The changes in the levels of Oestrogen and progesterone throughout pregnancy

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The human reproductive system is responsible for hormones and internal reproduction. When humans hit puberty male and female reproductive organs mature. In men a hormone called testosterone is produced in the testes. Sperm is produced by hundreds of seminiferous tubels, residing ins the scrotal sac outside the body (Sperm develops 2-3degree's belowbody temperature). Sperm travels to the epididymis to be stored. The seminal vesicle and the prostate gland create seminal fluid to help transport sperm, mixed together this fluid is known as semen. During intercourse the penis becomes erect enabling it to enter the vagina. Semen will travel along the urethra and deposit inside the vagina. Females have two ovaries which produce hormones. The ovaries will produce eggs (ova) and once a month one ova will leave the cervix and enter the fallopian tube. During fertilization, sperm will travel into the vagina and, if open, enter the cervix, sperm then passes into the uterus. From there the sperm will use their tails to swim into the female Fallopian tubes and find the egg. The egg is covered in a layer of corona radiata cells, sperm will push through this wall. The first sperm to reach the egg on the inside, it will fertilize the egg. (205)

Source of hormone_Hormone_Function(s)__The Corpus Luteum_Estrogen_This hormone triggers the development of certain vital organs inside the fetus. It increases hormone production in the fetus and stimulates growth.

Estrogen levels rise constantly throughout pregnancy__The Corpus Luteum_Progesterone _Progesterone plays a very important part in the mother's immune system.

Produced in the early stages of pregnancy progesterone levels rise then, when the placenta develops, it’ll near stop. ____Both Estrogen and Progesterone help maintain the lining of the uterus, thus keeping the fetus attached to the mother. They also help to prepare the mammary glands for the production of milk.__The Chorion (placenta) _Human chorionic gonadotropin (hCG)_HCG promotes the maintenance of the corpus lutenum in the beginning stages of pregnancy by telling it to maintain the production of progesterone.__Chorion (Fetal portion of the placenta)_Human Chorionic Somatomammotropin (hCS) (aka: Human placental lactogen (hPL))_This hormone increases in levels as the placentas size increases. It develops breast tissue which assist with lactation and deposits proteins into tissue which help with fetal growth. It also decreases levels of glucose used by the mother and gives the remainder to the fetus. Its a human growth hormone. __Placenta and Ovaries_Relaxin_Helps to relax muscles which dilate the cervix at the end of pregnancy.__Hypothalamus_Oxytocin_Oxytocin levels rise at the very end of pregnancy. It helps the cervix to stretch open and will stimulate the nipples to produce milk.__

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Method of contraception_Evaluation of advantages_Evaluation of disadvantages_Final Evaluation__Condoms_Prevents sexually transmitted diseases and infections. They are affordable, easy to buy over the counter and very simple to use._Condoms can sometimes split, leading sperm to enter the vagina (unknowingly in a lot of case’s) A condom has to be thrown away after every use and some people can be allergic to the latex._A Safe and easy form of contraception. Often a choosen form of short term contraception. Condoms are not expensive and can be brought in bulk so are a great form of contraception. __Diaphragm_Diaphragms can last for up to 6 hours and are inserted before intercourse, which does not disrupt sex._They do not protect you from sexually transmitted infections. They are expensive and must be fitted by a doctor. _A safe form of contraception, however can be considered a hassle to be fitted by the doctor and removed within the same day. __Cervical cap_Can be left in the vagina for up to two days and can be inserted hours before intercourse. It fits over the cervix and prevents sperm from entering._Have to use a spermicide along side it. Very expensive and must be fitted by a doctor. It needs to be kept in for 6-8 hours after sex and they are limited in size._Uncomfortable for the woman to leave it in for 6-8 hours after intercourse. Due to price and insertion, could be considered a hassle. __Contraceptive pill_Good “no pregnancy rate”. Doesn't interrupt intercourse. Can reduce periods and menstrual pain. _Reliant on woman taking it every day. Pill can be “countered” by other medication._Very reliable when used correctly. Easy to get hold of and very cost effective. __Coitus interruptus_Does Not involve any form of contraception and is often described as more pleasurable. _Not effective. The male might not “pull out” in time and pre-cum can contain traces of sperm_Not recommended for a form of contraception.__Intrauterine device_The longest lasting forms of contraception. Depending on the woman, can stay inserted between 5-10 years._Copper IUD’s sometimes increase menstrual bleeding and cramps. Expensive and must be inserted by a doctor. _Perfect for long term contraception. It doesn't protect against STI’s so a condom could be recommended as well. __Rhythm Method_When done correctly is effective. Does Not involve any form of contraception._Can sometimes be calculated wrong and does not protect against STI’s_For long term relationships this might be a good option if calculated correctly with a regular menstrual pattern.__

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Huntingtons disease is an inherited neurodegeneration dominant disease which affects nerve cells within the brain leading to impaired movement and some behaviour in later life.A later decline in mental state can lead to dementia. The gene will always be dominant over a “normal” gene and there are no carriers, this is passed down from other sufferers however as it isn't normally detected until the mid 30s onwards so it’ll already have passed down before discovered. To stop this disease genetic counselling is needed, monitoring who has the condition and stopping it from being passed on.

Sickle cell Anaemia is an inherited recessive gene. Red blood cells in sufferers are often misshapen like a sickle and can clump together which causes blockage. The faulty red blood cells contain a defective haemoglobin which stops the cell carrying oxygen around the body. Quite often sufferers can appear tired or breathless. This gene is passed on when both parents have the abnormal gene. If one parent has it and the other does not it's likely their children will have what is known as a sickle cell trait which means misshapen blood cells could be present but they do not affect the carrier as the majority of their blood is “normal”.

Cystic fibrosis is an inherited genetic mutation which affects the lungs and digestive system. Sufferers cannot produce a gene known as CFTR (Cystic fibrosis transmembrane conductance regulator). This gene creates a protein which regulates sodium and chloride within cells, if defective, the body doesn't use the right amount of water causing a sticky mucus within the bodies passageways. Being a recessive condition, somebody with normal genes can counteract the inheritance of the gene. Their children would likely just become carriers. If a carrier has a child with another carrier or somebody who suffers from Cystic Fibrosis the risk of their child having the gene will rise significantly.

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Genetic counselling is an important consideration, particular for couples at risk of a range of genetic based conditions and predispositions.

When couples are looking to start a family or have recently found out they are due to start one many questions will begin to be raised. Whether its Age, exploits, family history or an abnormal ultrasound finding genetic counselling is a means to provide information, resources and support to patients. By providing them with possible answers to these questions a genetic counsellor will then be able to support their patients every question. Genetic counselling isn’t necessary for everybody. Normally people will seek out (or are pointed in the direction of) a Genetic Counsellor when they know they have a history of abnormalities in their close family, if they are having trouble conceiving, if they have a history of substance abuse and want to know if that has harmed their child and such like. Its important to note that a Genetic counselor is there to advise and inform a family on what to expect. They are not there to treat anything just to support the patient, after talking to a genetic counselor a patient or child will be referred to a specialized health person for Genetic tests and further treatment.

The first step is known as “Pre-Test Genetic Counselling” For example, when a woman discovers she is newly pregnant she will talk to her midwife or health care provider about her family and her history. Another great example is for families wanting to start a family who have a history of abnormalities, questions they want answered such as, “Will my child have this?”Pre-test counselling will discuss the patient's right to know or right not to know, information will be given about certain predispositions. Following the information the patient will be offered a series of genetic diagnostic tests to help detect any abnormalities. Diagnostic testing is the first form of testing. Carrier testing is taken when a family have a history of abnormalities the parents, or close family relatives, will be tested and then the test can provide a estimation on whether their child would have the condition or not. Pre-natal diagnoses detects any possible birth defects the child might have, for example downs syndrome. This is done via Amniocentesis (Amniotic fluid test (AFT) where a small sample of amniotic sac is examined for genetic abnormalities or most commonly, a Medical ultrasonography will be taken. This is an ultrasound where the health professional can visualize if the baby is growing well. The Predictive and presymptomatic testing detect gene mutations which are discovered after the birth of a baby. Pharmacogenomics is a genetic test which observes drug response on the baby. Newborn screening is a test taken afterbirth where a midwife or healthvisitor will take a prick of blood from the heel of a baby and test it for any abnormalities. Next there are some non-diagnostic tests. The Forensic test is undetaken for legal purposes. It can identify an unsafe enviroment for the child and will report any possible crime. The parental testing determins who the baby belongs and the Genealogical DNA test can determin ancestory.

Genetic counselling is a non direct counselling service where a patient or family can contact a healthcare professional in confidence and seek the advice they need. Its one of today’s best ways of figuring out family genetics and considering further knowledge into future childrens health. The tests are a way to provide answers to families and enable them the chance to seek out extra help on what to do next. In today’s modern age genetic counselors are increasing in popularity as more people seek the aid they need in expanding their families.

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References

Patient, (2012), Genetic counselling a guide for GPs[online].Available:<http://www.patient.co.uk/doctor/genetic-counselling-a-guide-for-gps>[10/05/2015]

WebMD, (2014), Womens health: Comparing birth control types[online].Available:<http://www.webmd.com/women/guide/comparing-birth-control-pill-types-combination-mini-pills-more>[10/05/2015]

BabyCenter, (2014), Prenatal Genetic counselling [online]. Available: <http://www.babycenter.com/0_prenatal-genetic-counseling_1607.bc> [10/05/2015]

Babble, (2012), Understanding pregnancy hormones. [online] Available: <http://www.babble.com/pregnancy/pregnancy-understanding-your-hormones/>[01/05/2015]

Parents, (2012), A cheat sheet to pregnancy hormones. [online] Available: <http://www.parents.com/pregnancy/my-life/emotions/understanding-pregnancy-hormones/ >[01/05/2015]

Tortora Grabowski (1989). Principles of Anatomy and Physiology. New York: Harper Collins. 983.

Following the pre-test, is the “Post-Test Genetic Counselling”. These are the results of the diagnostic testing. One of the first things a counselor will do in the post-test counselling is see how the patient is feeling after receiving their results. The counsellor will discuss whether the condition is a dominant or a recessive gene. A common question when discovering their child has the condition is, “Will my future children have it aswell?”, the counselor can help in many cases to ease the mind of the patient by using a punnett diagram and help the family to figure out the likelihood of their future children having the same condition. For example when a couple has a child with cystic fibrosis they would have a 75% chance of their other children not having the condition. However, discovering these statistics are not always possible and shouldn’t be taken as a solid fact. The next steps are supportive counselling, when given bad news about their child having a condition most families will be very emotional. By providing as much information on how to cope and deal with the condition they can help ease the minds of the patient. From here they will discuss how to inform close family and friends of the results, supporting the patient in everything.

Finally, a follow-up counselling session is scheduled. Here everything of importance will be written up in a letter and given to the family. This will provide all the information the patients need to know about dealing with their situation, however if they patients have more questions the counselor will offer more sessions.

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