7. Contraception & fertility Flashcards
how can breastfeeding prevent pregnancy?
high prolactin levels negative feedback on GnRH secretion
must be exclusively breastfeeding
contraindications for COCP
migraine with aura
raised BMI
breast cancer
smoker
history of blood clots
how does the progesterone only pill raised chance of ectopic pregnancy?
pill reduces cilia activity in Fallopian tubes so higher chance a fertilised ovum won’t be moved along the tube
good contraception for someone with menorrhagia, and history of migraines
IUS
how long after ovulation could a copper coil be fitted?
5 days
secondary infertility
previous pregnancy (could be ectopic, terminated) and struggling to conceive again
examination of males in case of infertility
not usually needed
-penis examination for structural abnormalities
-scrotal exam
-secondary sexual characteristics
examination of females in case of infertility
-BMI
-hirsutism, acne
-abdo/pelvic/vaginal exam: mass, tenderness, infection, uterus size and position
advice to patients struggling to conceive
stop smoking
reduce alcohol
reduce stress
exercise and weight loss
regular sex 2-3 days
investigations in men for fertility checking
-semen analysis: motility, count
-bloods: FSH/LH, testosterone
-STI screen
-US testes
-karyotyping
investigations in women for fertility checking
-FHS/LH day 2
-day 21 progesterone
-thyroid function test, prolactin, androgens
-STI screen
-US pelvis
in a fertility clinic:
-hysterosalpingogram (look at tubes)
-laparoscopy (endometriosis)
when to refer to specialist
history, examination, investigations normal both partners and not conceived for 1 year
or women over 36 for 6 months
