Foundations

Before we can discuss possible causes of infertility and the treatment options, it is important to have an understanding of what your reproductive system does and what it encompasses.

The female reproductive system can be split into internal structures and external structures. In Women,

The internal structures are

  • Uterus
  • Fallopian Tubes
  • Ovaries
  • Vagina

And the external structures are

  • Labia Majora
  • Labia Minora
  • Clitoris
  • Urethral Opening
  • Vaginal Opening

Each of these structures play an important role in reproduction, the most important being the Internal Structures.

Ovary

The ovary is what hosts your eggs. Women are born with a fixed number of immature eggs or follicles for their life time. Each month, few follicles grow but only one matures enough to rupture. From the follicle the egg or ovum is released, and the remaining wrapper like structure that doctors call Corpus Luteum remains in the ovary. Now, the first part when the follicle develops, lasts for 14 days and is called the Follicular Phase. On the 14th day when the egg is released, its called Ovulation. The remaining days of the cycle which houses the Corpus Luteum is known as the Luteal Phase.

Fallopian tubes

The fallopian tubes are basically a path for the egg to travel from the ovary to the uterus. The tubes have tiny hair-like projections that help move the egg forward. Fallopian Tubes are the place where fertilization occurs – that is the fusion of the egg and the spermatozoa.

DID YOU KNOW?

MEDICAL to ENGLISH TRANSLATOR

ENGLISHMEDICAL TERMINOLOGY
OvaryAnything that begins with oo- suggests ovary. oocyte -> cell in the ovary that can become an egg -oophorectomy = removal of ovary -oocyst = cyst in ovary
Fallopian TubeAnything that begins with Salping- suggests fallopian tubes
Salphingitis = inflammation of the fallopian tube
Salpingectomy = removal of fallopian tube
Salpingocyesis= pregnancy in fallopian tube, a type of ectopic pregnancy
UterusIs made of 3 layers
Endometrium – inner cushion (that sheds off during periods)
Myometrium – Muscle layer
Perimetrium – outer layer

Uterus

Your uterus or womb has the intimidating responsibility of housing, nurturing, and growing a baby. During this process, the baby needs nice cushion, lots of food delivered through blood, and the correct set of hormones. Your uterus anticipates a baby every month, and creates this beautiful cushiony home for it. When there is no baby for it to nurture, the uterus discards the extra cushion it created and THAT is what is known as menstruation.

The bloody tears of the disappointed uterus – Menstruation

The male reproductive system

The male reproductive system is far less complicated although it involves a lot of pipes and tubes.

In Men, the main reproductive structures are

Penis
Scrotum
Testes

Men have many supporting structures that aid the production, storage and passage of sperm from the testes to the penis. These supporting structures are:

Epididymis
Spermatic Cords, Vas Deferens (or Ductus Deferens)
Seminal Vesicles
Ejaculatory Duct and Urethra
Prostate

The most important organs of the male reproductive system are the testes. The testes or testicles are responsible for producing sperm and testosterone. Because sperm requires a cooler temperature than the human body in order to be healthy, the testicles are kept away from the body in a sac-like organ called the scrotum. The scrotum adjusts the distance of the testes from the body to ensure the perfect temperature to produce sperm.

Once the sperm is manufactured in the testes, they are stored in a long coiled pipe called the epididymis which is located within the scrotum right next to the testes. The length of the epididymis is useful to allow the sperm to mature before they are passed on to the other parts of the male reproductive organs.

The epididymis is connected to a tube called the Vas deferens or Ductus Deferens. This tube moves sperm from the scrotal area, to the penis for ejaculation. The walls of the tube are made of smooth muscles that help move the sperm along the path. You may have heard of the birth control method called Vasectomy. Doctors clamp down and cut this tube, the Vas Deferens, to prevent the passage of sperm from the testes to the penis.

Now the vas deferens loops behind the urinary bladder and in front of the rectum. In this area there is a gland called the Seminal Vesicle that produces some of the fluid found in semen. This fluid is important to keep sperm alive. It is made of proteins and mucus that create a basic environment so that the sperm can survive the acidic environment of the vagina. The fluid also contains fructose that feeds the sperm so that they have enough energy to fertilize a female egg.

The seminal vesicle connects into the ejaculatory duct which is basically a tube that connects into the urethra. This ejaculatory duct passes through the Prostate that contributes a large amount of fluid in semen. This fluid contains enzymes, chemicals, and proteins that help nurture the sperm and is milky white in color.

After this, the sperm passes into the urethra which is a tube in the penis that passes urine and semen out of the body. Since urine is acidic and semen is basic, there are other glands located near the prostate that release mucus that helps neutralize the path for sperm to pass before ejaculation.

MEDICAL to ENGLISH TRANSLATOR

ENGLISHMEDICAL TERMINOLOGY
Testes / testiclesAnything that begins with Orch- orchid- or test- suggests testes
orchitis = inflammation of the testes
orchiectomy = removal of testes
orchioplasty = surgical reconstruction of the testes
PenisAnything that begins with Balan- suggests the tip of the penis
Balanitis = inflammation of the penis
Balanorrhea = discharge from the penis
balanoplasty= surgical reconstruction of the tip of the penis

HORMONES OF THE FEMALE REPRODUCTIVE SYSTEM

The Female Menstrual cycle is a part of the Endocrine System because it is controlled by the same Hypothalamus and Pituitary. Let’s dive into an endocrine analogy.

The endocrine system is like a factory that is owned by the Hypothalamus, and Pituitary. The factory produces a variety of hormones, and hence it has multiple assembly lines with different skilled workers. In this analogy the “corporate office” so to speak, where the CEO and Vice President sit, is in the brain which is quite far away from the workers in the reproductive system. Because of this distance, extra communication must take place to ensure that all employees are in sync. The communication and commands happen through hormones via roads or blood vessels that connect the organs.

The assembly line begins with the CEO giving the command to the Vice President saying “whatever hormone that should be made for this gender should be released”. This command is called “Gonado –trophin (gender specific hormone) Releasing Hormone” or “GnRH”. The Vice President, Ms. Pituitary, takes the command from the Madame Hypothalamus and has choice between two commands to send to the Reproductive System. Her choices are Follicle Stimulating Hormone and Luteinizing hormone. Since we are starting our story with day one, and we mentioned earlier that the first phase in the ovary is the maturation of the follicle, we obviously know that the Ms. Pituitary has to pick the FSH command! But how does she know which phase the ovary is in unless the ovary tells her?

In the Ovary, when the follicles just begin maturing, they produce a little bit of estrogen. As they grow and grow, the follicle produces more and more estrogen. The vice president uses the amount of estrogen that’s there to figure out what stage of follicle growth the ovary is in. If there is low estrogen, then Ms. Pituitary knows that she needs to send more FSH to stimulate more follicle growth. If there is a lot of estrogen then she knows that its now time to stop stimulating the follicle, and that she should give the command for Ovulation. This is when she switches her command to LH or Lutenizing hormone! This command tells the ovary to pick the most mature follicle, and let it “ovulate” or release its egg.

Let’s recall that earlier we said that the wrapper that remains is called the Corpus Luteum. Although its pretty much a dead follicle, it serves a very important function of producing hormones. These hormones are Estrogen, Inhibin, and lots of Progesterone. As we know, hormones are the language of your body, so let’s try to understand what the corpus luteum is saying. Lets start with the hormone that sounds the least intimidating… Estrogen. As most people know this is a very important hormone that makes a woman, womanly so to speak. Having many effects all over the body, estrogen contributes to the growth of the cushion known as the endometrium of the uterus, it maintains the female gender specific characteristics, and has other functions like supporting muscle and bone growth. Now moving on to Inhibin. Sounds like the word inhibit right? Believe it or not, it does exactly that. Inhibin tells Ms. Pituitary to stop or inhibit the release of the FSH command. Mainly because there is no need to stimulate any more follicles as an egg has already been released. Progesterone is the most important hormone that is produced by the Corpus Luteum and it serves many functions. To understand what this hormone is trying to say let’s break down the word. Gestation means pregnancy development. Pro-gestation hormone or progesterone, promotes the pregnancy by creating the cushion for the baby in your uterus. It also tells your CEO to “Stop giving any commands to the pituitary. There is a chance that we can have a baby this month, so don’t stimulate any other follicles unless its necessary!”

So we end up with the CEO giving no GnRH commands, which results in the VP not giving any FSH or LH commands. All the hormones needed right now are released by the corpus luteum, and the body is geared up to having a baby this month. Let us assume that no fertilization occurs, and that this is a normal menstrual cycle. The corpus luteum degenerates, and the hormones it produces disappear along with it. This removes the inhibition command from the CEO, who then gives the GnRH command to the VP, who can immediately restart the follicle growth phase and a New Cycle will begin. In addition, the decrease in hormones needed for the baby’s cushion in the uterus will result in the inability to maintain it. Hence the cushion sheds off, and women have their period!