one that will fertilize the ovum.
The zygote divides into different cell stages until it becomes a
blastocyst. The outer cell mass which is the trophoblast implants into
the endometrium. The tropoblast will become the placenta. The inner The hCG peaks at around 8-10 weeks of pregnancy. After 8-10 weeks, it
cell mass on the other hand will become the fetus. declines to reach a plateau at around 20 weeks.

Q: If the hCG declines, what will happen to the corpus luteum?

A: regress
Q: What will happen to the pregnancy?
A: It will continue because at 7 weeks, the placenta is already formed and it
takes over in the production of progesterone

T A K E N O T E
During the first few weeks of pregnancy, it is necessary to
retain the corpus luteum because it will maintain pregnancy through
its release of progesterone. This is made possible through hCG. The
hCG peaks and declines but is no longer a threat to pregnancy since
this usually happens at around the 20th week of pregnancy. By that
time, the placenta is already formed.

Functions of the Placenta

The corpus luteum secretes progesterone which maintains the secretory

endometrium. If the corpus luteum regresses, the secretion of progesterone
will decline. When the progesterone falls, the endometrium sloughs off.

Q: If the above situation happens during pregnancy, what will happen?

A: It will abort

During pregnancy, the corpus luteum is maintained it should be

retained. During this time, the levels of progesterone and estrogen are high but
the LH is flat-lining, it is declining.

Q: How is the maintenance of the corpus luteum done?

A: The trophoblast cells of the implanted ovum secrete another hormone;
the hCG (human chorionic gonadotropin) will cause the retention of the
corpus luteum. It will rescue the corpus luteum which will continuously
secrete progesterone to maintain pregnancy, otherwise it will abort.
1. Diffusion of oxygen
Early Intrauterine Nutrition of the Embryo 2. Diffusion of carbon dioxide
3. Diffusion of foodstuffs
The trophoblast cells release hCG which sustains the corpus luteum for 4. Diffusion of waste products
the continued production of the progesterone which is responsible for fetal
nourishment. The baby is connected to the maternal circulation through the placenta.

Q: How many arteries and veins are there in the umbilical cord?
A: 2 arteries, 1 vein

The umbilical vessels are just like the pulmonary circulation wherein the
oxygenated blood is carried by the umbilical vein, and the deoxygenated blood
is carried by the umbilical arteries.

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Fetal blood does not mix with the maternal blood. Every transfer occurs
via diffusion; diffusion of oxygen from the mother to the baby, diffusion of
carbon dioxide from the baby back to the mother, diffusion of foodstuffs from
the mother to the baby and excretion of waste products from the baby to the
mother.
The baby does not have a functioning respiratory, GI and excretory
system. All nutrients are coming from the mother and all of these products are
brought back to the mother to excrete. This is all occurring in the placenta.
Diffusion of Oxygen in the Placental Membrane
The maternal blood PO2 is 50 mmHg and the fetal blood PO2 is 30
mmHg. By the principle of diffusion the direction is towards the fetus.
Despite the small difference, there are factors that enable the fetus to
deliver enough 02 to its tissue:
1. Fetal hemoglobin carries more oxygen
2. Hemoglobin concentration of the fetal blood is 50%
greater
3. Bohr effect
Q: What is the Bohr Effect?
A: When the curve is shifted to the right, the O2 increases. When the
maternal blood and fetal blood meet, the baby donates the carbon dioxide
to the mother. So if the carbon dioxide in the mother is increased, fetal
carbon dioxide is decreased. Anything that will increase the carbon dioxide
in the blood shifts the curve to the right. In the Bohr Effect, oxygen is
released. Anything that will decrease the carbon dioxide in the blood, the
affinity of oxygen to hemoglobin will increase, the baby gets it. That is why
it is called as the Double Bohr Effect.
Diffusion of Carbon Dioxide through the Placental Membrane
The carbon dioxide in the baby is greater than that in the mother
that is why the diffusion is going towards the mother.
Diffusion of Foodstuffs through the Placental Membrane
It is mainly glucose that the mother is giving the baby. This process
is achieved through facilitated diffusion. This is also true for the other
following nutrients: fatty acids, ketone bodies, potassium, sodium and
chloride.
Excretion of Waste Products through the Placental Membrane
The waste products of metabolism from the baby are brought to
the placenta for the mother to excrete. E.g.: uric acid, urea, creatinine.
Hormonal Factors involved in Pregnancy
1. Human chorionic gonadotropin
It is secreted by the trophoblast cells of the fertilized
ovum. It can be measured from the maternal blood 8-9 days after
ovulation. But since the exact day of ovulation is not really known
or accurately known, hCG is measured in the urine after the next
missed period. It yields a positive pregnancy test.
The peak level of hCG is around 8-10 weeks after
fertilization. It functions to prevent the normal involution of the
corpus luteum so that it can continually produce progesterone and
estrogen to maintain the normal decidual nature of the
endometrium.
Removal of the corpus luteum: 7 weeks (spontaneous abortion)
Peak of hCG secretion: 8 weeks
Corpus luteum regresses: 13-17 weeks
Q: What is the hormone maintaining pregnancy?
A: Progesterone. It is not hCH. The sole purpose of hCG is just to rescue the
corpus luteum. It is the progesterone from the corpus luteum that will
maintain pregnancy.
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Female Physiology Part I 2013
2. Estrogen
It is responsible for the mothers enlargement of the
uterus. The uterus cannot be palpated because it is inside the pelvic
cavity. Once pregnant, the fundus of the uterus can be palpated just
below the xiphoid process.
Another function of estrogen is to promote the
enlargement of the mothers breasts ductal structures (stromal &
ductal structures). It promotes the enlargement of the female
external genitalia. If it would now widen, the head of the baby
cannot come out. It is also responsible for the relaxation of the
pelvic joints and ligaments.
3. Progesterone
It causes the decidual cells to develop. It decreases the
contractility of the prefnant uterus. It also nourishes the morula
and blastocysts as it travels through the fallopian tube for around
3-4 days. And it helps the estrogen prepare the mothers breasts for
lactation.
4. Human Chorionic Somatomammotropin (hCS)
It is secreted by the placenta. It is an anti-insulin or
diabetogenic hormone. It increases the level of maternal glucose
that can be transferred to the fetus.
However, there are mothers that cannot compensate
with the effect of hCS, they become diabetic.
T A K E N O T E
Pregnancy is diabetogenic because the hormones released in
the placenta are anti-insulin.
Other Hormonal Factors in Pregnancy
1. Corticosteroids
Increased glucocorticoids increase the mobilization of
amino acids that will be brought to the baby for fetal growth.
Increased aldosterone increases the retention of water and
sodium that is why mothers become edematous during
pregnancy.
2. Thyroid Gland
It is increased in size because of the increase in cellular
and vascularity of the gland. There is also increase production
of thyroxin.
Q: Why is there increase in thyroxin from the mother during pregnancy?
A: To increase thyroid hormone coming from the mother to give to the
baby because it helps in the fetal brain development.
3. Parathyroid Gland
It is also enlarged because during pregnancy. It removes
calcium from the mother, so that the calcium can be transferred to
the baby for the babys bone and teeth development.
T A K E N O T E
One of the supplements to be given a pregnant woman is
calcium to prevent the early onset of osteoporosis; because the mother
is donating her calcium to her baby.
 Female Physiology Part I 2013
Maternal Adaptation to Pregnancy
T A K E N O T E
1. Weight Gain
Progesterone makes the uterus quiet. Estrogen does the
The normal weight gain during pregnancy is around 24 lbs opposite. It makes the uterus contract by increasing the gap junctions.
7: fetus
4: amniotic fluid, placenta, fetal membranes
2: uterus
2: breasts a. Ratio of Estrogen & Progesterone
6: intravascular volume
3: fats ESTROGEN PROGESTERONE
<7 months AoG
2. Metabolism >7 months AoG

The basal metabolic rate is increased in a pregnant In a pregnancy that is less than 7 months, progesterone
woman primarily because of increase in maternal thyroid hormone is greater compared to estrogen but after the 7th month of
production. pregnancy, estrogen becomes greater. This is why mothers usually
complain at about 8 months, tumitigas tigas na ang tyan ko.
3. Nutrition
b. Effects of Oxytocin on the Uterus
Nutrition during pregnancy is not strict. Mothers are
just advised to maintain a balanced diet. However, deficiencies can One hormone secreted by the
occur in vitamins, iron and calcium. posterior pituitary gland is
oxytocin. It is synthesized in the
Iron requirement: 1000 mg hypothalamus and stored in the
300: fetus anterior pituitary gland. Its
200: obligatory loss function is to cause strong uterine
500: increase in the RBC volume contractions.

If the mothers are not supplemented with the proper c. Effects of Fetal Hormones
iron requirements, they become anemic.
Fetal hormones can also assist in the occurrence of
uterine contractions.
T A K E N O T E
Fetal pituitary gland oxytocin
Iron and calcium supplementation
Fetal adrenal gland cortisol
Fetal membranes prostaglandins
4. Cardiac Output
Mechanical Changes
It is also increased primarily because of the increased
blood volume.
These are mechanical factors that increase the contractility of the uterus.
5. Blood Volume
a. Stretch of the uterine musculature
It is increased primarily because of the increase in
The more you stretch the muscle, the more it would
aldosterone and estrogen secretion (causes fluid retention).
recoil. When the uterus is fully termed, it is much stretched, it is
eager to contract.
6. Respiration
b. Stretch or irritation of the cervix
It is increased primarily the tidal volume (because of
progesterone) and the minute ventilation rate.
When we stretch or irritate the cervix during internal
examination, by touching the cervix, there will be a release of
7. Renal
prostaglandins and that makes the uterus contract.
The glomerular filtration rate is increased primarily due
to the increased blood volume.
Sometimes, when the mother is fully termed, she is
already post-dated, obstetricians usually advice the mother to have
Parturition sexual activity with the husband because of 2 reasons:

Mainly defined as the process by which the baby is born. There are 2 1. The sperm contains prostaglandins
causes: 2. The penis irritates the cervix which causes the
release of prostaglandins
1. Progressive hormonal changes
2. Progressive mechanical changes

Hormonal Changes

a. Ratio of estrogen to progesterone

b. Effects of oxytocin on the uterus
c. Effects of fetal hormones on the uterus

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 Female Physiology Part I 2013
Stages of Labor Pregnant women are also capable of doing natural family planning
because of the following principle:
1st Stage From the onset of regular uterine contractions, until the
cervix is fully dilated (10 cm) Q: Does prolactin have a releasing factor from the hypothalamus?
A: No. But it has an inhibitory hormone, dopamine.
2nd Stage From the full cervical dilatation to the delivery of the
baby Once prolactin is released, dopamine is also released. Nursing mothers
do not ovulate because dopamine is secreted when a mother breastfeeds.
3rd Stage From the delivery of the fetus to the delivery of the When dopamine increases, it inhibits GnRH. When GnRH is inhibited, you cant
placenta secrete FSH and LH. FSH and LH are needed for ovulation to occur.

Once the uterus starts to contract mainly because of oxyctocin, the cervix
begins to dilate up to 10 centimeters (maximum) for the baby to come out.
Once it is fully dilated, the baby can come out. Lastly is the delivery of the
placenta. T A K E N O T E
Nursing mothers cannot ovulate. They can prevent
T A K E N O T E pregnancy for a certain period of time (maximum: 6 months). And they
also do not menstruate.
I always remind my students that there is a third stage of labor.

The usual set up is like this. When you deliver the baby, you can cut the
cord and hand the baby to the pediatrician or place it on top of the mothers
tummy. You cant leave the mother because you still have to deliver the
placenta.
Involution of the Uterus
It occurs about 4-6 weeks after delivery and this time, the uterus
assumes the non-pregnant size.
Q: Why can a nursing mother practice family planning with breastfeeding?
A: It is not because of prolactin. It is because of dopamine inhibiting the
GnRH.
Oxytocin is also produced from the posterior pituitary gland when the
baby suckles on the nipple. When the nipple is stimulated, sensory impulses
are sent to the hypothalamus resulting to the release of oxytocin and this is
responsible for the contraction of the myopithelial cells of the alveoli of the
breast resulting to the expression of milk from the alveoli to the ducts.

Lactation Q: What hormone promotes milk production?

A: Prolactin
Development of the Breast Q: What ejects the milk from the mothers breast?
A: Oxytocin
The breast begins to develop at puberty (1st sign) mainly because of
estrogen which causes the stromal and ductal growth of the breast.
Progesterone is only involved in the lobuloalveolar growth which is only
necessary in breast feeding.

Prolactin is secreted from the anterior pituitary gland. Its main function
is to promote milk production. The secretion of prolactin begins during the 5th
week of pregnancy until the baby is delivered. Estrogen stimulates the release
of prolactin.

Q: Have you seen a pregnant woman lactating?

A: No. It is not possible.

Even if it is stimulated by estrogen to be released from the anterior

pituitary gland, both estrogen (mainly) and progesterone inhibit its effect on
the breast.
The mechanism by which the pituitary gland releases oxcytocin by just
stimulating the nipple is also done in the delivery room. When the contraction
After the delivery of the placenta, the secretion of estrogen and
of the uterus is not adequate to expel the baby from the uterus, the mothers
progesterone will be decreased leading to the loss of suppressive effect on
are advised by the obstetricians to stimulate their nipples.
prolactin on the breast. After several days, lactation begins.
Summary
Once you the deliver the placenta, the stimulus which is estrogen is lost
so prolactin goes back to its non-pregnant level but with the stimulation of the
Estrogen is responsible for the stromal and ductal growth of the breast
nipples she will continuously or intermittently produce prolactin and this
while progestin is for the alveolar growth. Prolactin promotes milk production
leads to continuous lactation.
while oxytocin promotes milk letdown.
Q: How does breastfeeding promote prolactin release?
A: Nipple stimulation causes the release of 2 hormones

T A K E N O T E
One is prolactin and the other is oxytocin.

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