15) Contraception and Infertility Flashcards
What are some examples of natural contraceptive methods?
Fertility awareness method, lactational amenorrhoea
How does the fertility awareness method work?
Use of fertility indicators to identify fertile points in the cycle e.g. body temp
What are the advantages of natural contraceptive methods?
No hormones or contraindications
What are the disadvantages of natural contraceptive methods?
Not as effective, unreliable
How does breastfeeding affect ovulation?
Delays return of ovulation after childbirth (6 months)
What are some examples of barrier contraception?
Male/female condoms, female diaphragm
What are the advantages of barrier contraception?
Prevent STIs, inserted anytime before intercourse
What are the disadvantages of barrier contraception?
Sensitivity to latex
Female condoms not widely available
Spermicide can cause local reaction
What contraceptive methods work by preventing ovulation?
COCP, progesterone depot, progesterone implant
What are the advantages of the COCP?
Relieves menstrual disorders and reduces risk of ovarian cysts and cancer
What are the disadvantages of the COCP?
User dependent
Side effects (mood and breast tenderness)
Increased of thromboembolism and MI
How is the COCP administered?
Taken for 21 days and then a 7 day break
How is the progesterone depot administered?
Subcutaneous/IM injection, lasts 8-13 weeks
What are the advantages of the progesterone depot?
Convenient, relieves menstrual disorders
What are the disadvantages of the progesterone depot?
Altered and irregular bleeding
Delayed return to fertility
Small loss of bone mineral density
How is the progesterone implant administered?
Flexible rod below skin in upper arm, 3 years of protection
What are the advantages of the progesterone implant?
Long duration, relieves menstrual disorders
What are the disadvantages of the progesterone implant?
Small procedure
Local adverse effects
Changes in bleeding pattern
What is an example of contraceptive that inhibits sperm transport? What is its action?
Progesterone only pill
Thickens cervical mucus
How does the intrauterine system work?
Using progestogen, reduces endometrial proliferation and prevents implantation, also thickens cervical mucus
What are the advantages of the intrauterine system and device?
Convenient, long duration and relieve menstrual disorders
Device can be emergency contracpetion
What are the disadvantages of the intrauterine system?
Insertion unpleasant
IUS displacement
Menstrual irregularity in first 6 months
Risk of uterine perforation
How does the intrauterine device work?
Copper toxic to sperm and ovum so no fertilisation. Also copper causes endometrial inflammation to prevent implantation
What are the disadvantages of the intrauterine device?
Insertion unpleasant
IUD displacement
Heavy peirods
Risk of uterine perforation
What is a vasectomy?
Vas deferens interrupted to prevent sperm entering ejaculate
What is tubal ligation?
Fallopian tubes cut or blocked to stop ovum travelling from ovary to uterus
Define infertility:
Failure of conception in a couple having regular, unprotected coitus (2+ per week) for one year
What examinations may be performed to investigate infertility?
BMI Secondary sexual characteristics Galactorrhoea Pelvic examinations Testicular size and descent
What are some of the causes of infertility? (general)
Male factors Ovulatory disorders Tubal damage Uterine or peritoneal disease Other factors (unexplained)
What are some male factors causing infertility?
Idiopathic oligospermia
Varicocele
Abnormal sperm production
Hypothalamic-pituitary dysfunction
What are some ovulatory disorders causing infertility?
Hypothalamic-pituitary failure Polycystic ovary syndrome Congenital adrenal hyperplasia Adrenal tumours Turner's
What are the 3 core signs of polycystic ovary syndrome?
Polycystic ovaries
Anovulation
Hyperandrogenism - hirsutism (facial hair)
What can cause tubal damage leading to infertility?
Past pelvic infection e.g. chlamydia
Previous pregnancy or pelvic surgery
Developmental anomaly
Endometriosis
What uterine and peritoneal disease can cause infertility?
Endometriosis
Uterine fibroids
Cervical stenosis or hostility (acidic)
What is endometriosis?
Presence of endometrial tissue in sites other than uterine cavity
What are some signs of endometriosis?
Dysmenorrhoea, dyspareunia, chronic pelvic pain, infertility
How is endometriosis diagnosed?
Laparoscopy
What is the management of endometriosis?
Anti-inflamms and pill to regulate periods
What investigations can be performed in female infertility?
LH and FSH (day 2)
Progesterone (day 21)
Pelvic USS
Tubal patency by hysterosalpography
What investigations can be performed in male infertility?
Sperm analysis
Antisperm antibodies
USS
FSH, LH and testosterone
What treatment is there for inducing ovulation?
Clomefine citrate - increases GnRH
GnRH agonists
Changes to weight e.g. if anorexic
What treatment is there for tubal occlusion?
Surgery
Assisted conception
What are some treatments for male infertility?
Artificial insemination
Intracytoplasmic sperm injection
GnRH agonists or dopamine agonists
