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Assignment 1: The Ovaries
In the circle of life, the cycle begins with birth and ends with death. Essential to the conception of life are the female ovaries. One of the most important reproductive organs, they are vital in regulating women’s bodies and necessary for pregnancy. Though they might seem small, those two organs have a mighty big role in our lives. The main functions of the ovaries are the produce hormones like progesterone and estrogen which are vital for reproduction and female traits and characteristics, and ovulation which occurs during the menstrual cycle.1
Also referred to as the female gonads, the ovaries are close to the lateral pelvic wall and one can be found on each side of the uterus attached by the ovarian ligament, within the ovarian fossa which is under the fallopian tubes.1,2 The area where the ovaries can be found, the ovarian fossa, is in front of the ureter and the internal iliac artery, and bounded by the external iliac artery.2 The ovaries are connected to the pelvic sidewall wall of the body by the suspensory ligament, which is a good landmark to find them, and the mesovarium (contains the venous and arterial supply) connects them to the posterior area of the broad ligament.2,3 The ovarian ligament, mesovarium, and suspensory ligaments all support the ovaries. Central to the female reproductive system, ovaries are a pair of off-white oval sex glands with uneven surfaces that are about 3-4 cm long, 2-3 cm wide, and 1-2 cm thick, but they become smaller with menopause.1,2
The control system in charge of regulating ovarian functions are the pituitary gland and the hypothalamus in conjunction with the ovaries using positive and negative feedback loops.4 The ovarian cycle consists of the follicular phase during the first 14 days of the monthly cycle (which is realistically anywhere between 21 and 35 days), and the luteal phase which are the second 14 days.2 One of the main functions of the ovaries, like previously stated, includes ovulation, which is when an egg (female gamete) is released at day 14 of the female cycle.2 The ovaries are also in charge of follicular maturation and corpus luteum formation, which are processes induced by the hypothalamus produces Gonadotropin-releasing hormone (GnRH) which then gets delivered to the anterior pituitary to bind to receptors to release Follicle-stimulating hormone (FSH) and Luteinizing Hormone (LH).4
The ovary’s surface is covered by a “simple cuboidal-to-columnar “mesothelium lining.5 Each ovary can be divided between the outer cortex and inner medulla; the outer layer is the ovarian cortex which contains the ovarian follicles (which are surrounded by thin granulosa cells and have one oocyte per follicle) within the stroma, and the inner layer is the ovarian medulla which doesn’t have follicles.5 The follicles contain the theca of follicle, the liquor and antrum folliculi, as well as the zona pellucida, corona radiata, cumulus oophorus, and the membrana granulosa.5 The ovarian artery (accompanied by the vein) is the main vehicle with which blood supply reaches the ovaries, which originates from the descending aorta and enter/exit through the hilum.2 The right ovarian vein drains into the inferior vena cava while the left ovarian vein does so into the left renal vein.2 The nerve supply for the ovaries, which will be discussed later, goes along with the vasculature through the suspensory ligament, entering via the hilum.2 Lymphatic drainage is majorly to the lateral aortic nodes, but the iliac nodes as well.2
Development of the ovary starts when primordial germ cells experience mitosis, approximately during the 20th week of pregnancy, then they undergo meiosis and arrest during the meiotic prophase I which leads to the formation of germ cell cysts.6 A little bit after birth, the cysts regress to make the primordial follicle, follicles in resting condition, which has an oocyte and one later of granulosa cells.5,6 Females are born with about 1-2 million primordial follicles, which reduces to 400,000 to 500,000 by puberty and after the woman’s first period 1000 follicles are lost every month, with that rate increasing after the age of 35.6 Throughout each monthly ovarian cycle, some of the follicles can be activated by FSH and progress to ovulation through stages: primary, secondary, and tertiary (Graafian) follicles.5 Only 1 follicle normally goes through all of the stages, and the rest who started the process degenerate and sometimes show as atretic follicles.5
Different medical procedures can be done to the ovaries when necessary. An oophorectomy is a surgery that can be done to remove to ovaries, although usually used as a last resort and mostly done during a hysterectomy procedure to remove the uterus, this surgery can be unilateral or bilateral depending on what’s necessary.7 To reach the ovaries a surgeon would have to make 3-4 smaller incisions in the abdomen through which a small camera can be inserted into one of the incisions and surgical tools in the others.7 The ovaries can be separated from the tissue around it and the blood supply to be put into a pouch that can be taken out through an incision.7 To look at the ovaries more closely for other reasons, such as to remove an ovarian cyst (cystectomy), one small (laparoscopy) and one large (laparotomy) incision can be made on the abdomen and the latter gives the best view of the abdominal and female pelvic organs.8
The ovaries can face different alterations that can give rise to different diseases and disorders. A normal variant is Turner syndrome is a chromosomal abnormality that can happen by paternal nondisjunction due to the 45, X karyotype and it usually involves the dysfunction or complete absence of the ovaries despite still having a cervix, uterus, and vagina.2 There are 3 common types of pathophysiological variants for the ovaries; ovarian cysts, ovarian torsion, and ovarian cancer. An ovarian cyst is an enlargement bigger than 5 cm in an ovary and they can be benign or malignant, ovarian torsion is a cyst that’s grown so large it can turn over and twist the suspensory ligament which cuts off the blood supply, and ovarian cancer which is when a tumor forms and it can be detected physically like a cyst with a bimanual or physical examination.2 Ovarian cancer can’t really be detected well by tumor markers, which is why it’s the most fatal form of cancer for women. Other variants for the ovaries include ovarian transposition, surgical absence, changes because of metastatic disease, postradiation changes, and variations due to transgender procedures.2
Talking about reaching the ovaries, the innervation of the ovary/uterine tube has nerves that come from the superior ovarian group from the intermesenteric nerves and the renal plexus, the intermediate ovarian group from the pre-sacral nerve or the hypogastric nerve, and the inferior ovarian group from the pelvic plexus.9 The supply of ovarian nerves seem to be sympathetic, and the superior and intermediate nerves are the ones that mostly supply filaments to the ovaries.9
Overall, the ovaries evidently are extremely important for female characteristics and reproduction. Their healthy functioning is imperative for a woman’s health and I believe that more research should be done for the early diagnosis of ovarian diseases and disorders, especially ovarian cancer.
- Cox E, Takov V. Embryology, Ovarian Follicle Development. StatPearls. February 2019. https://www.ncbi.nlm.nih.gov/books/NBK532300/.
- G M. THE INNERVATION OF THE OVARY, UTERINE TUBE, TESTIS AND EPIDIDYMIS. The Ovary, Uterine Tube, Testis and Epididymis.:508-517. http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC1252357&blobtype=pdf.
- Karck U, Keck C. [Physiology of ovarian function]. [Physiology of ovarian function]. 2002;59(4):153-158.
- King D. Ovary. SIU SOM Histology ERG. http://www.siumed.edu/~dking2/erg/ovary.htm. Published January 2, 2013. Accessed August 25, 2019.
- Miller BF. Encyclopedia & Dictionary of Medicine, Nursing, & Allied Health. Philadelphia, PA: Saunders; 2003.
- Oophorectomy (ovary removal surgery). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/oophorectomy/about/pac-20385030. Published July 25, 2019. Accessed August 25, 2019.
- Ovary Anatomy: Gross Anatomy, Microscopic Anatomy, Natural Variants. Ovary Anatomy: Gross Anatomy, Microscopic Anatomy, Natural Variants. https://emedicine.medscape.com/article/1949171-overview. Published September 24, 2018. Accessed August 25, 2019.
- Saksouk FA, Johnson SC. Recognition of the Ovaries and Ovarian Origin of Pelvic Masses with CT. RadioGraphics. 2004;24(1). doi:10.1148/rg.24si045507.
- HS. Surgery for Ovarian Cysts. Surgery for Ovarian Cysts | Michigan Medicine. https://www.uofmhealth.org/health-library/hw178611. Published February 19, 2019. Accessed August 25, 2019.
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