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55 THE FEMALE REPRODUCTIVE SYSTEM

Ervin E. Jones

REPRODUCTIVE FUNCTION IN THE FEMALE HUMAN

Reproductive function in female humans is controlled by hormones that emanate from the
hypothalamic-pituitary-gonadal axis (see Chapter 47). The release of a mature ovum from an ovary,
known as ovulation, is the dominant event of the menstrual cycle. Whereas ovulation in some
mammals is triggered by mating, ovulation in the female human is spontaneous and is regulated
by cyclic functional interactions among signals coming from the hypothalamus, the anterior pituitary,
and the ovaries. Although many aspects of female reproduction are cyclic, maturation and demise
(i.e., atresia) of the functional units of the ovaries-the ovarian follicles-are continuous processes that
occur throughout reproductive life.

The ovaries are not the only female organs that undergo rhythmic changes. Alterations in cervical and
uterine function are controlled by changes in the circulating concentrations of ovarian hormones, that
is, the estrogens and progestins. For example, the uterine lining or endometrium thickens under the
influence of ovarian hormones and deteriorates and sloughs at the end of the cycle when ovarian
estrogen and progestin secretion diminishes. Menstruation reflects this periodic shedding of the
endometrium. Menstrual cycles are generally repetitive unless they are interrupted by pregnancy or
terminated by menopause. All the cyclic physiological changes prepare the female reproductive tract
for sperm and ovum transport, fertilization, implantation, and pregnancy.

Female Reproductive Organs Include the Ovaries and Accessory Sex Organs

The ovaries lie on the sides of the pelvic cavity (Fig. 55-1A). A layer of mesothelial cells covers the
surface of the ovary. The ovary itself consists of an inner medulla and an outer zone, or cortex, that
surrounds the medulla except at the hilar area. The cortex of the ovary in a mature woman contains
developing follicles and corpora lutea in various stages of development (Fig. 55-1B). These elements
are interspersed throughout the stroma, which includes connective tissue, interstitial cells, and blood
vessels. The medulla comprises large blood vessels and other stromal elements.

The female accessory sex organs include the fallopian tubes, the uterus, the vagina, and the
external genitalia. The fallopian tube provides a pathway for the transport of ova from the ovary to
the uterus. The distal end of the fallopian tube expands as the infundibulum, which ends in multiple
fimbriae. The infundibulum is lined with epithelial cells that have cilia that beat toward the uterus. The
activity of these cilia and the contractions of the wall of the fallopian tube, particularly around the time
of ovulation, facilitate transport of the ovum.