1 Quiz 09 Results Name Quiz 09a Attempt Score 1.27891 Attempts 147 (Total of 148 attempts for this assessment) Question 1: Multiple Choice Average Score 0.41837 points The area where the urethra exits the bladder is surrounded by a thickened layer of smooth muscle known as the bladder neck. Male infertility can be caused by various conditions that prevent the normal contraction of the bladder neck during orgasm. Why would failure of bladder neck contraction during orgasm lead to infertility? Correct Percent Answered The ducts of the bulbourethral glands are blocked. 0% Semen is pushed upward into the bladder instead of out the penis. 83.673% The temperature of the scrotum is too high, which impairs spermatogenesis. 0.68% The ducts leading from the seminal vesicles to the ejaculatory duct are blocked. 6.803% The vas deferens cannot transport sperm from the epididymus to the ejaculatory duct. 8.844% Unanswered 0% Question 2: Multiple Choice Average Score 0.40136 points A man went to see his doctor because he could not conceive children. Upon examination, he was found to have normal masculine secondary sex characteristics, increased plasma levels of FSH, and normal plasma levels of LH. What is the most likely explanation for his sterility? Correct Percent Answered excessive secretion of inhibin 2.041% deficient testosterone secretion 2.721% blockage of the vasa deferentia 10.884% impaired function of Sertoli cells 80.272% impaired function of Leydig cells 4.082% Unanswered 0% Question 3: Multiple Choice Average Score 0.45918 points A woman presented herself at her doctor’s office complaining of abdominal pain and unusual vaginal bleeding. She reported that her normal menstrual period is more than a month late, and she has a history of pelvic inflammatory disease caused by a Chlamydia infection. Lab tests revealed high levels of human chorionic gonadotropin, but ultrasonography revealed an empty uterus. Which one of the following is the most likely diagnosis? Correct Percent Answered2 appendicitis 0% ovarian tumor 7.483% ectopic pregnancy 91.837% urinary tract infection 0.68% recurrence of the Chlamydia infection 0% Unanswered 0% Question 4: Essay Average Score 0 points Kallman’s syndrome is a rare inherited disorder in which GnRH-releasing neurons fail to migrate to the hypothalamus during embryonic development. A woman with Kallman’s syndrome hears that you are a student in BISC 307 and asks for your recommendation for effective treatment of her condition, one that would not only restore her normal secondary sex characteristics but also allow her to be fertile. What would you recommend? Briefly explain the reasoning behind your recommendations. Given Answers Hormone replacement therapy of estrogen and progesterone can restore her secondary sex characteristics. The secretion of estrogen and progesterone depends on the secretion of LH and FSH. Because GnRH fails to migrate to the hypothalamus, it cannot stimulate the secretion of LH and FSH and thus, levels of estrogen and progesterone are low. GnRH therapy can induce her ovaries to make eggs in order to facilitate fertility. Injections of LH and FSH can also induce her ovaries to make eggs. LH and FSH are responsible for stimulating ovulation. Since the brain cannot regulate the secretion of LH and FSH from the anterior pituitary, the gonads can also be manipulated. Gonads can secrete either inhibin to inhibit or activin to stimulate secretion of gonadotropins. If one can stimulate the gonads to increase release of activin, this could potentially stimulate the anterior pituitary to secrete more FSH and LH. Giving the patient a high and sustained dose of estrogen for at least 36 hours might also work, for the positive feedback also stimulates the production of gonadotropins from the anterior pituitary in addition to GnRH from the brain. If GnRH-releasing neurons fail to migrate to the hypothalamus, the patient should have a deficiency in GnRH. As a result, the anterior pituitary is not able to release FSH and LH, which are gonadotropins necessary for secondary sex characteristics. Her condition can be treated by injecting her with FSH and LH, which stimulate granulosa cells and theca cells, respectively. High and rising levels of FSH need to be present to cause proliferation of the follicle whereas a surge in LH causes an eventual release of the oocyte, allowing the woman to be fertile. Injections of GnRH can also be given, which would stimulate the anterior pituitary to release FSH and LH. However, the injections would have to be pulsitile like it is in a patient that does not have Kallman's syndrome. In order to treat the infertility one would have to give the woman LH and FSH in order to stimulate the prouction of the eggs. Human Chorionic gonadotropin can also be given to the woman in order to stimulate ovulation. Recommend her to use Hormone Replacement Therapy, specifically estrogen, and pituitary hormones (lutenizing hormone and follicule stimulating hormone). This would allow her secondary sex characteristics to present, as well as would do something to induce her fertility.3 Treating the patient with GnRH (hormone therapy) would work if the GnRH receptors on the anterior pituitary are functional. This would stimulate the production and secretion of LH and FSH by the anterior pituitary cells. These gonadotropins would stimulate granulosa cells and thecal cells in the ovarian follicle, eventually leading to the production of estradiol and progesterone. This would help her restore her normal secondary sex characteristics and also allow her to be fertile. Another way is to treat her directly with LH or FSH, bypassing the GnRH level. Considering the GnRH- releasing neurons fail to migrate to the hypothalamus during embryonic development, the patient will not experience puberty during adolescence or impaired puberty due to little or no GnRH secretion, leading to low levels of LH and FSH. There are some effective treatments that can combat this symptom. One way to effectively treat the symptoms is to administer hormone replacement and fertility treatments. This means the patient must be injected with normal levels of FSH and LH which will signal her body to produce eggs and make her fertile, as well as other hormones such as progesterone and estradiol that will allow for her normal secondary sex characteristics to arise. This will be the most