(7.2) Contraception & Infertility

Question 1

Suggest ways of contraception from a male.

Answer 1

• Vasdectomy (prevent sperms into ejacuate)
• Condom
• Pre-ejaculation

Question 2

Suggest ways of contraception from a female.

Answer 2

• Diaphragm (not completely fit)
• Cap (completely fit)
• Intrauterine Contraceptive Device (one type: Produces Progesterone or another type: Intrauterine Inert Copper interferes uterine enzymes)
• Hormonal: Combined (progesterone + oestrogen), Progesterone Only Pill (POP), Depot Progesterone (3 monthly), Progesterone implants, Post-Coital (high dose within 72 hrs)

Question 3

How does hormonal contraception work? What types are there?

Answer 3

• Progesterone -> viscous & acidic cervical mucous + -ve feedback to prevent follicle development
• Oestrogen -> prevent +ve feedback in mid-cycle -> no LH surge
• Combined
• Progesterone Only Pill
• Depot Progesterone (3 monthly)
• Progesterone Impregnated
• Post-Coital (high dose Progesterone within 72 hrs)

Question 4

How is infertility defined?

Answer 4

Failure to conceive within 1 year

Question 5

Suggest reasons of a female being infertile. How are they diagnosed?

Answer 5

• Menopause - high FSH & LH + low Oestrogen
• Hypothalamic/Pituitary Anovulation - low FSH & LH + high Oestrogen
• Ovarian Anovulation - high FSH & LH + low Oestrogen
• Polycystic Ovarian Syndrome - high LH:FSH ratio + normal Oestrogen (Follicles still develop, Inhibin only inhibits FSH)
• Tubal obstruction e.g. Pelvic Inflammatory Diseases - Laprascopy/Hysterosalpingogram

Question 6

Suggest ways to treat infertile women due to Hypogonadotrophic Anovulation

Answer 6

• Anti-Oestrogen
• Gonadotrophin
• GnRH Agonist

Question 7

Suggest two different methods of barrier contraception.

Answer 7

• Condom

- Cap or Diaphragm - keep sperms in acidic vagina longer

Question 8

Suggest two different methods of natural contraception.

Answer 8

• Self-enforced restraint

- Pre-ejaculation

Question 9

What is Vasdectomy?

Answer 9

• Divide Vas deferens on both sides to prevent sperms entering ejacuate
• Need to wait few months make sure it works

Question 10

Why is Combined Oral Contraceptives better than Progesterone Only Pill? When is POP preferred?

Answer 10

• POP does not regulate menstruation like combined oral contraceptive pills (COCP) -> premenstural tension/dysmenorrhoea
• Breastfeeding mom: Oestrogen inhibits Prolactin & Prolactin -> inhibits GnRH -> reduces Oestrogen
• Women with risks of CVD: Oestrogen -> changes in lipids & cholesterol levels -> CVD

Question 11

What is rhythm method of contraception?

Answer 11

Can’t have sex 7 days before ovulation or 3 days after - avoiding days 7-16

Question 12

Why is OCP contraindicated in breast feeding mother?

Answer 12

Oestrogen inhibits Prolactin

Question 13

How does Varicoele lead to infertility?

Answer 13

Dilated Pampiniform Plexus -> trapped sperms at high temperature -> die

Question 14

How long is the sperm viable in the vagina and cervix?

Answer 14

48-72 hours

Question 15

Suggest reasons of a male being infertile.

Answer 15

• Abnormal semen (Less than 20 ml / 20x10^6 sperms per ml)
• Infection
• Tubule obstruction
• Hypothalmic/Pituitary dysfunction
• Vasectomy

Question 16

What are the risks of using Intrauterine Contraceptive Device?

Answer 16

• Infection/PID
• Cramp
• Infertility