1. 1- Anatomy of the female reproductive system
   1. external part
      1. clitiros
      2. labia
         1. majora
         2. minora
      3. vaginal opening
   2. internal part
      1. ovaries
      2. uterine tubes
         1. infundibulum
            1. fimbrae
         2. ampulla
         3. isthmus
         4. uterine
      3. uterus
         1. fundus
         2. body
         3. internal OS
         4. cervical canal
         5. external OS
      4. vagina
         1. 2 vaginal fornix
         2. posterior to
            1. urethra
   3. blood supply
      1. abdominal aorta
         1. ovarian arteries
            1. ovarian branch
            2. tubal branch
      2. interna illiac
         1. ascending branch of uterian a
   4. blood drainage
      1. pampiniform plexus
      2. uterine venous plexus
      3. R & L ovarian veins
         1. IVC
2. 2- Histology of the female reproductive system
   1. ovaries
      1. encapsulated by the tunica albuginea
      2. covered by the germinal epithelium
         1. simple cuboidal epithelium
      3. PRIMORDIAL FOLLICLES
         1. principle follicles present before birth
            1. consists of
            2. primary oocyte
            3. enveloped by
            4. single layer of flattened follicular cells.
      4. PRIMARY FOLLICLES
         1. zona pellucida
      5. SECONDARY FOLLICLES
         1. enlargement of the zona granulosa
         2. follicular antrum
      6. MATURE (GRAAFIAN) FOLLICLE
         1. corona radiata
   2. uterine tubes
      1. musculomembranous tube
      2. simple columnar epithelial layer
         1. peg cells
         2. ciliated cells
   3. uterus
      1. outer wall of the uterus
         1. perimetrium (Serosa)
      2. middle layer
         1. myometrium
      3. inner most layer
         1. endometrium
   4. vagina
      1. non-keratenized stratified squamous epithelium
3. 3- Physiology of Female Reproductive Tract
   1. Menstrual cycle
      1. Under hormonal control
      2. Pre-ovulatory phase
         1. Characterized with high estrogen levels
         2. Follicular phase in ovaries
            1. Follicle development and release of oocyte
         3. Proliferative phase in uterus
            1. Endometrium thickening
            2. Emergence of spiral arteries
            3. Thin watery cervical mucus
            4. More hospitable for sperms
      3. Ovulation
         1. In day 14 of the cycle
         2. Due to Estorgen induced LH surge
            1. Rupture of graafian follicle
            2. Expulsion of the ovum
            3. Entrance of ovum to fallopian tube
      4. Post-ovulatory phase
         1. Characterized with high progesterone levels
         2. Luteal phase in ovaries
            1. Formation of corpus luteum
            2. Production of progesterone/ estrogen and inhibin
            3. Degenerates to corpus albicans if there was no fertilization
         3. Secretory phase in uterus
            1. Spiral arteries grow longer
            2. Uterine glands secrete more mucus
            3. Thick cervical mucus
            4. Less hospitable for sperms
            5. Functional layer of endometrium sloughs off if there was no fertilization
            6. Menstruation
   2. Fertilization
      1. In ampulla
      2. 3 Phases
         1. Penetration of corona radiata
            1. After capacitation of sperms
         2. Penetration of zona pellucida
            1. Acrosome reaction
         3. Fusion of oocyte and sperm cell membrane
            1. Cortical and zona reaction
4. 4- Polycystic ovarian syndrome
   1. PCOS
      1. Caused by elevation of LH
         1. Overstimulate theca cell
            1. Produce androstenedione
            2. Increase LH To FSH ratio
      2. Insulin resistance
         1. Hyperinsulinemia via inc androgenic enzymes and dec in SHBG
   2. Clinical features
      1. Hirsutism
      2. Acne
      3. Male pattern alopecia
      4. Menstrual abnormalities
      5. Weight gain 60%
      6. Acanthus is nigricans
   3. Risk factor
      1. Genetic-Obesity - sedentary lifestyle - intrauterine androgen exposure
   4. Morphology
      1. Both ovaries will be enlarged with multiple subcortical cysts
5. 9 - Population dynamics
   1. crude birth rate
      1. the number of live births per 1,000 population in a given year
   2. general fertility rate
      1. number of live births per 1,000 women ages 15-44 in a given year​
   3. age specific fertility rate
      1. Number of births per 1000 women of a specific age (group) in a given year​
         1. compare fertility across countries and diffferent age groups
   4. gross reproduction rate
      1. TFR ∗ (Proportion of female births)
   5. net reproduction rate
      1. Takes into account mortality rate compared to GRR​
         1. therefore, will always be less than the GRR
6. 8- Correlation and regression model
   1. finding the line that best describes the data plot present
   2. linear regression
      1. outcome is continuous
         1. important to include the dummy variable for the binary explanatory variables
            1. interpretation using Y=mx+b
   3. logistic regression
      1. outcome is binary
         1. the constant is the baseline odds
            1. after getting the odds, they are converted to probability by dividing 1+odds
   4. goodness of link
      1. tests if the data is actually in a straight line or no
   5. goodness of fit
      1. tests if the line is good enough or no
         1. indicates how far or close the points are
7. 7- Prevalence and epidemiology of female infertility
   1. PCOS has a prevalence of 10 percent of women worldwide
   2. prevalence of PCOS is 18.3 percent in Qatar
8. 6- labor
   1. stages
      1. stage 1
         1. latent phase
         2. active phase
         3. transitional phase
      2. stage 2
         1. pushing stage
            1. cardinal movements
            2. engagement
            3. flexion
            4. internal rotation
            5. extension
            6. restitution
            7. expulsion
      3. stage 3
      4. stage 4
      5. starts with onset of true labor till the cervix is 10 cm dilated and 100% effaced
      6. starts when the cervix is 100% effaced and 10cm dilated till the baby is delivered
      7. starts from the expulsion of fetus till the expulsion of the placenta
      8. starts after the placenta is delivered till 1-4 hrs after delivery
   2. complications
      1. postpartum hemorrhage
      2. hematomas
      3. lacerations
      4. DVT
      5. Infections
      6. retained placenta
      7. placenta accreta
      8. hypertension disorders
   3. labor induction
      1. pharmacologically
         1. PDE2 gel
      2. mechanically
         1. trans-cervical catheter
   4. followed by amniotomy to shorten the time from induction to delivery
9. 5- Management of PCOS
   1. Lifestyle modification
      1. Diet and exercise
   2. Oral contraceptives
      1. Managing (hirsutism)
         1. Increased risk of venous thromboembolism (VTE)
      2. if not effective for 6 months
         1. Spironolactone
         2. Finasteride
   3. Induction of ovulation
      1. Clomiphene citrate
         1. Antagonist of Estrogen receptor
            1. side effects
            2. Abnormal vaginal/uterine bleeding
      2. Letrozole
         1. Subtopic 1
            1. inhibitor of aromatase enzyme
            2. side effects
            3. constipation, hot flashes
      3. Gonadotropins
      4. Pulsatile gonadotropin-releasing hormone [GnRH]
      5. Dopamine agonists
   4. Dye test
      1. with
         1. laparoscopic ovarian drilling
            1. Risks:
            2. potential adhesion formation
   5. others
      1. intrauterine insemination
      2. IVF