1

10-15 ng/dLe

10-15 ng/dLe

Follicular phgge

Lutegi P^se

30-40 cc Wood lost

OvUato«

Implantation HCG detectable 1 4 mm I

Menstrual 4j 5

Low volume

Thick

Cloudy

No foming

Max mal colluianty

Low elasticity tase

:ret roiiferative pha

ory ph [21I22I

?123124125126127128 Low volume Thick Cloudy Nofemmg Maximal cellularity Low elasticity

High volumo Thin Clear Femmg

Minimal coUularity

High elasticity (Spinnbarkeit)

Sccrotions Nausea

Sharp or dull pain Spotting übktof

Irritability Anxiety Depression Bleeding

Lower aodommal pam

Back and leg pain

Headaches

Nausea

Dizziness

Diarrhea

LOido ort

Infoction

Nosebieods

Sccrotions Nausea

Sharp or dull pain Spotting übktof

Follicle

Ovary

* Actual size at ovulation

Weight gam Bloatmg Eyes swollen Ankles swollen Breast fulness Breast tenderness Anxiety Depression

Headaches

Nausea

Acne

Spotting

Discharge

Constipation

FSH = Follide Stimulating Hormone

HCG.

LH = Lulemizmg Hormone Human Chorionic Gonadotropm

FIGURE 48-1. Menstrual cycle events. "Estradiol: 40 pg/mL = 147 pmol/L; 250 to 400 pg/mL = 918 to 1,468 pmol/L; 125 to 250 pg/mL = 459 to 918 pmol/L. ^Progesterone: 1 ng/dL = 0.032 nmol/ L; 10 to 15 ng/dL = 0.32 to 0.48 nmol/L. (Adapted from Ref. 6.)

Initially, the hypothalamus releases gonadotropin-releasing hormone (GnRH), which stimulates the anterior pituitary to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The levels of FSH and LH released vary depending on the phase of the menstrual cycle. Just prior to ovulation, FSH and LH both are at their peak levels. The FSH helps to promote growth of the follicle in preparation for ovulation by causing granulosa cells lining the follicle to grow and produce estrogen. The LH promotes androgen production by theca cells in the follicle, promotes ovulation and oocyte maturation, and converts granulosa cells to cells that secrete progesterone after ovulation.

Conception is most likely to occur when viable sperm are present in the upper region of the reproductive tract at the time of ovulation. Fertilization occurs when a spermatozoan penetrates an ovum. Approximately 6 to 8 days after ovulation, attachment of the early embryo to the lining of the uterine cavity—implantation—occurs.

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