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Reproduction (Semester 4) > 5.2: Infertility and Contraception > Flashcards

5.2: Infertility and Contraception Flashcards

1
Q

Name 7 general methods/targets of contraception

A

1) Natural method
2) prevent sperm from entering ejaculate (vasectomy)
3) prevent sperm from reaching cervix (barrier method)
4) prevent ovulation (hormonal methods)
5) inhibit transport along fallopian tube (sterilisation)
6) Inhibit sperm passing through cervix (POP/Implant)
7) Inhibit implantation (ntrauterine Contraceptive Device)

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2
Q

Name three methods of ‘natural contraception’

A

1) Abstinence
2) Coitus interruptus
3) Rhythm method (getting to know your cycle really well)

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3
Q

Define coitus interruptus

Why may this be an ineffective method of ‘natural contraception’?

A

The pull out method

May be ineffective because sperm is still present in pre-ejaculate fluid

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4
Q

Using the Rhythm method of ‘natural contraception’ what day would the ‘fertile period’ be and how would you work this out?

Wat is a requirment for this method and Include assumptions

A

Requirment: need regular cycle.

1) Assume maximum sperm survival of 7 days (average 3-4 days)
2) Assume ovum survival of 1 day.
3) So for a regular 28 day cycle, with ovulation on day 14 or 15, the ‘fertile period’ is day 7- 16 of cycle

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5
Q

What is a vasectomy and what is the purpose in terms of contraception?

What is one disadvantage to this form of contraception?

A

Cutting/dividing the vas deferns bilaterally which prevents sperm from leaving the ejaculate. Sperm that is not ejected is reabsorbed in the epididymis

Disadvantage: you have to wait a while for the contracpetion to be effective because following procedure some sperm will still exist superior to the incision. Condom use is recomended for three months after

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6
Q

Name three barrier methods of contraception,

List one more that should be used in conjunction with one of the other 3

A

1) Condoms
2) Diaphragm
3) Cap: first across the cervix (physical barrier)

Spermicide should be used in conjunction with 2 or 3 above for most effectivness (product inserted into vagina prior to intercourse that kills sperm)

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7
Q

Give 3 advantages of condoms

A

1) Readily available
2) protects against STIs/STDs
3) highly effective if used correctly

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8
Q

What barrier method is this image showing and explain how it works

Give 2 disadvantages

A

Diaphragm: lies diagonally across cervix to prevent sperm from reaching cervix. Works to hold sperm in acid environment of vagina (without reaching cervix) and reduces survival time

Disadvantage:

  • needs correct fitting
  • does not completely occlude passage of sperm
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9
Q

Name 4 methods of hormonal contraception and briefly explain the main way each works

A

1) Combined OCP: oestorgen and progesterone

  • Inhibits ovulation
  • thickens cervical mucus
  • thins the lining of the cervix

2) Depot progesterone: 3 monthly injections of progesterone

  • Inhibits ovulation
  • thickens cervical mucus
  • thins the lining of the cervix

3) Progesterone-only pill:

  • thickens cervical mucus
  • thins the lining of the cervix
  • (some may inhibit ovulation)

4) Progesterone implants:

  • thickens cervical mucus
  • thins the lining of the cervix
  • (some may inhibit ovulation)
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10
Q

How do methods of hormonal contraception inhibit ovulation?

A

oestrogen and/or progesterone ➞ negativly feedback to the hypothalamus/pituitary ➞ decrease FSH, LH ➞ inhibits development of follicle ➞ no ovulation

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11
Q

How do hormonal methods of contraception thicken cervical mucus?

A

Cervical mucus thickness and acidity varies throughout the menstral cycle

  • Progesterone rich during luteal phase ➞ thick, acidic cervical mucus

Hence giving progesterone, mimics this phase of the female cycle which makes it difficult for sperm to swim

** This is the main mechanism of the progesterone only pill

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12
Q

Which hormonal method most commonly causes the endometrial lining to thin?

How does it do this + how does this act as a contraception?

A

Mainly the POP

Constant low levels of progestogen leads to development of endometrial thinning with scanty and atrophied glands + reduced synthesis of progesterone receptors

This means if fertilisation has occured, implantation will be much less favourable

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13
Q

Name three methods of administering hormonal contraception

A

The pill, patch and injections

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14
Q

List the 2 main ways that hormonal contraception work?

A

1) negative feedback via HPG to prevent ovulation
2) thickening of cervical mucous (more difficult for sperm to swim) and thinning of uterus lining (makes implantation less likley if fertilisation does occur)

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15
Q

What is Sterilisation in females?

A

Occlusion of fallopian tubes through clips, rings or ligation

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16
Q

Name two potential consequences of having excessive progesterone in the body?

A

1) can induce over proliferation of endometrium - leading to neoplasms
2) Excessive suppression of oestrogen

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17
Q

Give 3 forms of contraception that can inhibit implantation of the embryo in the uterine lining and state how

A

1) Hormonal contraception: directly effects receptivity of endometrium + absence of corpus luteum prevents preparation of endometrium for implantation
2) Postcoital contraception (ECP)
3) IUDs (can also be used as post-coital contraception for upto 5 days)

18
Q

What are the two main types of IUDs and how do they work?

A

1) Copper: interferes with the endometrial enzymes to prevent implantation and act as a physical barrier against sperm transport
2) Progesterone: -ve feedback via HPG axis

19
Q

Is male hormonal contraception currently available, why or why not?

Which hormone would be involved?

A

No, some trials have been successful with testosterone being the most suitable exogenous hormone (used in combination with progesterone to reduce the side effects).

However, issues such as low level sperm production, persisting side effects (i.e mood swings), reversibility and problems caused with the male repro tract/sexual function still need to be overcome

20
Q

Define infertility (primary and secondary)

A

Defined as ‘failure to conceive within 1 year’

Primary: when you have not had a previous pregnancy

Secondary: when you have had a previous pregnancy, successful or not

21
Q

Name 4 factors that might contribute to male infertility (to do with poor semen quality)

A

1) Low sperm count
2) Poor sperm morphology/motility
3) Low ejaculate volume
4) Sperm autoimmunity

22
Q

Name 2 factors that contribute to male infertility related to coital impairment

A

1) Retrograde ejaculation: semen enters bladder rather than emerging through the penis during orgasm
2) Erectile dysfunction

23
Q

Name 2 factors that can cause female infertility related to ovulatory failure

A

1) Hormone imbalance
2) PCOS (polycystic ovarian syndrome)

24
Q

Name 3 factors that can cause female infertility related to impaired gamete/zygote transport

A

1) Tube defects
2) Anti-sperm antibodies
3) Non-optimal cervical mucous

25
Q

Name 2 factors that can cause female infertility related to Implantation defects

A

1) Chromosomal abnormalities
2) Endometrial abnormalities

26
Q

Define anovulation

How does this relate to menstruation?

A

When ovaries do not release an oocyte during a menstrual cycle. Can be normal, especially at the extremes of reproductive life

Often results in often amenorrhoea or oligomenorrhoea

27
Q

What are 6 potential causes of anovulation?

A
  1. stress
  2. exercise
  3. weight loss
  4. pituitary tumours
  5. necrosis
  6. ovarian failure
  7. menopause
  8. chemicals: radio/chemotherapy
28
Q

Why can polycystic ovarian syndrome result in female infertility?

What is a common symptom?

What other disease can arise as result of PCOS?

A

It leads to increased androgen secretion which causes a raised LH/FSH ratio. This ratio is important to ensure proper follicular development.

Symptom: Multiple small ovarian cysts

PCOS can also cause insulin resistance, potentially leading to type 2 diabetes

29
Q

How might you diagnose anovulation?

How might differentiate causes?

A

Diagnosis: measure serum progesterone levels in midluteal phase (approx. day 21)

Differentiate causes: by looking at hormone levels (FSH, LH, Oestrogen)

30
Q
A
31
Q

List and explain 3 ways to induce ovulation

A

1) Anti-oestrogens: reduce negative feedback to hypothalamus/pituitary to increase GnRH, FSH and LH
2) Gonadotrophins: FSH administration
3) GnRH agonists: pulsatile to mimic normal secretion

32
Q

What is tubal occlusion?

Name two causes, two methods for diagnosis and two treatment options

A

Occlusion of the fallopian tubes so egg cannot be transported

Causes:

  • sterilization
  • scarring from infection or endometriosis

Diagnosis:

  • Laparoscopy and dye insufflation
  • Hysterosalpingogram HSG (x-ray using dye to look at the uterus and fallopian tubes)

Treatment:

  • tubal surgery (reanastomosis)
  • assisted conception (intrauterine insemination (IUI) and in vitro fertilisation (IVF))
33
Q

Name 3 factors that might cause abnormal/absent sperm production

A

1) Abnormal production e.g. Testicular disease
2) Obstruction of ducts e.g. Infection, vasectomy
3) Hypothalamic/pituitary dysfunction

34
Q

List the values that correspond with each category in a normal semen analysis:

a) Volume
b) sperm count
c) % of sperm in the semen that are motile
d) % of sperm in the semen with a normal morphology

A

a) >1.5mL
b) >15 million/mL
c) >40%
d) >4%

35
Q

Name 4 things you need to investigate when managing a couple with suspected infertility

A

1) Regular unprotected intercourse?
2) Ovulating?

  • regular menstrual cycle?
  • day 21 progesterone?

3) Patent tubes?

  • history of infection/ sterilisation?
  • dye insufflation or HSG

4) Adequate sperm count?

36
Q

Name 3 treatments for infertility

When cannot be treated, and what other options may you have to dicuss with the patient?

A

1) Drugs to correct hormone problems e.g. Induce ovulation
2) Overcome tubal occlusion by surgery
3) Overcome timing/fertilisation issues with IVF

If issue is with implantation, there is NO treatment as an embryo cannot be grown to term in a lab ➞ may discuss adoption or surrogacy

37
Q

Explain the process of IVF

A

1) Stimulate ovary and retrieve oocytes
2) Retrieve sperm
3) Fertilise in vitro
4) Allow embryo to develop in vitro
5) Transfer embryo to uterus

38
Q

If the problem is inadequate sperm/transport, what are your options for IVF? (2)

A

1) Donor gametes
2) Variations on IVF:

  • IUI- Intrauterine insemination
  • ICSI- Intracytoplasmic sperm injection
  • TESA- Testicular sperm aspiration
  • GIFT- Gamete intrafallopian transfer
  • ZIFT- Zygote intrafallopian transfer
39
Q

If the problem is inadequate sperm/transport, what are your options for IVF? (2)

A

1) egg donation
2) CT- Cytoplasmic transfer (often in cases of mitochondrial disease)

40
Q

What is primary vs secondary amenorrhoea?

Give the 2 most common causes of secondary amenorrhoea

A

Primary: never had periods

Secondary: cessation of periods for 3 months after they have begun

Causes: pregnancy (test hCG) or a fall in body weight (test FSH and LH levels)

Reproduction (Semester 4) (20 decks)

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