A2. Fertility and family planning Flashcards
what is infertility?
Infertility is when a couple cannot get pregnant (conceive) despite
having regular unprotected sex (NHS).
common causes for infertility?
-Lack of regular ovulation (often due to PCOS)
-Poor quality semen or lack of sperm
-Blocked/damaged fallopian tubes
-Endometriosis – tissue behaves like lining of womb which is outside of the
womb
-Side effects of medication e.g. chemotherapy
risk factors of infertilty?
-Age (fertility declines with age)
-Weight – overweight/obese, if severely underweight can affect ovulation
-STIs
-Smoking
-Alcohol
-Stress
treatment options for infertility?
-Medicines:
* Clomifene– encourages ovulation
* Tamoxifen
* Metformin – usually used for T2DM, but beneficial in PCOS
* Surgical Procedures
* Assisted Conception – intrauterine insemination, in vitro fertilisation
support available for infertility?
Patient’s GP practice
British Fertility Society
Fertility Network UK
what is a miscarriage?
A miscarriage is the loss of a pregnancy during the first 23 weeks
what is a still birth?
A stillbirth is when a baby is born dead after 24 completed weeks of pregnancy.
medications to be aware of?
Dopamine agonists e.g. bromocriptine to stop breast milk production
support available for a patient with stillbirth or miscarriage?
These are all sources you could direct a patient to:
-Tommy’s Baby Loss Support
-Refer patient/partner to appointment with GP if struggling to cope
-The Miscarriage Association
-Cruse Bereavement Care
-SANDS
-Local hospices
Support for LGBTQ+ communities?
-donor insemination
-IUI (intrauterine insemination)
-surrogacy
-adoption or fostering
-co-parenting
what to eat for pregnant women?
-Starch-based foods, fruit & vegetables, plenty of fibre, protein, dairy
-IRON (red meat, pulses, dried fruit, green veg & fortified cereals)
-CALCIUM (milk, cheese, yoghurt)
-FOLIC ACID (green veg, brown rice & fortified cereals)
-VITAMIN D (oily fish, eggs, fortified cereals and & margarine)
what foods to avoid during pregnancy?
-foods rich in vitamin A
-Foods which may have high levels of listeria
-Foods which may have high levels of salmonella
what foods are rich in vitamin A?
-Liver and liver products such as liver pâté and cod liver oil supplements.
-Vitamin tablets or supplements which contain vitamin A.
what foods may have high levels of listeria?
-Pâté
-Mould-ripened & soft cheese such as Brie, Camembert, blue-veined cheeses
-Raw shellfish & raw fish
-Unpasteurised milk
what foods may have high levels of salmonella?
-Avoiding raw/partially cooked eggs
-Raw or partially cooked meat, especially poultry
caffeine limit in pregnancy?
200mg/day (NHS)
Describe alcohol during pregnancy
-No safe level to drink during pregnancy (Chief Medical Officer’s Low Risk Drinking Guidelines 2016)
-Alcohol can cause damage to developing baby
-Alcohol can cross through placenta & baby cannot process alcohol
-Syndrome of severe abnormalities: Foetal Alcohol Syndrome- development defects, growth retardation, facial abnormalities, learning and behavioural disorders
-Foetal Alcohol Spectrum Disorders: Severity & nature linked to amount drunk & developmental stage of foetus at the time
smoking during pregnancy?
-At first contact with woman, midwife should discuss smoking status
-Avoid smoking due to damage it can cause to unborn baby
-All women should be informed of risks of continuing smoking during pregnancy: Low birth weight, Pre-term baby, Stillbirth
-Pharmacists should support for smoking cessation
Describe folic acid nutritional supplements
Folic acid (400 micrograms per day) before conception (ideally 4
weeks before) and throughout the first 12 weeks of pregnancy. It helps babys spine and brain develop.
What can cause increased risk of having a child with a spinal cord
problem?
-Women who have previously had an infant with a neural tube defect
-Women or partner have spinal cord defect
-On antiepileptic medicines
-Diabetes
-Sickle-cell disease
-Obese → BMI >30
-Coeliac disease
-Thalassaemia
dose for higher risk women of having a child with spinal cord problem?
5mg per day
vitamin D during pregnancy?
10 micrograms of vitamin D daily
throughout pregnancy and if
breastfeeding
Vitamin A during pregnancy?
Avoid vitamin A supplements risk of birth defects
iron during pregnancy?
Iron should not be offered routinely
