5.2: Infertility and contraception

Question 1

Define coitus interruptus

Answer 1

the pull out method

Question 2

Name three methods of ‘natural contraception’

Answer 2

1. Abstinence2. Coitus interruptus3. Rhythm method (getting to know your cycle really well)

Question 3

What is one disadvantage to having a vasectomy?

Answer 3

Not immediately effective since there may still be sperm existing in the male tract

Question 4

Name three barrier methods of contraception, what product can they all be used in conjunction with?

Answer 4

1. Condoms
2. Diaphragm: (lies diagonally across cervix and holds sperm in an acidic environment to reduce its survival time)
3. Cap: across cervix

All can be used with spermicide: inserted into vagina pre-intercourse to kill sperm

Question 5

What is a combined OCP and how does it work?

Answer 5

Has estrogen and progesterone which:

1. stimulates -ve feedback to the hypothalamus/pituitary -> inhibits follicular development/ovulation
2. Loss of the estrogen positive feedback means no LH surge

Question 6

What forms of contraception inhibit transport of the oocyte down the fallopian tube? How effective is it?

Answer 6

Occluding the fallopian tubes; clips, rings, ligation, tubes RARELY rejoin

Question 7

What form of contraception inhibits sperm from passing through the cervix chemically? (Not physically)

Answer 7

Combined OCP or progesterone only pill/implant/depot: Tricks body into thinking its pregnant -> thick acidic cervical mucus, endometrial changes, etc.

Question 8

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

Answer 8

1. Induces over-proliferation of endometrium -> cancer

2. Excessive suppression of estrogen

Question 9

Name three forms of contraception that can inhibit implantation of the embryo in the uterine lining

Answer 9

1. Hormonal contraception affects the receptivity of the endometrium
2. Postcoital contraception
3. IUDs

Question 10

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

Answer 10

Both act as a physical barrier against sperm transport and..

1. Copper: interferes with the endometrial enzymes to prevent implantation
2. Progesterone; -ve feedback in the axis

Question 11

Define primary and secondary infertility

Answer 11

Infertility: Unable to conceive within 1 year Primary: no previous pregnancy
Secondary: previous pregnancy, successful or not

Question 12

Name four factors that might contribute to male infertility (not psychological)

Answer 12

1. Low sperm count
2. Poor sperm morphology/motility
3. Low ejaculate volume (inadequate secretions from accessory glands)
4. Sperm autoimmunity

Question 13

Name two factors that contribute to male infertility during coitus

Answer 13

1. Retrograde ejaculation: semen enters bladder rather than emerging through the penis
2. ED

Question 14

Briefly describe three major factors that can cause female infertility

Answer 14

1. Ovulatory failure: Hormone imbalance or polycystic ovaries
2. Impaired gamete/zygote transport; tube defects, anti-sperm antibodies, non-optimal cervical mucous
3. Implantation defects; chromosomal abnormalities (embryo unable to reach blastocyst stage) or endometrial abnormalities (i.e endometriosis)

Question 15

Define anovulation, is it ever normal?

Answer 15

Ovaries don’t release an oocyte during a menstrual cycle, occasionally normal at the extreme ends of reproductive life (young and old)

Question 16

What are 6 potential causes of anovulation?

Answer 16

1. Stress factors; stress, exercise, weight loss 2. Pituitary tumours
2. Necrosis
3. Ovarian failure
4. Menopause
5. Chemicals: radio/chemotherapy

Question 17

Describe why polycystic ovarian syndrome can result in female infertility? Name two other conditions which may arise as a result of PCOS

Answer 17

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.

Question 18

How might you diagnose anovulation?

Answer 18

Measure plasma hormone levels

Question 19

Name three methods you can use to induce ovulation in a patient with anovulation

Answer 19

1. Anti-estrogen: tricks body into thinking estrogen levels are low so there’s an increase in FSH
2. Gonadotrophins: like FSH
3. GnRH agonists; (pulsatile)

Question 20

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

Answer 20

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)

Question 21

Name three factors that might be causing abnormal sperm production

Answer 21

1. Testicular disease
2. Duct obstruction; infection or vasectomy
3. Hypothalamic/pituitary dysfunction

Question 22

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)

Answer 22

a) 1.5-4mLb) >15 million/mLc) >40%d) >4%The normal range is 20-200 million sperm/ml

Question 23

Name four things you may have to check when managing a couple with suspected infertility

Answer 23

1. They’re having regular unprotected sex
2. Regular menstrual cycle (21-35 days) and normal day 21 progesterone levels (evidence of ovulation)
3. Check patient tubes; history of infection, sterilization
4. Adequate sperm count

Question 24

Name three major methods you can use to manage/solve infertility.

Answer 24

1. Drugs to overcome hormone problems
2. Surgery to overcome tubal occlusion
3. Overcome timing/fertilization issues with IVF

Question 25

How does an IVF work?

Answer 25

1. Stimulates ovary to release more oocytes
2. Take sperm sample and fertilize the oocyte in vitro
3. Allow embryo to develop until blastocyst stage in vitro -> transfer back to uterus

Question 26

Name four ways you could overcome the issue of inadequate sperm/sperm transport in a couple when providing IVF?

Answer 26

IUI: intrauterine insemination
ICSI: intracytoplasmic sperm injection
TESA: testicular sperm aspiration
GIFT: gamete inrafallopian transfer

Question 27

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

Answer 27

1. Egg donation

2. CT (cytoplasmic transfer); often relating to mitochondrial disease

Question 28

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?

Answer 28

Chromosomal abnormalities resulting from nondisjunction

Thus, better to use another type of contraception 1-2 menstrual cycles before attempting to get pregnant

Question 29

Name three ways a patient with PCOS tends to present clinically

Answer 29

1. Secondary amenorrhea/infertility
2. Hirsutism; abnormal growth of facial and bodily hair
3. Obesity

Question 30

Briefly describe the mechanism of action of the ‘morning-after pill’

Answer 30

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

Question 31

Name two conditions/diseases which may arise as a result of PCOS

Answer 31

1. Abnormal estrogen secretions put women at risk of endometrial malignancy.
2. PCOS can cause insulin resistance -> type 2 diabetes

Question 32

In what scenerio can’t you manage infertility?

Answer 32

If the infertile issue is with implantation as an embryo cannot be grown to full fetal development in a lab