7.2 Contraception

Question 1

Give the main methods to contraceptions

Answer 1

Natural
- Abstinence, coitus interuption, rhythm

Vasectomy

Barrier methods

Spermicide

Hormonal

Inhibition of transport along uterine tubes
Sterilisation

Inhibition of implantation:
IUCD

Question 2

Give 3 methods of natural contraception.

Answer 2

Abstinence
Coitus interruptus
Rhythm method.

Question 3

What is the problem with coitus interrupts?

Answer 3

Stop sex before ejaculation

Sperm in pre-ejaculate

Question 4

What is the rhythm method? Disadvantage?

Answer 4

Have sex only in non-fertile period
7-16 days

Requires regular cycle.

Question 5

What is a vasectomy?

Answer 5

Prevent sperm from entering ejactulate by dividing cad deferens bilaterally.

Question 6

Give 3 barrier methods of contraception. Prupose?

Answer 6

Condoms
Diaphragm
Cap

Prevent sperm from reaching cervix

Question 7

Advantages of condoms?

Disadvantages of diaphragm

Answer 7

Condoms:
Readily available
Protect against STIs

Diaphragm
Requires correct fitting
Does not completely occlude passage
Holds sperm in acid environment of vagina, reducing survival time.

Question 8

How does progesterone act as contraception? Oestrogen?

Answer 8

Thick hostile cervical mucus plug
Prevents sperm from entering uterus
Negative feedback to hypothalamus/pituitary
Decrease frequency of GnRH pulses, inhibiting follicular development.

Oestrogen negatively feeds back on ant pit
Loss of positive feedback - no LH surge - inhibits ovulation

Question 9

Giv the types of hormonal contraception.

Answer 9

Combined OCP

POP

Depot progesterone:
3 monthly injections
Negative feedback to inhibit ovulation

Progesterone implants

Question 10

What is sterilisation?

Answer 10

Occlusion of Fallopian tubes:

Clips, rings, ligatino.

Question 11

Give some IUCDs

Answer 11

Inert copper
Interferes with endometrial enzymes
Interferes with implantation

Progesterone impregnated

Question 12

Describe post-coital contraception

Answer 12

•	Combined Oestrogen / Progesterone High Dose
o	Or Progesterone only
•	Up to 72 hours after intercourse
•	May disrupt ovulation
•	Blocks implantation
•	May also impair luteal function

Question 13

What is infertility? What can it be due to?

Answer 13

• Failure to conceive within 1 year
• Primary (no previous pregnancy) or secondary (previous pregnancy)
• Due to:
o Coital problems
o Anovulation
• Occasionally anovulatory cycles are normal at extremes of reproductive life

Question 14

Describe polycystic ovarian syndrome.

Answer 14

•	Uncertain pathogenesis
•	Increased androgen secretion
•	Raised LH/FSH ratio
o	Lack of pulsatile GnRH release
o	Many follicles begin to develop but dominant follicle is not selected to mature.
•	Insulin resistance
•	Multiple small ovarian cysts
•	Anovulation, amenorrhoea/oligomenorrhoea

• LH dependent excess androgen production from both ovaries and adrenals
o Androgens may suppress LH surge
o Hirsutism
• Abnormal hair growth
o Oily skin/acne
• Abnormal oestrogen secretion put women at risk of endometrial malignancy
o Sustained oestrogen stimulation of endometrium

Question 15

How can ovulation be induced?

Answer 15

•	Anti-oestrogen
o	Reduce negative feedback to hypothalamus/pituitary. 
o	Increase GnRH/FSH
•	Gonadotrophins
o	FSH administration
•	GnRH agonists
o	Pulsatile to mimic normal secretion

Question 16

How is infertility due to tubal occlusion caused, diagnosed and treated?

Answer 16

•	Caused by:
o	Sterilisation
o	Scarring from infection/endometriosis
•	Diagnosed by:
o	Laparoscopy and dye
o	Hysterosalpingogram
•	Treatment:
o	Tubal surgery
o	Assisted conception

Question 17

How is infertility due to abnormal sperm caused, diagnosed and treated?

Answer 17

•	Abnormal production
o	Testicular disease
•	Obstruction of ducts
o	Infection
o	Vasectomy
•	Hypothalamic/pituitary dysfunction

Question 18

Normal values for semen analysis?

Answer 18

Volume > 2ml
Sperm count > 20 million per ml
Motility > 50%
Morphology > 50%