EMBRYOLOGICAL

DEVELOPMENT OF CERVIX AND

OVARY

ASHMA SHAHI
1ST YEAR RESIDENT
• Testes form:
a) anti Mullerian hormone (AMH) or (MIS) that
destroys Mullerian duct
b)Testosterone that masculinizes the fetus

• Ovaries produce
Estrogen that enables
the development of
Mullerian duct
 SRY gene
• Sex determining region Y
• Located on short arm of chromosome Y
• Encodes TDF
• Causes male gonadal development
• Mutation will result
in the embryo developing
female genitalia
despite XY chromosome
 EMBRYOLOGY OF CERVIX

• Paramesonephric ducts are paired ducts along

the lateral sides of urogenital ridge and
terminate at primitive urogenital sinus
• Fused lower vertical parts of the two
paramesonephric ducts
• Differentiated from corpus by 10th week
 Cervix anatomy
• Measures 2.5 -3.5 cm
• Extend from histological
internal os and ends at
external os
• Nulliparous os: circular
• Parous os: bilateral slits
with anterior and posterior lip.
• Cervix is insensitive to touch, heat and when
grasped by instrument
• Endocervix- columnar cells
• Ectocervix- stratified non-
keratinizing squamous
epithelium
• Junction- transitional
zone: 1-10mm width;
normally situated at
external os; changes with
level of estrogen; chance
of dysplasia, CIN, invasive carcinoma
 DEVELOPMENTAL ANOMALIES
• Atresia:
Failure of Paramesonephric duct to canalize
Presentation: Early adolescence with
amenorrhea and cyclical pelvic
pain
Complication: hematocolpos,
hematosalphinx, endometrioma,
pelvic adhesions
Cervical duplication
 EMBRYOLOGY OF OVARY
• Gametes are cells that carry out reproductive
function
• Gametes are derived from primordial germ
cells (PGC) formed in epiblast during the second
week, move through primitive
streak and migrate to the wall
of yolk sac
• During the fourth week, these
cells migrate from yolk sac towards
developing gonads , where they arrive by the end
of fifth week
• Gonadal ridge formed between dorsal
mesentery (medially) and mesonephric ridge
(laterally)
• Coelemic epithelium: cortex and covering
epithelium
• Mesenchyme: medulla
• Germ cells : endodermal in origin; undergo a
number of rapid mitotic divisions and
differentiate into oogonia reaching maximum
at 20th week at 7 million.
• Fertilization; male gamete, the sperm unites
with female gamete, the oocyte giving rise to
a zygote
• By the 21st day the embryo is completely
covered by ectoderm, and the primitive gut
(endoderm) has acquired a mesentery which
attaches it to the posterior wall of the body
cavity (coelom).
• The lining of the latter develops from
mesenchyme; mesoderm is present between
it and ectoderm
• On either side of the root of the mesentery is
the intermediate cell mass of mesoderm and
one part of this proliferates to form the
urogenital ridge or nephrogenic cord
extending from the cervical to the caudal
region of the embryo
• Sexual differentiation of the gonad is
recognisable by the 6th week
• The primordial germ cells—oogonia and
spermatogonia— are formed at a very early
stage from cells of the dorsal part of the
hindgut (originally yolk sac)
 Sexual differentiation
• Somatic cells : 23 homologous pairs forming
diploid number of 46 chromosomes
• 22 pairs of matching chromosomes called
autosomes and 1 pair of sex chromosomes
• Each gamete contains haploid number of 23
chromosomes and on fertilization restores
diploid number of 46 chromosomes
• Primary sex determination: determination of
gonads
• Secondary sex determination: phenotype
 Ovary
• Located intrapertoneally in the ovarian fossa
• Attachments: posterior wall of broad ligament
by mesoovarium, to lateral pelvic wall; by
infundibulopelvic ligament; to uterus by
ovarian ligament
• Size:
Neonate: 1.3cm*0.6cm*0.4cm
Reproductive: 4cm*2cm*3cm
Menopause: 2cm*1.5cm*0.5cm
• Volume: 10cm3 (max: 18cm3)
• Combined exocrine ( produces Ova) and
endocrine function (Estrogen and
Progesterone)
• Structure of ovary varies with species, age and
sexual cycle
• Germinal epithelium: simple epithelium
covering surface of ovary
• Tunica albuginea: whitish capsule of dense
connective tissue
• Outer cortex: containing follicles called
oogonia, corpora lutea and interstitial
endocrine cells; all oogonia to be used
throughout the fertile life are produced at an
early stage and do not multiply thereafter
• Inner medulla : containing connective tisue,
blood vessels and lymph vessels and ‘ rete
ovarii’ (hilus at which nerves and vessels
enter ovary)
 Oogenesis
• In late fetal period, primary oogonia enlarge to form
primary oocyte
• At the time of birth, primary oocytes are in the
prophase of first meiotic division and do not divide
until ovulation
• With each menstural cycle, few primary oocytes
mature and complete the first meiotic division before
ovulation
• First meiotic division of a primary oocyte produces
two unequal daughter cells with haploid
chromosomes largest cell recieves most of
cytoplasm called secondary oocyte and smaller cell
called the first polar body.
• Secondary oocyte immediately enters second
meiotic division
• Ovulation takes place with oocyte in metaphase;
secondary oocyte remains arrested in metaphase
until fertilization
• Second meiotic division is completed only if
fertilization occurs resulting in two unequal
daughter cells with the smaller one called the
second polar body.
• If fertilization does not occur , secondary
oocyte fails to complete the second meiotic
division and degenerates in about 24hrs after
ovulation
• In each menstural cycle 5-30 primary oocyte
start maturing but only one of them ovulates
• Graffian follicles are stromal cells that surround and
protect ova
• Follicular cells of stroma are
flattened and surround an
oocyte  become columnar
and are called Primordial follicle
• Zona pellucida forms between
follicular cells and oocytes
• Follicular cells proliferate forming Granulosa cells
• A cavity (antrum) appears within the membrana
granulosa and rapidly increases in size pushing the
oocyte eccentrically in the follicle forming cumulus
oophoricus
 Ovulation
• Release of secondary oocyte from ovary
following rupture of a mature Graffian follicle;
available for conception
• Sustained peak Estrogen for 24-36hrs in late
follicular phase LH surge  after16-24hrs
Ovulation
• Preovulatory rise of progesteronepositive
feedback of Estrogen to induce FSH surge
 Fate of ovum
• Ovum released from ovary is carried by
fimbriated ends of fallopian tubes
• If intercourse occurs at about this time
spermatozoa deposited in vagina swim
towards the tubes and fertlization may occur
leading to an embryo that may get implanted
in the walls of uterus
• If not fertilized the ovum dies within 12- 24 hrs
and gets discharged through vagina
 Corpus luteum
• When follicles rupture , the walls collapses
and folded and rapidly increases in size
• The cytoplasm is filled with a yellowish
pigment (lutein) now called corpus luteum
 If no fertilization occurs: corpus luteum
persists for about 14 days, secreting
progesterone as corpus luteum of
mensturation and finally degenerates as
corpus albicans
 If fertilization occurs: corpus luteum persists
for 3-4 months as corpus luteum of pregnancy,
secretes progesterone and helps maintain
pregnancy; in early months of pregnancy CL is
maintained by hCG secreted by trophoblast
cells of developing embryo
 Ovarian dysfunction

Classified into 6 main groups (WHO 1996)

• Group I: Hypothalamic pituitary failure Eg
anorexia nervosa, kallman’s syndrome, sheehan
syndrome
• Group II: hypothalamic pituitary dysfunction Eg
PCOS, CAH, adrenal tumors and androgen
producing ovarian tumors
• Group III: Ovarian failure: Eg Turners syndrome,
Pure gonadal dysgenesis, Swyer syndrome,
Autoimmune disorders, Infections, radio and
chemotherapy
• Group IV: Congenital or acquired genital tract
disorders Eg Imperforate hymen, Mayer Rockitansky
Kuster Hauser syndrome, Asherman syndrome
• Group V: hyperprolactinomia with a space
occupying lesion in hypothalamic pituitary region Eg
pituitary adenoma
• Group VI: Hyperprolactinoma without SOL Eg:
Hypothyroidism, Chronnic renal failure, drug
induced
• Group VII: Amenorrhea with SOL in hypothalamic-
pituitary region with normal or low PRL Eg
Craniopharyngioma
 Descent of Ovaries

• Descent from lumbar region to pelvic cavity

during 7th to 9th month
• Cranial genital ligament forms: the
infundibulopelvic ligament
• Caudal genital ligament: the ligament of ovary
proper and round ligament of uterus
extending into labia majora
 DEVELOPMENTAL ANOMALIES
• ABSENCE OR UNDERDEVELOPMENT
• Rudimentary ovary- functionless ;
• Gonadal dysgenesis streak gonads;(Turners
syndrome) associated with errors in sex
chromosome pattern
 Gonadal dysgenesis
• Turners syndrome (45X0); non disjunction; 1 in
2500
• One of the missing gene SHOX gene,
responsible for long bone growth
• Classical type (X chromosome is completely
missing) or Mosaicism ( mixed chromosome in
some of the cell)
• Diagnosis:
a. Physical symptoms in childhood
b. Failure to go through normal puberty in
adolescence
c. Karyotyping
d. Chorionic villous sampling or amniocentesis in
pregnancy

• Treatment: Hormone replacement therapy:

growth hormone, Androgen, Estrogen
• Ovarian hypoplasia: Low number of primordial
follicles
• Failure of descent: Ovary at pelvic brim or lower
pole of kidney
 Accessory or supernumerary ovary
• Single ovary divided into two parts and attached
by fibrous tissue
• True supernumerary
• ovaries or portion of ovarian tissue found in
broad ligament or elsewhere
acounting for mensturation
even after removal of both
ovaries

(Accessory ovary in utero ovarian ligament)

 Polycystic Ovarian Syndrome(PCOS)
• Reproductive age group
• Amenorrhoea, hirsuitism, obesity with enlarged
polycystic ovaries
• Diagnosis:
 TVS: Ovaries are enlarged in volume >10cm3 and
peripherally enlarged cysts (2-9mm)
 LH levels elevated ; LH: FSH > 2:1
 Raised level of estradiol and estrone
 SHBG reduced
 Raised serum testosterone
and DHEA
 Insulin resistance
 Laparoscopy
 Ovotestes
• Gonad with both tesicular and ovarian aspect
• Karyotype: 46XX (most common)
• Internal genitalia: both Mullerian & Wolffian
derivative
• Phenotype variable
• Gonadal biopsy required to confirm diagnosis
 References:
• Human Embryology: Inderbir Singh
• DC Dutta textbook of Obstetrics and
Gynaecology
• Langman’s medical embryology