5.2: Infertility and contraception Flashcards
Define coitus interruptus
the pull out method
Name three methods of ‘natural contraception’
- Abstinence2. Coitus interruptus3. Rhythm method (getting to know your cycle really well)
What is one disadvantage to having a vasectomy?
Not immediately effective since there may still be sperm existing in the male tract
Name three barrier methods of contraception, what product can they all be used in conjunction with?
- Condoms
- Diaphragm: (lies diagonally across cervix and holds sperm in an acidic environment to reduce its survival time)
- Cap: across cervix
All can be used with spermicide: inserted into vagina pre-intercourse to kill sperm
What is a combined OCP and how does it work?
Has estrogen and progesterone which:
- stimulates -ve feedback to the hypothalamus/pituitary -> inhibits follicular development/ovulation
- Loss of the estrogen positive feedback means no LH surge
What forms of contraception inhibit transport of the oocyte down the fallopian tube? How effective is it?
Occluding the fallopian tubes; clips, rings, ligation, tubes RARELY rejoin
What form of contraception inhibits sperm from passing through the cervix chemically? (Not physically)
Combined OCP or progesterone only pill/implant/depot: Tricks body into thinking its pregnant -> thick acidic cervical mucus, endometrial changes, etc.
Name two potential consequences of having excessive progesterone in the body?
- Induces over-proliferation of endometrium -> cancer
2. Excessive suppression of estrogen
Name three forms of contraception that can inhibit implantation of the embryo in the uterine lining
- Hormonal contraception affects the receptivity of the endometrium
- Postcoital contraception
- IUDs
What are the two main types of IUDs and how do they work?
Both act as a physical barrier against sperm transport and..
- Copper: interferes with the endometrial enzymes to prevent implantation
- Progesterone; -ve feedback in the axis
Define primary and secondary infertility
Infertility: Unable to conceive within 1 year Primary: no previous pregnancy
Secondary: previous pregnancy, successful or not
Name four factors that might contribute to male infertility (not psychological)
- Low sperm count
- Poor sperm morphology/motility
- Low ejaculate volume (inadequate secretions from accessory glands)
- Sperm autoimmunity
Name two factors that contribute to male infertility during coitus
- Retrograde ejaculation: semen enters bladder rather than emerging through the penis
- ED
Briefly describe three major factors that can cause female infertility
- Ovulatory failure: Hormone imbalance or polycystic ovaries
- Impaired gamete/zygote transport; tube defects, anti-sperm antibodies, non-optimal cervical mucous
- Implantation defects; chromosomal abnormalities (embryo unable to reach blastocyst stage) or endometrial abnormalities (i.e endometriosis)
Define anovulation, is it ever normal?
Ovaries don’t release an oocyte during a menstrual cycle, occasionally normal at the extreme ends of reproductive life (young and old)
What are 6 potential causes of anovulation?
- Stress factors; stress, exercise, weight loss 2. Pituitary tumours
- Necrosis
- Ovarian failure
- Menopause
- Chemicals: radio/chemotherapy
Describe why polycystic ovarian syndrome can result in female infertility? Name two other conditions which may arise as a result of PCOS
Lack of pulsatile GnRH secretions and increased androgen secretions -> raises/confuses LH/FSH ratio -> difficult follicular development; follicles produce abnormal patterns of estrogen secretions -> chronic anovulation due to inappropriate feedback signals from the ovary to the hypothalamus/pituitary.
How might you diagnose anovulation?
Measure plasma hormone levels
Name three methods you can use to induce ovulation in a patient with anovulation
- Anti-estrogen: tricks body into thinking estrogen levels are low so there’s an increase in FSH
- Gonadotrophins: like FSH
- GnRH agonists; (pulsatile)
What aspects of a patient history may lead you to suspect that they have tubal ligation?
Name two ways tubal ligation can be diagnosed and two treatment options
Pevious pelvic infection, previous scarring (infection, endometriosis), sterilization
Laparoscopy and dye, HSG (hysterosalpingogram; X-ray with thin tube threaded into uterus and contrast material)
Treatment: tubal surgery (reanastomosis) or assisted conception (insert fertilized embryo from the lab into the uterine lining)
Name three factors that might be causing abnormal sperm production
- Testicular disease
- Duct obstruction; infection or vasectomy
- Hypothalamic/pituitary dysfunction
List the values that correspond with each category in a normal semen analysis:a) Volumeb) sperm count c) % of sperm in the semen that are motile d) % of sperm in the semen with a normal morphologyWhat is the normal range of sperm count (millions/ml)
a) 1.5-4mLb) >15 million/mLc) >40%d) >4%The normal range is 20-200 million sperm/ml
Name four things you may have to check when managing a couple with suspected infertility
- They’re having regular unprotected sex
- Regular menstrual cycle (21-35 days) and normal day 21 progesterone levels (evidence of ovulation)
- Check patient tubes; history of infection, sterilization
- Adequate sperm count
Name three major methods you can use to manage/solve infertility.
- Drugs to overcome hormone problems
- Surgery to overcome tubal occlusion
- Overcome timing/fertilization issues with IVF
How does an IVF work?
- Stimulates ovary to release more oocytes
- Take sperm sample and fertilize the oocyte in vitro
- Allow embryo to develop until blastocyst stage in vitro -> transfer back to uterus
Name four ways you could overcome the issue of inadequate sperm/sperm transport in a couple when providing IVF?
IUI: intrauterine insemination
ICSI: intracytoplasmic sperm injection
TESA: testicular sperm aspiration
GIFT: gamete inrafallopian transfer
Name two ways to overcome the issue of inadequate eggs when providing a couple with IVF
Bonus: name one condition that often requires one of these solutions
- Egg donation
2. CT (cytoplasmic transfer); often relating to mitochondrial disease
What is often the cause of early miscarriages/ spontaneous abortions in women who become pregnant shortly after discontinuing the pill? What can be concluded from this?
Chromosomal abnormalities resulting from nondisjunction
Thus, better to use another type of contraception 1-2 menstrual cycles before attempting to get pregnant
Name three ways a patient with PCOS tends to present clinically
- Secondary amenorrhea/infertility
- Hirsutism; abnormal growth of facial and bodily hair
- Obesity
Briefly describe the mechanism of action of the ‘morning-after pill’
Estrogen taken in large doses within 72 hours of intercourse prevents IMPLANTATION
Likely by:
- altering tubal motility
- interfering with corpus luteum
- causing abnormal changes in the endometrium
Name two conditions/diseases which may arise as a result of PCOS
- Abnormal estrogen secretions put women at risk of endometrial malignancy.
- PCOS can cause insulin resistance -> type 2 diabetes
In what scenerio can’t you manage infertility?
If the infertile issue is with implantation as an embryo cannot be grown to full fetal development in a lab
