REPRODUCTIVE AND SEXUAL HEALTH
GONAD
Þ body organ that produces the cells necessary for
reproduction; produces gametes (testes and
ovaries)
INTRAUTERINE DEVELOPMENT
WEEK 5 OF INTRAUTERINE LIFE
• Mesonephric (wolfian) and paramesonephric
(mullerian) ducts, the tissue that will become
ovaries and testes, have already formed.
WEEK 7 OR 8 OF INTRAUTERINE LIFE
• In chromosomal males, this early gonadal tissue
begins formation of testosterone.
• Under the influence of testosterone, the
mesonephric duct regresses.
• If testosterone is not present by week 10, the
paramesonephric duct becomes dominant and
develops into female reproductive organs.
• When ovaries form, all of the OOCYTES are
already present.
WEEK 12 OF INTRAUTERINE LIFE
• The external genitals begin to develop.
• In males , penile tissue elongates and the ventral
surface of the penis closes to form a urethra.
• In females, with no testosterone present, the
uterus, labia minora, and labia majora form.
• Ambigous Genitalia - testosterone secretion is
halted in utero, a chromosomal male could be
born with female-appearing genitalia
• If a pregnant woman should be prescribed a form
of testosterone or, because of a metabolic
abnormality, she produce a high level of
testosterone, a chromosomal female could be
born with male-appearing genitalia.
PUBERTAL DEVELOPMENT
PUBERTY
Þ The stage of life at which secondary sex changes
begin.
Þ FSH & LH are termed gonadotrophin (gonad =
“OVARY”; trophin = growth) hormones not only
because they begin the production of androgen
and estrogen, which in turn initiate secondary sex
characteristics, but also because they continue to
cause the production of eggs and influence
menstrual cycles throughout women’s lives
THE ROLE OF ANDROGEN
ANDROGENIC HORMONE
Þ Hormones responsible for muscular development,
physical growth, and the increase in sebaceous
gland secretions that cause typical acne in both
boys and girls during adolescence.
• In males, androgenic hormones are produced by
the adrenal cortex and the testes
• In females, by the adrenal cortex and the
ovaries
• Adrenarche - the level of the primary androgenic
hormone, testosterone, is low in males until
puberty (between 12 & 14 years) when it rises to
influence pubertal changes in the testes, scrotum,
penis, prostate, and seminal vesicles; the
appearance of male pubic, axillary, and facial hair;
laryngeal enlargement with its accompanying
voice change; maturation of spermatozoa; and
closure of growth plates in long bones
• In girls, testosterone influences enlargement of
the labia majora and clitoris and formation of axilla
and pubic hair
 THE ROLE OF ESTROGEN ANATOMY & PHYSIOLOGY OF THE
— primary female sex hormone. REPRODUCTIVE SYSTEM
— responsible for the development and regulation of
the female reproductive system MALE EXTERNAL STRUCTURES
and secondary sex characteristics.
— Development of uterus, fallopian tubes, and SCROTUM
vagina — Is a rugated, skin covered, muscular pouch
— Typical female fat distribution suspended from the perineum
— Hair patterns — Its functions are to support the testes and help
— Breast development regulate the temperature of sperm
— Closes the epiphyses of long bones in girls the TESTES
same way testosterone closes the growth plate in — Two ovoid glands, 2 to 3 cm wide, that rest in
boys the scrotum.
— Thelarche – beginning of breast development — Encased by a protective white fibrous capsule
starts 1 to 2 years before menstruation and is composed of a number of lobules.
PENIS
SECONDARY SEX CHARACTERISTICS — Composed of three cylindrical masses of
erectile tissue in the penis shaft.
PUBERTAL CHANGES (GIRLS) — The urethra passes through these layers of
— Growth spurt tissue, allowing the penis to serve as both the
— Increase in the transverse diameter of the pelvis outlet for the urinary and reproductive tracts in
— Breast development men
— Growth of pubic hair EPIDYDYMIS
— Onset of menstruation — The seminiferous tubule of each testis leads
— Growth of axillary hair to a coiled tube
— Vaginal secretions — Responsible for conducting sperm from the
— Average age at menarche occurs at 12 years of tubule to the vas deferens, the next step in the
age passage to the outside
— May occur as early as age 9 years or as late as — 20 ft long
age 17 years VAS DEFERENS (DUCTUS DEFERENS)
— Additional hollow tube surrounded by arteries
BOYS and veins and protected by a thick fibrous
— Increase in weight coating, which altogether, are referred to as
— Growth of testes spermatic cord.
— Growth of face, axillary, and pubic hair — Carries sperm from the epididymis through the
— Voice changes inguinal canal into the abdominal cavity where
— Penile growth it ends at the seminal vesicles and the
— Increase in height ejaculatory ducts below the bladder.
— Spermatogenesis
SEMINAL VESICLES
— Two convoluted pouches that lie along the
lower portion of the bladder and empty into
the urethra by ejaculatory ducts.
PROSTATE GLAND
— Chestnut-sized gland that lies just below the
bladder and allows the urethra to pass
through the center of it, like the hole in a
dougnut.
BULBOURETHRAL GLANDS/COWPER’S GLANDS
— Lie beside the prostate gland and empty by
short ducts into the urethra.
URETHRA
— Hollow tube leading from the base of the
bladder, which, after passing through the
prostate gland, continues to the outside
through the shaft and glans of the penis.
— 8 in. (18 to 20 cm) long
THE FEMALE REPRODUCTIVE SYSTEM
VULVA
— The structures that form the female external
genitalia
MONS VENERIS
— Pad of adipose tissue located over the
symphysis pubis, the pubic bone joint.
— Covered by a triangle coarse, curly hairs
— an important obstetrical landmark
— To protect the junction of the pubic bone from
trauma
LABIA MINORA
— Posterior to the mons veneris
— Two hairless folds of connective tissue
— It is moist highly vascular, sensitive and richly
supplied with sebaceous glands
LABIA MAJORA
— Two folds of tissue, fused anteriorly but
separated posteriorly positioned lateral to the
labia minora
— Composed of loose connective tissue covered
by epithelium and pubic hair
— Its functions is to provide covering and
protection to the external organs located
under it
VESTIBULE
— Flattened, smooth surface inside the labia
— Openings to the bladder (urethra) and the
uterus (vagina)
CLITORIS
— Small (approx 1-2 cm), rounded organ of
erectile tissue at the forward junction of the
labia minora.
— Sensitive to touch and temperature
— Center of sexual arousal and orgasm in a
woman
TWO SKENE GLANDS
1. PARAURETHRAL GLANDS
— Located on each side of the urinary meatus;
their ducts open into the urethra
2. BARTHOLIN GLANDS (vulvovaginal glands)
— located on each side of the vaginal opening
with ducts that open into the proximal vagina
near near the labia minora and hymen
FOURCHETTE
— Ridge tissue formed by the posterior joining of
the labia minora and labia majora
— This is the structure that sometimes tears
(laceration) or is cut (episiotomy) during
childbirth to enlarge the vaginal opening
HYMEN
— Tough but elastic semicircle of tissue that
covers the opening to the vagina during
childhood.
— It is often torn during the time of first sexual
intercourse
VULVAR BLOOD SUPPLY
— Mainly from PUDENDAL ARTERY and a
portion is from the INFERIOR RECTUS
ARTERY.
— Venous return is through the pudendal vein.
VULVAR NERVE SUPPLY
— The anterior portion of the vulva derives its
nerve supply from the ILIOINGUINAL &
GENITOFEMORAL NERVES (L1 level)
— The posterior portions of the vulva and vagina
are supplied by the PUDENDAL NERVE (S3
level)
FEMALE INTERNAL STRUCTURES
OVARIES
— Approx 3 cm long by 2 cm in diameter and 1.5
cm thick or the size and shape of almonds.
— Grayish white and appear pitted, with minute
indentations on the surface.
— Located close to and on both sides of the
uterus in the lower abdomen
— Function of the two ovaries is to produce,
mature, and discharge ova (the egg cells)
— In the process of producing ova, the ovaries
also produce estrogen and progesterone and
initiate and regulate menstrual cycles
FALLOPIAN TUBES
— Arise from each upper corner of the uterine
body and extend outward and backward until
each opens at its distal end, next to an ovary
— Approx 10 cm long in a mature woman
— Function is to convey the ovum from the
ovaries to the uterus and to provide a place
for fertilization of the ovum by sperm
4 PARTS OF FALLOPIAN TUBES
1. INTERSTITIAL PORTION
— The most proximal division
— Lies within the uterine wall
— 1 cm in length; its lumen is only 1 mm in
diameter
2. ISTHMUS
— The distal portion
— 2 cm in length; remains extremely narrow
— The portion of the tube that is cut or sealed in
a tubal ligation, or tubal sterilization procedure
3. AMPULLA
— Third and the longest portion of the tube
— 5 cm in length
— Portion of the tube where fertilization of an
ovum usually occurs
4. INFUNDIBULLAR
— Most distal segment of the tube
— 2 cm long, funnel shaped, and covered by
fimbria (small hairs) that help to guide the
ovum into the fallopian tube
UTERUS
— Hollow, muscular, pear shaped organ located
in the lower pelvis, posterior to the bladder
and anterior rectum
— With maturity, about 5 to 7 cm long, 5 cm
wide, and widest part 2.5 cm deep
— Non pregnant state – weighs approx 60g
— Function is to receive the ovum from the
fallopian tube, provide a place for implantation
and nourishment; furnish protection to a
growing fetus; and at maturity of the fetus,
expel it from a woman’s body.
3 DIVISIONS OF UTERUS
1. BODY/CORPUS
— Uppermost part and forms the bulk of the
organ
2. ISTHMUS
— Short segment between the body and the
cervix (non pregnant state – 1-2 mm in length)
3. CERVIX
— Lowest portion of the uterus
— Represents 1/3 of the total uterine size and
approx 2-5 cm long
UTERINE AND CERVICAL COATS
ENDOMETRIUM
— inner layer of mucous membrane
MYOMETRIUM
— Middle layer of muscle fibers
PERIMETRIUM
— Outer layer of connective tissue
VAGINA
— A hollow, musculomembranous canal located
posterior to the bladder and anterior to the
rectum.
— Extends from the cervix of the uterus to the
external vulva
— Its function is to act as the organ of
intercourse and to convey sperm to the cervix.
— With childbirth, it expands to serve as the birth
canal.
MAMMARY GLANDS/BREASTS
— Form early in intrauterine life
— Remain in a halted stage of development until
a rise in estrogen at puberty causes them to
increase in size.
— Located anterior to the pectoral muscle,
breast tissue extends well into the axilla.
— Nipple composed of smooth muscle capable
of erection on manual or sucking stimulation
— Areola –darkly pigmented skin sorroundings of
the nipple about 4 cm.
— Montgometry tubercles – area of areola
appears rough on the surface
MENSTRUATION
MENSTRUAL CYCLE
• Female reproductive cycle
• Episodic uterine bleeding in response to cyclic
hormonal changes
• Purpose of menstrual cycle is to bring an
ovum to maturity and renew a uterine tissue
bed that will be necessary for the ova’s
growth should it be fertilized
• Average length is 28 days (from the beginning
of one menstrual flow to the beginning of the
next)
• It is not unusual for cycles to be as short as 23
days or as long as 35 days
• The length of the average menstrual flow is 4
to 6 days
CHARACTERISTICS OF NORMAL
MENSTRUAL CYCLES
 THE PHYSIOLOGY OF MENSTRUATION
FOUR BODY STRUCTURES
1. Hypothalamus
2. Pituitary gland
3. Ovaries
4. Uterus
HYPOTHALAMUS
• The release of GnRH from the hypothalamus
initiates the menstrual cycle.
• GnRH then stimulates the pituitary gland to
send gonadotrophic hormone to the ovaries to
produce estrogen.
• When the level of estrogen rises, release of
GnRH is repressed and no further menstrual
cycles will occur (the principle that birth
control pills use to eliminate menstrual flows)
• Excessive levels of pituitary hormones can
also inhibit release.
PITUITARY GLAND
Under the influence of GnRH, the anterior lobe of the
pituitary gland (the adenohypophysis) produces two
hormones:
1. FSH, a hormone active early in the cycle that
is responsible for maturation of the ovum
2. 2. LH, a hormone that becomes most active
at the midpoints of the cycle and is
responsible for ovulation, or release of the
mature egg cell from the ovary. It also
stimulates growth of the uterine lining during
the second half of the menstrual cycle.
OVARIES
• Every month during the fertile period of a
woman’s life (from menarche to menopause),
one of the ovary’s oocytes is activated by FSH
to begin to grow and mature.
• As the oocytes grows, its cells produce a clear
fluid (follicular fluid) that contains a high
degree of estrogen and some progesterone.
• As the follicle surrounding the oocytes grows,
it is propelled toward the surface of the ovary.
• At full maturity, the follicle is visible on the
surface of the ovary as a clear water blister
approximately 0.25 to 0.5 in across.
• At this stage of maturation, the small ovum
visible to naked eye, about the size of a
printed period) with its surrounding follicular
membrane and fluid is termed GRAAFIAN
FOLLICLE.
I. PROLIFERATIVE PHASE (DAY 6 – 13)
FOLLICULAR PHASE
THE FIRST PHASE OF THE MENSTRUAL CYCLE
• Immediately after a menstrual flow (which occurs
during the first 4 to 5 days of a cycle), the
endometrium, or lining of the uterus, is very thin,
approximately one cell layer in depth.
• As the ovary begins to produce estrogen (in the
follicular fluid, under the direction of the pituitary
FSH), the endometrium begins to proliferate so
rapidly the thickness of the endometrium
increases as much as eightfold from day 5 to 14.
• This first half of a menstrual cycle is
intechangeably termed the proliferative,
estrogenic, follicular, or postmenstrual phase.
• Estrogen production increases, leading to
proliferation of endometrium and myometrium in
preparation for possible implantation
• Follicle secretes estradiol
• Fsh stimulates graafian follicle
• Fsh production decreases before ovulation
(around day 14)
II. SECRETORY PHASE (DAY 14 – 25)
THE SECOND PHASE OF THE MENSTRUAL
CYCLE
• After ovulation, the formation of progesterone in
the corpus luteum (under the direction of LH)
causes the glands of the uterine endometrium to
become corkscrew or twisted in appearance and
dilated with quantities of glycogen (an elementary
sugar) and mucin (a protein).
• It takes on the appearance of rich, spongy velvet.
• This second phase of the menstrual cycle is
termed the progestational, luteal, premenstrual, or
secretory phase.
• The corpus luteum forms under the influence of lh
• Estrogen and progesterone production increase
• The endometrium is prepared for implantation of
fertilized ovum
III. ISCHEMIC (DAY 26 – 28)
ISCHEMIC PHASE
THE THIRD PHASE OF THE MENSTRUAL CYCLE
• If fertilization does not occur, so the corpus
luteum in the ovary begins to regress after 8 to 10
days, the production of progesterone decreases.
• With the withdrawal of progesterone, the
endometrium of the uterus begins to degenerate
(at about day 24 or day 25 of the cycle)
• The capillaries rupture, with minute hemorrhages,
and the endometrium sloughs off.
• The corpus luteum degenerates if conception
doesn’t occur
• Estrogen and progesterone levels decline if
conception doesn’t occur
IV. MENSES (DAY 1 – 5)
MENSTRUAL PHASE
THE FOURTH PHASE OF THE MENSTRUAL
CYCLE
• Menses, or a menstrual flow, is composed of a
mixture of blood from the ruptured capillaries;
mucin; fragments of endometrial tissue; and the
microscopic, atrophied, and unfertilized ovum.
• Menses is actually the end of an arbitrarily defined
menstrual cycle. Because it is the only external
marker of the cycle, however, the first day of
menstrual flow is used to mark the beginning day
of a new menstrual cycle.
• estrogen and progesterone levels decrease
• fsh levels rise and steady levels of of lh influnece
the ovary to secrete estrogen
• mestrual flow begins
• Contrary to common belief, a menstrual flow
contains only 30 to 80 ml of blood; if it seems to
be more, it is because of the accompanying
mucus and endometrial shreds.
• The iron loss in a typical menstrual flow is
approximately 11 mg.
• This is enough loss that many women need to
take a daily iron supplement to prevent loss
depletion during their menstruating years
MENSTRUAL DISORDERS
DYSMENORRHEA
• Painful menstruation
MENORRHAGIA
• Abnormally heavy menstrual flows
METRORRHAGIA
• Bleeding between menstrual periods
MENOPAUSE
• Cessation of menstrual cycles
• The age range at which menopause occurs is
wide, between approximately 40 and 55
years, with a mean age of 51 years.
PERIMENOPAUSAL
• Term used to denote the period during which
menopausal changes are occurring.
POSTMENOPAUSAL
• Describes the period following the final
menses.
CLIMACTERIC
• Refers to the total changes that occur at this
life stage
• At the beginning of each cycle, when estrogen
secretion from the ovary is low, cervical
mucus is thick and scant.
• Sperm survival in this type of mucus is poor.
• At the time of ovulation, when the estrogen
level has risen to a high point, cervical mucus
becomes thin, stretchy (spinnbarkeit), and
copious.
• Sperm penetration and survival in this thin
mucus are both excellent.

PHYSICAL CHANGES
• Hot flashes
• Vaginal dryness
• Osteoporosis (loss of bone mineral density)
SEXUALITY
• Urinary incontinence from lack of bladder
support
• Multidimensional phenomenon that includes
feelings, attitudes, and actions.
TEACHING ABOUT MENSTRUAL HEALTH
• It has both biologic and cultural diversity
components.

Biologic Gender
• The term used to denote a person’s
chromosomal sex:
MALE (XY)
FEMALE (XX)
Gender identity or sexual identity is the inner sense a
person has of being male or female, which maybe the
same as or different from biologic gender.
CERVICAL CHANGES
• The mucus of the uterine cervix also changes
in structure and consistency each month
during a menstrual cycle.
 THE HUMAN SEXUAL RESPONSE
THE SEXUAL RESPONSE CYCLE
EXCITEMENT
• Occurs with physical and psychological
stimulation (sight, sound, emotion, or thought)
that causes parasympathetic nerve stimulation
• This lead to arterial dilation and venous
constriction in the genital area.
• The resulting increased blood supply leads to
vasocongestion and increasing muscular
tension.
PLATEAU
• The plateau stage reached just before
orgasm.
• In the woman, the clitoris is drawn forward
and retracts under the clitoral prepuce; the
lower part of the vagina becomes extremely
congested (formation of orgasmic platform),
and there is increased breast nipple elevation
• In men, vasocongestion leads to distention of
the penis.
• Heart rate increases to 100 to 175 beats per
minute and rspiratory rate to about 40
breaths/min
ORGASM
• Orgasm occurs when stimulation proceeds
through the plateau stage to a point at which a
vigorous contraction of muscles in the pelvic
area expels or dissipates blood and fluid from
the area of congestion.
• The average number of contractions for the
woman is 8 to 15 contractions at intervals of 1
every 0.8 seconds.
• In men, muscle contractions surrounding the
seminal vessels and prostate project semen
into the proximal urethra .
• These contractions are followed immediately
by three to seven propulsive ejaculatory
contractions, occurring at the same time
interval as in the woman, which force semen
from the penis.
RESOLUTION
• The resolution is a 30-munite period during
which the external and internal genital organs
return to an unaroused state.
• For the male, a refractory period occurs during
which further orgasm is impossible.
• Women do not go through this refractory
period, so it is possible for women who are
interested and properly stimulated to have
additional orgasms immediately after the first.
TYPES OF SEXUAL ORIENTATION
HETEROSEXUALITY
• A person who finds sexual fulfillment with a
member of the opposite gender.
HOMOSEXUALITY
• A person who finds sexual fulfillment with a
member of his or her own sex.
BISEXUALITY
• People are bisexual if they achieve
satisfaction from both homosexual and
heterosexual relationships.
TRANSEXUALITY
• A transexual or transgender person is an
individual who although of one biologic
gender, feels as if he or she is of the opposite
gender.
• People who have this feeling may have
gender affirmation surgery (previously termed
sex change operations) so they appear
cosmetically as the sex they feel they really
are.
TYPES OF SEXUAL EXPRESSION
MASTURBATION
• Self stimulation for erotic pleasure; it can also
be a mutually enjoyable activity for sexual
partners.
EROTIC STIMULATION
• The use of visual materials such as
magazines or photographs for sexual arousal
FETISHISM
• Paraphilia is a sexual arousal to objects,
situations, or individuals. The most common
form of this is fetishism, the sexual arousal
from the use of certain objects perceived to
have erotic qualities such as leather, rubber,
shoes or feet
SADOMASOCHISM
• Involves inflicting pain (sadism) or receiving
pain (masochism) to achieve sexual
satisfaction
TRANSVESTISM
• A transvestite is a form of fetishism in which
an individual dresses in the clothes of the
opposite sex.
• Transvestites can be heterosexual,
homosexual, or bisexual.
• Many are married
VOYEURISM
• Is obtaining sexual arousal by looking at
another person’s body.
Additional Types of Sexual Expression
Exhibitionism
• Revealing one’s genitals in public
Bestiality
• Sexual relations with animals
Pedophiles
• Individuals who are interested in sexual
encounters with children
Obscene phone calling
DISORDERS OF SEXUAL FUNCTIONING
1. FAILURE TO ACHIEVE ORGASM
• Can be a result of poor sexual technique,
concentrating too hard on achievement, or
negative attitudes toward sexual relationships
2. ERECTILE DYSFUNCTION (ED)
• Formerly referred to as impotence, is the
inability of a man to produce or maintain an
erection long enough for penetration or
partner satisfaction
3. PREMATURE EJACULATION
• Ejaculation before the sexual partner’s
satisfaction has been achieved. It applies to
both same sex and opposite sex couples.
Premature ejaculation can be unsatisfactorily
and frustrating for both partners.
4. PERSISTENT SEXUAL AROUSAL
SYNDROME (PSAS)
• Occurs in women and is the excessive and
unrelenting sexual arousal in the absence of
desire. It may be triggered by either
medications or psychological factors and is
associated with restless leg syndrome and
overactive bladder.
 5. PAIN DISORDERS
• Because the reproductive system has a
sensitive nerve supply, when pain occurs in
response to sexual activities, it can be acute
and severe and can impair a person’s ability
to enjoy this aspect of their life.
6. VAGINISMUS
• Involuntary contraction of the muscles at the
outlet of the vagina when coitus us attempted,
which prohibits penile penetration.
7. DYSPAREUNIA
• Is pain during coitus.
• Can occur because of endometriosis
(abnormal placement of endometrial tissue),
vestibulitis (inflammation of the vestibule),
vaginal infection, or hormonal changes such
as those that occur with menopause and
cause vaginal drying.
CONCEPTION
In just 38 weeks, a fertilized egg (ovum) matures from
a single cell to a fully developed fetus ready to be
born.
TERMS USED TO DESCRIBE FETAL GROWTH
FERTILIZATION:
The Beginning of Pregnancy
FERTILIZATION
Þ Also referred to as conception and impregnation
Þ The union of an ovum and a spermatozoa
Þ This usually occurs in the outer third of a
fallopian tube, termed the ampullar portion
Þ Occurs with the fusion of a spermatozoon and
an ovum (oocyte) in the ampulla of the
fallopian
Þ The fertilized egg is called ZYGOTE
HOW FERTILIZATION OCCURS?
Þ Fertilization begins when the spermatozoon is
activated upon contact with the ovum
Þ The spermatozoon has a covering called the
acrosome that develops small perforation
through which it releases enzymes necessary for
the sperm to penetrate the productive layers of
the ovum before fertilization
Þ The spermatozoon then penetrates the zona
pellucida (the inner membrane of the ovum).
Þ This triggers the ovum’s second meiotic division
(following meiosis), making the zona pellucida
impenetrable to other spermatozoa
Þ After the spermatozoon penetrates the ovum, its
nucleus is released into the ovum, its tail
degenerates, and its head enlarges and fuses
with the nucleus of the ovum.
Þ This fusion provides the fertilized ovum, called a
zygote, with 46 chromosomes
Þ After the spermatozoon penetrates the ovum, its
nucleus is released into the ovum, its tail
degenerates, and its head enlarges and fuses
with the nucleus of the ovum.
Þ This fusion provides the fertilized ovum, called a
zygote, with 46 chromosomes
Þ The diploid number of chromosomes (44 placenta formation, or the inners cell mass,
autosomes and 2 sex chromosomes) is a discrete cell cluster enclosed within the
restored when the zygote is formed trophoblast, which will form the embryo (late
• A male zygote is formed if the ovum is blastocyst)
fertilized by a spermatozoon carrying a Y
chromosomes
• A female zygote is formed if the ovum is
fertilized by a spermatozoon carrying an X
chromosomes

Þ Usually, only one of a woman’s ova reaches

maturity each month.
Þ Once the mature ovum is released (i.e.,
ovulation), fertilization must occur fairly quickly
because an ovum is capable of fertilization for
Þ Because the spermatozoon and ovum each
only about 24 hours (48 hours at the most).
carried 23 chromosomes (22 autosomes and 1
Þ After that time, it atrophies and becomes
sex chromosome), the fertilized ovum has 46
nonfunctional
chromosomes.
Þ Because the functional life of spermatozoon is
Þ If an X – carrying spermatozoon entered the
also about 48 hours, possibly as long as 72
ovum, the resulting child will be have two X
hours, the total critical time span during which
chromosomes and will be FEMALE (XX).
sexual relations must occur for fertilization to be
Þ If a Y-carrying spermatozoon fertilized the ovum,
successful is about 72 hours (48 hours before
the resulting child will have an X and a Y
ovulation plus 24 hours afterward)
chromosome and will be MALE (XY)
Þ Normally, an ejaculation of semen averages 2.5
ml of fluid containing 50 to 200 million
Þ Cellular multiplication occurs when the zygote
spermatozoa per milliliter, or an average of
undergoes mitosis, dividing into two cells,
400 million sperm per ejaculation
four cells, and so on
Þ At the time of ovulation, there is a reduction in the
• These cells, called blastomeres, eventually
viscosity (thickness) of the woman’s cervical
form the morula, a solid ball of cells.
mucus, which makes it easy for spermatozoa
• After the morula enters the uterus, a cavity
to penetrate it.
forms within the dividing cells, thus
Þ Sperm transport is so efficient close to ovulation
changing the morula into a blastocyst
that spermatozoa deposited in the vagina
• The blatocyst cells differentiate into one of two
generally reach the cervix within 90 seconds and
forms – trophoblast, which develop into
the outer end of a fallopian tube within 5
fetal membranes and contribute to
minutes after deposition.
Fertilization is never a certain occurrence Þ After implantation, the endometrium is called the
because it depends on at least three separate DECIDUA
factors:
• Equal maturation of both sperm and ovum
• Ability of the sperm to reach the ovum
• Ability of the sperm to penetrate the zona
pellucida and cell membrane and achieve
fertilization

IMPLANTATION
Þ Once fertilization is complete, a zygote migrates
over the next 3 to 4 days toward the body of the
PLACENTATION
uterus, aided by the currents initiated by the
Þ In placentation, the chorionic villi invade the
muscular contractions of the fallopian tubes.
decidua
Þ During this time, mitotic cell division, or cleavage,
Þ This becomes the fetal portion of the future
begins
placenta

STAGES OF FETAL DEVELOPMENT

I. PRE EMBRYONIC PERIOD

• Begins with fertilization and lasts about 3 weeks
• As the zygote passes through the fallopian tube, it
undergoes a series of mitotic divisions, or
cleavage
Þ Occurs when the cellular wall of the blastocyst • Once formed, the zygote develops into the
(the trophoblast) implants itself in the morula and then blastocyst, eventually
endometrium of the anterior or posterior fundal becoming attached to the endometrium
region, 7 to 9 days after fertilization after the zona
pellucida degenerates.
Þ Primary villi will appear within weeks after
implantation
Þ The trophoblast, in contact with the endometrial
lining, proliferates and invades the underlying
endometrium by separating and dissolving
endometrial cells
Þ The invading blastocyst sinks below the surface of
the endometrium
Þ Continuity of the surface is restored as the site of
penetration heals.
EMBRYONIC PERIOD
• Begins with the fourth week of gestation and
ends with the seventh week
• During this period, the zygote begins to take on
a human shape
• The zygote is now called an EMBRYO

EMBRYONIC AND FETAL STRUCTURES

• The placenta and membranes, which will serve as

the fetal lungs, kidneys, and digestive tract in
utero as well as help provide protection for the

• Germ layers develop, giving rise to organ systems fetus, begin growth in early pregnancy in

• The embryo is highly vulnerable to injury from coordination with embryo growth.

maternal drug use, certain maternal infections,

and other factors. A. THE DECIDUA OR UTERINE LINING
Þ The endometrium is now typically termed the
DECIDUA (the latin word for “falling off”),
because it will be discarded after birth of the
child

Þ Refers to the endometrial lining during

FETAL PERIOD
pregnancy
• Begins with the 8th week of gestation and
Þ Provides a nesting place for the developing
continues until birth
ovum
• During this period, the embryo, now called a
Þ Has some endocrine functions
FETUS, matures, enlarges, and grows heavier
Þ Secretes prolactin to promote lactation
q The head of the fetus is
Þ Secretes relaxin, which relaxes the connective
disproportionately larger when
tissue of the symphysis pubis and pelvic
compared to its body
ligaments; also promotes cervical dilation
q The fetus also lacks subcutaneous fat
Þ Secretes prostaglandin, a potent hormone like
fatty acid, important for mediating several
physiologic functions
Þ Is divided into three separate layers
1. DECIDUA BASALIS – lies directly under the
embryo; it’s where the trophoblasts connect
to the maternal blood vessels
2. DECIDUA CAPSULARIS – stretches over or
forms a capsule over the trophoblast ;
enlarges as the embryo grows, eventually
coming into contact and fusing with the
opposite side of the uterine wall
3. DECIDUA VERA – is the remaining area of
the endometrial lining
B. FETAL MEMBRANES
Þ The chorion is the fetal membrane closest to the
uterine wall
• It gives rise to the placenta
• It forms the outer wall of the blastocyst
• Vascular projections, called CHORIONIC
VILLI, arise from its periphery
Þ As the chorionic vesicle enlarges, villi arising from
the superficial portion of the chorion (the chorion
laeve) atrophy, leaving the surface smooth
Þ Villi arising from the deeper part of the chorion
(the chorion fondosum) proliferate, projecting
into the large blood vessels within the decidua
basalis, through which the maternal blood
flows
Þ Blood vessels form within the villi as they grow,
becoming connected with blood vessels
formed in the chorion and in the body of the
embryo
Þ Blood flows through this developing network of
vessels as soon as the embryo’s heart begins
to beat
Þ The amnion is thin, tough inner fetal
membrane that lines the amniotic sac
Key facts about fetal membrane
• Chorion is closest to the uterine wall
• Chorion becomes the placenta and forms the
outer wall of the blastocyst
• Amnion is the inner fetal membrane
• Amnion lines the amniotic sac
EMBRYONIC GERM LAYERS
1. ECTODERM
Þ The outermost layer
Þ Generates the epidermis, nervous system,
pituitary gland, salivary glands, optic lens, lining of
the lower portion of the anal canal, hair, and tooth
enamel
2. ENDODERM
Þ The innermost layer
Þ Generates the epithelial lining of the larynx,
trachea, bladder, urethra, prostate gland, auditory
canal, liver, pancreas, and alimentary canal
3. MESODERM
Þ The middle layer
Þ Generates the connective and sclerous
tissues; blood and the vascular system;
musculature; teeth (except enamel);
mesothelial lining of the pericardial, pleural,
and peritoneal cavities; kidneys and ureters
• Layers developed during the embryonic period
that later become specific organs and tissues
• Ectoderm – outermost layer
• Endoderm – outermost layer
• Mesoderm – middle layer
C. YOLK SAC
Þ Forms next to the endoderm of the germ disk
Þ A portion is incorporated into the
developing embryo and forms the GI tract
Þ Another portion develops into primitive
germ cells, which travel to the developing
gonads and eventually form the oocytes or
spermatocytes after sex has been determined
Þ Also forms blood cells during the early
embryonic period
Þ Eventually undergoes atrophy and
disintegrates
Þ A portion is incorporated into the embryo and
becomes the GI tract
Þ Another part becomes the oocytes or
spermatocytes
Þ It forms blood cells
Þ It eventually atrophies and disintegrates
D. AMNIOTIC SAC
Þ is enclosed within the chorion
Þ Gradually increases in size and surrounds the
embryo
Þ Expands into the chorionic cavity as it
enlarges
Þ Fuses with the chorion by the 8th week of
gestation
Þ Contains fluid, known as AMNIOTIC FLUID
Þ Contains fluid, known as AMNIOTIC FLUID
Þ With the sac, helps provide the fetus with a
buoyant, temperature-controlled
environment
Þ Serve as fluid wedge that helps to open
the cervix during birth
• Early in pregnancy, comes from the three
sources
1. Fluid is filtered into the amniotic sac from the
maternal blood as it passes through the uterus
2. Fluid is filtered into the sac from fetal blood
passing through the placenta
3. Fluid diffuses into the sac from the fetal skin
and respiratory tract
• Later in pregnancy, when the fetal kidneys begin
to function, the fetus urinates into the amniotic
fluid; fetal urine then becomes the major
source of amniotic fluid
• Replaced every three hours
• Production of amniotic fluid from maternal and
fetal sources balances amniotic fluid per day
• This fluid is absorbed into the fetal circulation
from the fetal GI tract
• Some is transferred from the fetal circulation
to the maternal circulation and excreted in
maternal urine
• Contains albumin, lanugo, urea, creatinine,
bilirubin, fat, fructose, protein, enzymes, lecithin,
sphingomyelin, and leukocytes
• Prevents heat loss, preserves constant fetal body
temperature, cushions the fetus, facilitates
symmetrical fetal growth and development,
provides a source of oral fluid, and serves as a
repository for fetal waste
• At term, the uterus contains 800 to 1,200 ml of
amniotic fluid, which is clear and yellowish and
has specific gravity of 1.007 to 1.025 and a pH
of 7.0 to 7.25
FUNCTIONS OF AMNIOTIC FLUID
• Provides buoyancy and temperature control
• Prevents heat loss
• Preserves constant fetal body temperature
• Cushions the fetus
• Facilitates symmetrical fetal growth and
development
• Provides a source of oral fluid
• Provides a repository for fetal waste
• Helps open the cervix during birth
E. UMBILICAL CORD
Þ Serves as the lifeline from the embryo to the
placenta
Þ Measures from 30.5 to 90 cm in length and 2 cm
in diameter at full term
Þ Contains two arteries and one vein
• The umbilical arteries transport blood from the
fetus to the placenta
• The umbilical vein returns blood to the fetus from
the placenta
Þ Contains Wharton’s jelly, a gelatinous
substance that helps prevent kinking of the
cord in utero
Þ Blood flows through the cord at about
400ml/minute
KEY FACTS ABOUT UMBILICAL CORD
• Lifeline for the embryo
• Has two arteries and one vein
• Blood flows at 400 ml/minute
• Wharton’s jelly helps prevent kinking
• The placenta (latin for “pancake,” which is
descriptive of its size and appearance at term)
grows from a few identifiable trophoblast cells
at the beginning of pregnancy to an organ 15 to
20 cm in diameter and 2 to 3 cm in depth,
covering about half the surface of the internal
uterus at term.
F. THE PLACENTA
Þ A flat disk-shaped structure formed from the
chorion, chorionic villi, and adjacent decidua
basalis
Þ Contains 15 to 20 subdivisions called
COTYLEDONS
Þ Weighs 450 to 600 g, measures from 15 to 25.5
cm in diameter, and is 2.5 to 3 cm thick at full
term
Þ Has a rough texture; appears red on the
maternal surface and shiny and gray on the
fetal surface
Þ Functions as a transport mechanism between
the mother and the fetus, from the 3rd month of
pregnancy until birth
• The placental’s life span and function depend
on oxygen consumption and maternal
 circulation; circulation to the fetus and
placenta improves when the mother lies on
her left side
Þ the placenta receives maternal oxygen via
diffusion
Þ It produces hormones, including human chorionic
gonadotrophin, human placental lactogen,
gonadotrophin-releasing hormone,thyrotrophin-
releasing factor, corticotropin, estrogen, and
progesterone
Þ It supplies the fetus with carbohydrates, water,
fats, protein, minerals, and inorganic salts
Þ It carries end products of fetal metabolism to the
maternal circulation for excretion
Þ It transfers passive immunity via maternal
antibodies
Þ Receives maternal oxygen via diffusion
Þ Produces hormones
Þ Supplies the fetus with carbohydrates, water, fats,
protein, minerals, and inorganic salts
Þ Carries end products of fetal metabolism to
maternal circulation for excretion
HORMONES PRODUCED IN THE PLACENTA
• Human chorionic gonadotrophin
• Human placental lactogen
• Gonadotrophin-releasing hormone
• Thyrotropin-releasing factor
• Corticotropin
• Estrogen
• Progesterone
HCG
Þ Hormone produced by the placenta after
implantation. The presence of hcg is detected in
some pregnancy tests
HUMAN PLACENTAL LACTOGEN
Þ Also called as human chorionic
somatomammotropin (hcs) – a polypeptide
placental hormone, the human form of placental
lactogen . It modifies the metabolic state of
mother during pregnancy to facilitate the energy
supply of the fetus
GONADOTROPHIN RELEASING HORMONE
Þ Releasing hormone responsible for the release of
follicle stimulating hormone and luteinizing
hormone from the anterior pituitary
THYROTROPIN-RELEASING FACTOR – OR
THYROLIBERIN
Þ Is a releasing hormone, produced by the
hypothalamus, that stimulates the release of
thyrotropin and prolactin from the anterior
pituitary
CORTICOTROPIN RELEASING HORMONE (CRH)
Þ also known as corticotropin releasing factor or
crf corticoliberin is a peptide hormone involved
in the stress response
ESTROGEN
Þ primary female sex hormone . It is responsible for
the development and regulation of the female
reproductive system and secondary sex
characteristics.
PROGESTERONE
Þ is an endogenous steroid and progesterone sex
hormone involved in the menstrual cycle,
pregnancy and embryogenesis of humans
 PLACENTAL CIRCULATION
FETAL CIRCULATION STRUCTURES
Þ Umbilical vein carries oxygenated blood to the
fetus from the placenta
Þ Umbilical arteries carry deoxygenated blood
from the fetus to the placenta
Þ Foramen ovale serves as the septal opening
between the atria of the heart
Þ Ductus arteriosus connects the pulmonary
artery to the aorta, allowing blood to shunt
around the fetal lungs
Þ Ductus venosus carries oxygenated blood from
the umbilical vein to the inferior vena cava,
bypassing the liver
Þ Blood from the placenta is carried to the fetus by
the umbilical vein. In humans, less than a third of
this enters the fetal ductus venosus and is
carried to the inferior vena cava, while the rest
enters the liver proper from the inferior border of
the liver.
Þ The branch of the umbilical vein that supplies the
right lobe of the liver first joins with the portal vein.
Þ The blood then moves to the right atrium of
the heart
Þ In the fetus, there is an opening between
the right and left atrium (the foramen ovale), and
most of the blood flows through this hole directly
into the left atrium from the right atrium, thus
bypassing pulmonary circulation.
Þ The continuation of this blood flow is into the left
ventricle, and from there it is pumped through
the aorta into the body.
Þ Some of the blood moves from the aorta through
the internal iliac arteries to the umbilical
arteries, and re-enters the placenta,
where carbon dioxide and other waste products
from the fetus are taken up and enter the
maternal circulation
Þ Some of the blood entering the right atrium does
not pass directly to the left atrium through
the foramen ovale but enters the right
ventricle and is pumped into the pulmonary artery.
Þ In the fetus, there is a special connection between
the pulmonary artery and the aorta, called
the ductus arteriosus, which directs most of this
blood away from the lungs (which are not being
used for respiration at this point as the fetus is
suspended in amniotic fluid)
GRAAFIAN FOLLICLE
Þ a fluid-filled structure in the mammalian ovary
within which an ovum develops before ovulation.

CORPUS LUTEUM
Þ a hormone-secreting structure that develops in an
ovary after an ovum has been discharged but
degenerates after a few days unless pregnancy
has begun.