Prof. dr. Djaswadi Dasuki, MPH, Ph.D Menarche and spermache MENARCHE AND SPERMACHE Block 7, August 30, 2005 Week 5 International Programme

Objective GOI : To understand physiology of menarche and spermache SOI : To understand micro environment of menarche and spermache To understand macro environment of menarche and spermache To understand inhibiting factor related to menarche and spermache To understand the relationship of menarche and live cycle health problem

Prof. dr. Djaswadi Dasuki, MPH, Ph.D Menarche and spermache Ovarian Physiology Oocyte Maturation Follicle Development The Effect of LH on Theca Cells The Effect of FSH on Granulosa Cells Follicular Microenvironment Inhibin Follicle-Regulatory Protein Prostaglandins Melatonin Steroids, Gonadotropins, and Prolactin Block 7, August 30, 2005 Week 5 International Programme

Definition Menarche : mēn/month + archē/beginning; the establishment or beginning of the menstrual function. Menses : Mensis/month; the monthly flow of blood from the genital tract of women

Spermache. :. Sperma/seed ‘testicular secretion’. arche/beginning Spermache : Sperma/seed ‘testicular secretion’ arche/beginning. The establishment or beginning of the testicular secretion/ejaculate. Ejaculate : to expel suddenly, especially semen. Ejaculation : ejaculation a sudden act of expulsion, as of the semen.

Sperm : Sperma/seed; the semen or testicular secretion. Semen : The thick, whitish secretion of the reproductive organs in the male; spermatozoa in their nutriant plasma, secrections from the prostate, seminal vesicles, and various other glands, epithelial cells and minor constituents.

Menstruation. :. The cyclic physiologic uterine Menstruation : The cyclic physiologic uterine bleeding which normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period of the female of the human and a few other species of primates.

The menstrual cycle has an average duration of 28 days with a range of 21-35 days. It consists of proliferative and secretory phases that correspond with the follicular and luteal phases of the ovarian cycle.

Delayed menarche If menstruation has not started by 16 years of age in the presence of otherwise normal sexual development it is considered delayed and required investigation.

Causes of delayed menarche Vaginal atresia Defective cycle initiation Androgen insensitivity syndrome

Table Types of amenorrhea Description Primary No spontaneous menses by age 16 yrs Secondary Cessation of spontaneous menses for  4 mo Central Low basal gonadotropin levels, low blood estradiol concentrations (<50 pg/ml) Peripheral High basal gonadotropin levels, low estradiol levels (<25 pg/ml)

Prof. dr. Djaswadi Dasuki, MPH, Ph.D Menarche and spermache EVALUATION OF AMENORRHEA Amenorrhea Prior menstrual history Wight change Cyclical pain Autoimmune disorders Stress Excessive exercise Eating disorders Physical examination Rule out pregnancy Prolactin level Exclude Normal Asthenic habitus Genetic syndrome, Genital anomaly, Outflow obstruction galactorrhea Elevated Administer progesterone Evaluate for pituitary adenoma and hypothyroidism Withdrawal bleeding Anovulation LH, FSH Primary amenorrhea Measure TSH Secondary Chromosome karyotype Eclude Kalmann’s Normal or low Menopause Hypothalamic Block 7, August 30, 2005 Week 5 International Programme

Puberty is a time of profound physical and psychological development linking childhood to adulthood. The most obvious change is the appearance of the secondary sex characteristics. These begin to appear at a mean age of 10.5 years, but there is great individual variation.

The adult ovary is organized on a pattern comparable to the testis with stromal tissue containing the primordial follicles (homologous to tubules) and also glandular tissue, the so-called interstitial glands (homologous to the Leydig cells).

The stages of puberty Five morphological changes are seen; Breast growth Pubic hair growth Axillary hair growth Growth spurt menstruation

Delayed puberty This mean failure of the development of secondary sex characteristics by 14 years of age.

Abnormalities of puberty The onset of puberty varies within a wide age range, and is dependent on the integrity of the HPO axis. Abnormalities of puberty include: Delayed puberty Delayed menarche Precocious puberty Pseudo-precocious puberty

Reproductive Physiology of the Male Pituitary-Testicular axis of Spermatogenic Regulation Structure and Function of Leydig Cells Androgen Biosynthesis Testosterone Transport and Metabolism Pituitary-Leydig Cell Axis: Hormonal Control Pituitary-Seminiferous Tubule Axis Sertoli Cells and FSH Inhibin Paracrine Regulation of Spermatogenesis Histology of Spermatogenesis Spermatocytogenesis Meiosis Spermiogenesis Sperm Maturation in the Epididymis Sperm Capacitation and Acrosome Reaction Normal Semen Analysis

The testis has two major products: the spermatozoa that transmit the male’s genes to the embryo; and the androgens required for completion of masculinization. The synthesis of androgens and spermatozoa occurs in two separate compartments within the testis. Spermatozoa develop within the tubules while androgens are synthesized between the tubules.

Table Disorders that produce primary testicular failure Congenital Acquired Kinefleter’s syndrome (47.XXY and variants) Orchitis (mumps, pyogenic, traumatic) Cryptorchidism Malignancy (germ cell leukemia, lymphoma) Congenital anorchia (vanishing testis syndrome) Torsion Varicocele Noonan’s syndrome Spinal cord injury Myston’s muscular dystrophy Systemic illness (liver disease, renal failure) Sickle cell disease Drugs X-irradiation Aging

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