Fertility, contraception and reproductive technology

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Catatan pelajaran

Big idea: change, development and choice

Big idea (key concept): Change. The human reproductive system changes through the month and through life, controlled by hormones. Understanding those changes lets us help people who want a baby and people who want to wait.
Related concept: Development. An egg develops in the ovary, a lining develops in the uterus and, after fertilisation, an embryo develops. Every stage is timed by hormones.
Global context: Fairness and development. Access to contraception and fertility treatment is very different from one country to another and from one family to another. Who should have access, and who should pay?
This lesson is factual and balanced. People hold many different views about contraception and fertility treatment, for personal, cultural and religious reasons. Science can explain how these methods work and how well they work, but it cannot decide what any person should do.
Fertility is the ability to conceive a child. A woman's ovaries release one egg cell roughly once a month. A man's testes make millions of sperm every day. Fertilisation happens when a sperm nucleus fuses with an egg nucleus, usually in the oviduct.
Four hormones run the female cycle. FSH and LH are made by the pituitary gland at the base of the brain. Oestrogen and progesterone are made by the ovaries. The pituitary controls the ovaries, and the ovaries send signals back to the pituitary. This two-way control is a negative feedback system for some steps and a positive one at the LH surge.

The menstrual cycle and its hormones

The menstrual cycle repeats about every 28 days (anything from about 21 to 35 days is normal). Day 1 is the first day of bleeding. During menstruation, usually for about 3 to 7 days, the thickened lining of the uterus breaks down and leaves the body.
FSH (follicle stimulating hormone) is released by the pituitary gland. It makes a follicle in the ovary grow, with an egg cell maturing inside it. It also stimulates the ovary to make oestrogen.
Oestrogen is made by the follicle. It makes the uterus lining repair and thicken after menstruation. When oestrogen reaches a high level it inhibits FSH (negative feedback) and stimulates the pituitary gland to release a surge of LH.
LH (luteinising hormone) shows a sharp peak at about day 14. This LH surge triggers ovulation, the release of a mature egg from the ovary into the oviduct.
After ovulation the empty follicle becomes the corpus luteum, which makes progesterone. Progesterone maintains the thick lining of the uterus, ready for an embryo, and inhibits FSH and LH so no more eggs mature while a pregnancy might be starting.
If the egg is not fertilised, the corpus luteum breaks down, progesterone falls, and the lining is shed. That is the start of the next cycle. If the egg is fertilised, the embryo sends a signal that keeps progesterone high (see the next section), so the lining stays.
An egg survives for about a day after ovulation, but sperm can survive for several days in the female system. This is why pregnancy is possible for a few days before ovulation as well as just after it, and why fertility awareness methods are not very reliable.

FSH and LH levels and the uterus lining across a 28-day cycle

Pregnancy, hCG and why fertility can be reduced

If a sperm fertilises the egg, the zygote divides as it travels down the oviduct. After several days the embryo sinks into the thick uterus lining. This is implantation.
The cells around the early embryo make a hormone called hCG (human chorionic gonadotrophin). hCG keeps the corpus luteum alive so that it carries on making progesterone. Later the placenta takes over and makes progesterone itself.
Because hCG is only made in pregnancy and leaves the body in urine, it is the hormone that a pregnancy test detects. The test strip holds monoclonal antibodies that bind only to hCG. A line appears where hCG has been captured. A separate control line shows that the test worked.
Infertility means a couple has not conceived after a year or more of trying. It is common and has many causes, found in women, in men and sometimes in both. Many people are affected, and it is not anyone's fault.
Causes in women include ovulation disorders (for example, hormone imbalance), blocked oviducts and conditions affecting the uterus. Causes in men include a low sperm count or sperm that do not swim well. Sometimes no clear cause is found.
Age matters. On average, the chance of conceiving in each cycle goes down as a woman gets older, especially after the mid-30s, because fewer eggs remain and they are less likely to develop normally. Male fertility also falls with age, but more slowly.
Lifestyle factors can reduce fertility in both sexes: smoking, heavy drinking, being very overweight or underweight, and some drugs. Changing these can help, but not in every case.

How a pregnancy test detects hCG

Fertility treatments and IVF

Treatment depends on the cause. Fertility drugs containing FSH and LH (or drugs that raise the body's own FSH) can stimulate ovulation in a woman who is not releasing eggs. A possible side effect is the release of several eggs at once, which raises the chance of twins or triplets.
In artificial insemination, sperm are placed in the uterus at the time of ovulation. In IVF (in vitro fertilisation), fertilisation happens outside the body. 'In vitro' means 'in glass', in a laboratory dish.
The steps of IVF. (1) The woman takes FSH and LH so that several follicles mature. (2) The eggs are collected from the ovaries. (3) The eggs are mixed with sperm in a dish. (4) Fertilised eggs grow into embryos for a few days. (5) One, or sometimes two, healthy embryos are placed in the uterus. Hormones such as progesterone may be given to help the lining.
If the sperm are very few or weak, a single sperm can be injected into an egg. This is called ICSI. Eggs, sperm or embryos can also be frozen and stored for later use.
Success is not guaranteed. IVF success depends strongly on the woman's age. As an approximate guide, clinic statistics show about one in three treatment cycles ending in a live birth for women under 35, falling to only a few in a hundred for women over 42. Success is usually reported as live births per cycle or per embryo transferred, so check which one a clinic means.
Risks and costs. Fertility drugs can overstimulate the ovaries in a small number of women. Transferring more than one embryo raises the chance of multiple births, which carry greater risks for mothers and babies, so many clinics transfer a single embryo. IVF can also be expensive, physically demanding and emotionally stressful.

Contraception: how each method works

Contraception reduces the chance of pregnancy. Methods work in four main ways: they stop sperm reaching the egg, stop eggs being released, stop sperm surviving or stop an embryo implanting, or they permanently block the tubes that carry gametes.
Barrier methods. A condom (worn on the penis, or an internal version) and a diaphragm physically stop sperm entering the uterus. Condoms are the only common method that also reduces the risk of sexually transmitted infections (STIs).
Hormonal methods. The combined pill contains oestrogen and progesterone. These keep FSH low, so eggs do not mature and ovulation does not happen. The pill is taken for 21 days, then there is a break during which the lining is shed. Progesterone-only methods (the pill, an implant under the skin of the arm, or an injection) release progesterone that thickens the mucus at the cervix so sperm struggle to pass, and can also stop ovulation.
Intrauterine devices. A copper IUD is placed in the uterus. Copper ions are toxic to sperm and also make it harder for an embryo to implant. An intrauterine system (IUS) releases progesterone locally. Both last for years and can be removed by a doctor.
Surgical methods. In a vasectomy the sperm ducts are cut, so semen contains no sperm. In female sterilisation the oviducts are blocked or cut, so eggs cannot meet sperm. These methods are meant to be permanent.
Natural methods such as fertility awareness (tracking the cycle, temperature or mucus) have no side effects but are among the least reliable, because ovulation can shift. Not having sex at all is the only way to be sure of avoiding pregnancy, but it is not what most couples choose.
Failure rate is the number of pregnancies per 100 users in one year. Approximate typical-use figures are: no method about 85, male condom about 13, combined pill about 7, injection about 4, copper IUD about 1, implant under 1. 'Typical use' is higher than 'perfect use' because people forget pills or use a method incorrectly. Methods that do not rely on remembering, such as the implant and IUD, have the lowest typical-use failure rates.

Think like a scientist: IVF ethics and evaluating the evidence

Benefits of IVF. It has helped millions of couples and single people to have children. Embryos can be tested for serious inherited disorders before transfer (preimplantation genetic testing), so a family with a known risk may avoid passing on a condition.
Ethical questions. IVF often creates more embryos than are used. They may be stored, donated for research or for other couples, or allowed to perish, and people disagree about the moral status of an embryo. There are also questions about access, because treatment is expensive and funded very differently in different countries, and about how far embryo testing should go.
Evaluating claims. A statement such as 'this clinic has a 40% success rate' needs checking: success means a live birth or a positive test? Per cycle or per embryo? Which age group? A clinic that treats younger patients will look better without being any more skilful.
A fair comparison needs the groups to be similar in everything except the factor you are testing. If couples who use method A are older or use it less consistently than couples who use method B, the difference in pregnancies may be caused by those other variables and not by the method.
Use the percentage formula for any success or failure rate: rate = (number of events / number of people or cycles) x 100. Always show the units and say what the denominator is.
Inquiry task: a clinic reports that 120 of 400 cycles for patients under 35 and 30 of 300 cycles for patients over 40 ended in a live birth. Calculate both percentages, then write two sentences evaluating a newspaper headline that says 'Clinic A is three times better than Clinic B', where Clinic B mostly treats older patients. Suggest one extra piece of information you would ask for.

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1.Which gland makes FSH and LH?
Easy
- AThe ovary
- BThe thyroid gland
- CThe pituitary gland
- DThe pancreas
2.Where does fertilisation usually happen?
Easy
- AIn the oviduct
- BIn the vagina
- CIn the ovary
- DIn the bladder
3.Ovulation is the release of a mature egg from an ovary.
Easy
True or false?
4.In a typical 28-day cycle, on about which day does ovulation happen?
Easy
- ADay 1
- BDay 7
- CDay 28
- DDay 14
5.Which hormone causes a follicle to develop and an egg to mature in the ovary?
Easy
- AProgesterone
- BFSH
- ChCG
- DTestosterone
6.What is the main job of LH in the menstrual cycle?
Easy
- AIt thickens the lining of the uterus
- BIt triggers ovulation
- CIt stops the next period
- DIt keeps the embryo in the uterus
7.Complete the sentence.
Easy
After ovulation the hormone ____ maintains the thick lining of the uterus.
8.Which hormone does a pregnancy test detect in urine?
Easy
- AFSH
- BOestrogen
- CLH
- DhCG

Soal lainnya

9.Which contraceptive method works as a physical barrier to sperm?
Easy
- AA condom
- BThe combined pill
- CA vasectomy
- DA hormone implant
10.The male condom can reduce the risk of passing on sexually transmitted infections.
Easy
True or false?
11.In a vasectomy, which tubes are cut or blocked?
Easy
- AThe oviducts
- BThe ureters
- CThe sperm ducts
- DThe sperm-producing tubules in the testes
12.Match each contraceptive method to how it works.
Easy
- Combined pill
- Condom
- Copper IUD
- Vasectomy
- Blocks sperm from entering the uterus
- Copper ions harm sperm in the uterus
- Cuts the tubes that carry sperm
- Hormones keep FSH low so no egg matures
13.In 'in vitro fertilisation', what does 'in vitro' mean?
Easy
- AInside the uterus
- BBefore the egg is released
- CUsing a donor egg
- DIn glass, outside the body
14.Put the main steps of IVF in order.
Easy
- Eggs are mixed with sperm in a dish
- The woman takes FSH and LH so several eggs mature
- Fertilised eggs grow into embryos
- Eggs are collected from the ovaries
- An embryo is placed in the uterus
15.Which event causes the lining of the uterus to be shed during menstruation?
Easy
- AProgesterone level rises
- BProgesterone level falls
- CFSH level peaks
- DAn embryo implants
16.FSH is made in the ovary.
Easy
True or false?
17.Which of these can reduce fertility? (select all that apply)
Easy
- ABlocked oviducts
- BEating a varied diet
- CA low sperm count
- DHaving had a blood test
- EOvulation not happening regularly
18.Which structures make oestrogen and progesterone?
Easy
- AThe ovaries
- BThe testes
- CThe pituitary gland
- DThe placenta only
19.Complete the sentence.
Easy
In IVF, an egg is fertilised by sperm in a laboratory ____ outside the body.
20.Which hormone, made by the ovary, makes the uterus lining repair and thicken after menstruation?
Easy
- ALH
- BhCG
- COestrogen
- DInsulin
21.When the level of oestrogen becomes high, what happens to the release of FSH?
Medium
- AIt is inhibited (reduced)
- BIt is increased further
- CIt stays exactly the same
- DIt changes into LH
22.Which hormone shows a sharp peak at about day 14?
Medium
- AProgesterone
- BhCG
- CInsulin
- DLH
23.How does the combined pill prevent pregnancy?
Medium
- AIt kills the sperm in the vagina so that none can reach the egg in the oviduct
- BIts hormones inhibit FSH, so eggs do not mature and ovulation does not happen
- CIt blocks the oviducts so that the eggs can no longer travel to the uterus
- DIt makes the uterus lining so thin that a sperm cannot get through it
24.Which is one way that progesterone-based contraceptives such as the implant reduce the chance of pregnancy?
Medium
- AThey destroy the eggs stored in the ovary permanently
- BThey thicken the cervical mucus so sperm struggle to pass
- CThey carry sperm away from the oviduct before it meets an egg
- DThey raise the level of FSH so that the eggs are all used up
25.On average, the chance of conceiving in each cycle falls as a woman gets older.
Medium
True or false?
26.Why do pregnancy tests contain monoclonal antibodies?
Medium
- AThey destroy the hCG so the test is safe to handle
- BThey change colour when any hormone is present
- CThey are made from the embryo's own cells
- DThey bind specifically to hCG and to nothing else in the urine
27.On a pregnancy test strip, what does the control line show?
Medium
- AThat the test has worked correctly
- BThat the woman is pregnant
- CThat the urine contains no hCG
- DThat the woman is not ovulating
28.Match each hormone to where it is made.
Medium
- FSH
- Oestrogen
- Progesterone after ovulation
- hCG
- Developing follicle in the ovary
- Corpus luteum in the ovary
- Cells around the early embryo
- Pituitary gland
29.A woman's menstrual cycle is 32 days long, counting day 1 as the first day of bleeding. Assume ovulation happens 14 days before the next period starts. On which day of the cycle is ovulation expected?
Medium
30.In one survey, 52 pregnancies occurred in a year among 400 couples using the same method of contraception. What is the failure rate as a percentage?
Medium
31.
The table shows approximate typical-use failure rates (pregnancies per 100 users in one year).
Method Pregnancies per 100 users
No method 85
Male condom 13
Combined pill 7
Implant 0.1
About how many times higher is the failure rate of the male condom than that of the combined pill?
Medium
- AAbout 6 times
- BAbout 0.5 times
- CAbout 2 times
- DAbout 20 times
32.1000 couples use no contraception for a year and 85% of them become pregnant. Another 1000 couples use a method with a failure rate of 0.5%. How many fewer pregnancies are expected in the second group?
Medium
33.Why is the typical-use failure rate of a method often higher than its perfect-use failure rate?
Medium
- AThe method itself changes during the year
- BPerfect-use figures are only measured on older people
- CTypical use includes people who want to become pregnant
- DPeople sometimes forget to use the method or use it incorrectly
34.Why are women given FSH and LH before egg collection in IVF?
Medium
- ATo stop the eggs being fertilised inside the body before collection
- BTo make several eggs mature in the same cycle so more can be collected
- CTo make the lining of the uterus break down before the transfer
- DTo make the sperm swim faster when they are mixed with eggs
35.Why do many clinics now transfer a single embryo?
Medium
- AA single embryo is certain to implant in the uterus lining
- BSeveral embryos would use up all of the mother's remaining eggs
- CIt lowers the chance of a multiple pregnancy, which carries more risks
- DTwo embryos can never grow together in the same uterus
36.IVF always results in a pregnancy.
Medium
True or false?
37.Which of these is an ethical question raised about IVF?
Medium
- AWhat should happen to embryos that are made but not used
- BWhether IVF changes the genes of the baby it produces
- CWhether IVF can only be used by women over 40
- DWhether the eggs used in IVF come from the pituitary gland
38.Which of these work mainly by stopping sperm reaching an egg? (select all that apply)
Medium
- AMale condom
- BThe combined pill
- CDiaphragm
- DAn FSH injection
- EVasectomy
39.A clinic wants to test whether a new drug increases sperm count. Which plan is the fairest test?
Medium
- ARandomly give the drug to one group and a placebo to a matched group, then count sperm the same way
- BGive the drug to all of the men, then compare their results with last year's results from other men
- CGive the drug to a group of older men and the placebo to a group of younger men
- DLet each man choose whether he takes the drug or the placebo, then count sperm
40.A survey finds that couples using method X report fewer pregnancies than couples using method Y. Why can't we conclude that X is the more effective method?
Medium
- ASurveys can never be used to study how well contraception works at all
- BMethod X must have fewer side effects than method Y does
- CPregnancies are impossible to count accurately in any survey
- DThe two groups may differ in age or in how consistently they use their method
41.Roughly which days of a typical 28-day cycle does menstruation (the shedding of the lining) take place?
Medium
- AAbout days 10 to 14
- BAbout days 1 to 5
- CAbout days 15 to 20
- DAbout days 25 to 28 only
42.Put these events of the menstrual cycle in order, starting with the pituitary gland.
Medium
- A surge of LH triggers ovulation
- The pituitary gland releases FSH and a follicle grows
- Progesterone from the corpus luteum maintains the lining
- Oestrogen rises and the uterus lining thickens
- Progesterone falls and the lining is shed
43.Which statement about progesterone is correct?
Medium
- AIt triggers ovulation by peaking at about day 14
- BIt maintains the lining and inhibits FSH and LH
- CIt is made by the pituitary gland at the base of the brain
- DIt is the hormone that a pregnancy test detects in urine
44.A blood test on day 21 of a 28-day cycle shows a high level of progesterone. What does this suggest?
Hard
- AOvulation has not yet happened in this cycle
- BThe woman is not producing any oestrogen at all
- CThe pituitary gland has stopped releasing both FSH and LH
- DOvulation has happened and a corpus luteum is making progesterone
45.
A clinic recorded these figures for one year (invented figures for practice).
Age group IVF cycles Live births
Under 35 800 280
35 to 39 600 150
40 and over 400 40
What percentage of ALL the cycles ended in a live birth? Give your answer to one decimal place.
Hard
46.Using the invented clinic figures (under 35: 280 live births from 800 cycles; 35 to 39: 150 from 600; 40 and over: 40 from 400), which statement is correct?
Hard
- AThe success rate falls with age, from 35% to 25% to 10%
- BThe success rate is 35% for every age group
- CThe 40 and over group had the highest success rate because it had the fewest cycles
- DThe 35 to 39 group had a success rate of 15%
47.A clinic advertises 'a 40% success rate'. Which piece of information is most important when evaluating this claim?
Hard
- AThe colour of the clinic's logo and the design of its website
- BHow many members of staff the clinic employs in total
- CWhether success means a live birth, and the age of the patients treated
- DWhether the clinic is based in a large city or a small town
48.A woman on the combined pill has a bleed during the 7-day break between packs. Which explanation is best?
Hard
- AShe has ovulated during the break between the packs
- BThe pill has stopped working and she is now pregnant
- CThe pituitary gland has released a surge of LH at that time
- DHormone levels fall in the break, so the lining is shed
49.Which statements are fair evaluations of condoms as a method of contraception? (select all that apply)
Hard
- AThey are the most effective method available, with a failure rate below 1 in 100
- BThey also reduce the risk of sexually transmitted infections
- CThey permanently prevent pregnancy once used
- DTheir typical-use failure rate is higher than their perfect-use rate
- EThey have no hormonal side effects
50.The corpus luteum would break down after about 14 days if no pregnancy occurred. Why does early pregnancy avoid this?
Hard
- AThe embryo makes FSH, which restarts the menstrual cycle
- BThe uterus makes LH, which causes a second ovulation to occur
- CThe embryo makes hCG, which keeps the corpus luteum active
- DThe ovary stops making every hormone until the baby is born
51.Explain how the combined contraceptive pill prevents pregnancy.
Hard
52.Suggest why a woman who does not ovulate may be given injections of FSH and LH, and state one possible side effect.
Hard
53.Evaluate IVF by giving two benefits and two concerns.
Hard
54.Compare how the male condom and the contraceptive implant work, and suggest why the implant has a lower typical-use failure rate.
Hard
55.A student wants to investigate whether smoking affects fertility. Which is the dependent variable?
Medium
- AThe time it takes couples to conceive
- BWhether the person smokes or not
- CThe age of the people in the study
- DThe country where the study is carried out

Catatan ulasan

## The big idea - The reproductive system changes through the month under hormone control (**Change**, **Development**). Access to contraception and fertility treatment is not equal everywhere (**Fairness and development**). ## The menstrual cycle - **FSH** (pituitary) matures an egg and stimulates **oestrogen**. Oestrogen thickens the lining, inhibits FSH and prompts the **LH surge**. - **LH** peaks at about **day 14** and triggers **ovulation**. The corpus luteum makes **progesterone**, which maintains the lining and inhibits FSH and LH. - If there is no pregnancy, progesterone falls and the lining is shed. ## Pregnancy and fertility - The embryo makes **hCG**, which keeps progesterone high. Pregnancy tests detect hCG with **monoclonal antibodies**. - Causes of infertility include ovulation disorders, blocked tubes, low sperm count, age and lifestyle. - **IVF**: hormones mature several eggs, eggs are collected, fertilised in a dish, and an embryo is placed in the uterus. Success falls with age. ## Contraception - **Barrier** (condom, diaphragm), **hormonal** (combined pill stops ovulation, progesterone methods thicken mucus), **intrauterine** (copper IUD, IUS), **surgical** (vasectomy, female sterilisation). - **Failure rate** = pregnancies per 100 users per year. Typical use is higher than perfect use. ## Evaluating - Check what success means, per cycle or per embryo, and the age of patients. Compare similar groups. Use balanced arguments for ethical questions.

Fertility: The ability to conceive a child.
FSH: A hormone from the pituitary gland that makes a follicle grow and an egg mature, and stimulates oestrogen production.
LH: A hormone from the pituitary gland whose surge at about day 14 triggers ovulation.
Oestrogen: An ovarian hormone that repairs and thickens the uterus lining and inhibits FSH at high levels.
Progesterone: A hormone from the corpus luteum that maintains the uterus lining and inhibits FSH and LH.
Ovulation: The release of a mature egg from the ovary.
Corpus luteum: The structure formed from the follicle after ovulation that makes progesterone.
hCG: A hormone made by cells around the early embryo that maintains the corpus luteum; detected in a pregnancy test.
Infertility: Difficulty conceiving after a year or more of trying.
IVF: In vitro fertilisation: eggs are fertilised by sperm in a laboratory dish and the embryo is placed in the uterus.
Contraception: Methods that reduce the chance of pregnancy.
Barrier method: A contraceptive that physically stops sperm reaching the egg, such as a condom.
Failure rate: The number of pregnancies per 100 users of a method in one year.
Vasectomy: A surgical method in which the sperm ducts are cut so semen contains no sperm.
Implantation: The embedding of the early embryo in the lining of the uterus.

Kartu flash

Which gland makes FSH and LH?

The pituitary gland.

What does FSH do?

It makes a follicle grow and an egg mature, and stimulates the ovary to make oestrogen.

What does LH do?

A surge of LH at about day 14 triggers ovulation.

What does oestrogen do?

It repairs and thickens the uterus lining. At a high level it inhibits FSH and prompts the LH surge.

What does progesterone do?

It maintains the uterus lining and inhibits FSH and LH.

What is the corpus luteum?

The structure left by the follicle after ovulation. It makes progesterone.

Why does menstruation start?

If there is no pregnancy, the corpus luteum breaks down, progesterone falls and the lining is shed.

What does hCG do and how is it used?

It is made by the early embryo and keeps the corpus luteum making progesterone. Pregnancy tests detect it in urine.

Why do pregnancy tests use monoclonal antibodies?

They bind specifically to hCG and nothing else in urine.

List three causes of infertility.

Ovulation disorders, blocked oviducts, a low sperm count, age, smoking (any three).

What are the main steps of IVF?

Hormones mature several eggs, eggs are collected, fertilised in a dish, embryos grow and one is placed in the uterus.

How does the combined pill work?

Oestrogen and progesterone inhibit FSH, so eggs do not mature and there is no ovulation.

How do progesterone-only methods work?

They thicken the mucus at the cervix so sperm struggle to pass, and may also stop ovulation.

Which contraceptive also reduces the risk of STIs?

The condom.

How does a copper IUD work?

Copper ions are toxic to sperm and make implantation harder.

What is a vasectomy?

A surgical method in which the sperm ducts are cut, so semen contains no sperm.

What does failure rate mean?

The number of pregnancies per 100 users of a method in one year.

Why is typical-use failure higher than perfect-use?

People forget or use methods incorrectly.

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Soal ujian lampau

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Segera hadir

Method	Pregnancies per 100 users
No method	85
Male condom	13
Combined pill	7
Implant	0.1

Age group	IVF cycles	Live births
Under 35	800	280
35 to 39	600	150
40 and over	400	40