Chapter 29Family Planning Flashcards

Exam 4 (Final)

1
Q

Family Planning:

What kind of interventions does it include?

A

Family planning includes any educational, social, or healthcare interventions that allow people to plan reproduction.

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2
Q

Family Planning

What else does it include?

A

Family planning includes contraception, abortion, and interventions and education when subfertility or infertility is identified.

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3
Q

Family Planning:

Nurses in Family Planning must be how?

A

Nurses participating in family planning must be respectful of patient’s choice and careful not to interject their own biases

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4
Q

Contraception: What is the goal of it?

A

The goal of contraception is to prevent unwanted or mistimed pregnancy.

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5
Q

Contraception:

Major types of contraception include:

A

Long-acting reversible contraception (LARC)

Combined oral contraceptives (COCs)

Progestin-only pills (POPs)

Hormonal patches

Hormonal vaginal rings

Barrier methods

Spermicide

Natural family planning (NFP)

Withdrawal

Contraceptive injections

Sterilization

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6
Q

Contraception Considerations:

What are the most effective methods of birth control?

A

The most effective methods of birth control are sterilization (bilateral tubal ligation [BTL] and vasectomy), and methods of contraceptive implants and intrauterine contraception (LARC).

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7
Q

Contraception Considerations:

What are the two forms of sterilization?

A

sterilization (bilateral tubal ligation [BTL] and vasectomy),

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8
Q

Contraception Considerations:

What do contraceptive decisions involve?

A

Contraception decisions involve evaluating family planning goals.

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9
Q

Contraception Considerations:

How effective are contraceptive methods?

A

A contraceptive method is only as good as the patient’s adherence to and continued, consistent use of the method once adopted.

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10
Q

Hormone-Containing Birth Control: COCs

COCs generally contain what?

A

COCs generally contain 21 hormone-containing pills followed by 7 placebo pills.

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10
Q

Hormone-Containing Birth Control: COCs

When taken correctly, what is failure rate?

With typical combined oral contraceptives are how effective?

A

When taken correctly, failure rate is 0.1%. With typical use, combined oral contraceptives (COCs) are 92% effective.

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11
Q

Hormone-Containing Birth Control: COCs

How does it work?

A

Works by increasing viscosity of cervical mucus, suppressing ovulation, and thinning the uterine lining.

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12
Q

Hormone-Containing Birth Control: COCs

How long can healthy non smokers take the pill? What can it help with?

A

Healthy, nonsmokers may take the pill until the age of probable menopause (which may help control discomforts of perimenopause).

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13
Q

Hormone-Containing Birth Control: COCs

What is an alternative method known as?

What is an example?

A

An alternative method is known as extended cycling. (An example of alternative method packaging is 84 hormone pills followed by 7 placebo pills.)

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14
Q

Hormone-Containing Birth Control: COCs

What are contraindications for birth control?

A

Contraindications for birth control containing estrogen include migraine with aura, history of blood clots, and hypertension.

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15
Q

Hormone-Containing Birth Control: POPs

What are they?

A

Progestin-only pills (POPs) contain only progestin (artificial form of progestin).

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16
Q

Hormone-Containing Birth Control: POPs

Who are they usually prescribed for?

A

Usually prescribed for patients when estrogen is contraindicated (e.g., migraine with aura and hypertension)

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17
Q

Hormone-Containing Birth Control: POPs

Who is it safe for?

A

Safe for breastfeeding mothers

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18
Q

Hormone-Containing Birth Control: POPs

What is contained in the pack?

A

All 28 pills in a pack contain progestin (no placebo pills)

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19
Q

Hormone-Containing Birth Control: POPs

How must it be taken to be effective?

A

Must be taken within a 3-hour window every day to be effective

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20
Q

Hormone-Containing Birth Control: POPs

What is a primary side effect?

A

Primary side effect is a less regular period and more breakthrough bleeding.

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21
Q

Hormone-Containing Birth Control: POPs

How would a pregnancy be if it occurred while taking this? Why?

A

If pregnancy does occur, more likely to be ectopic due to slowing of motility of cilia in fallopian tube in response to progestin.

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22
Q

Hormone-Containing Birth Control: Contraceptive Ring

What are they?

A

Contraceptive rings are flexible silicone rings impregnated with estrogen and progestin.

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23
Q

Hormone-Containing Birth Control: Contraceptive Ring

Who places it? For how long? Why?

A

The female places the ring inside her vagina for 3 weeks, removes it for a week to create a withdrawal bleed, and then replaces it with a new ring.

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24
Q

Hormone-Containing Birth Control: Contraceptive Ring

How long can a new ring be used?

A

New ring can be used for up to a year (13 menstrual cycles) left in for 21 days and removed for 7 and then repeated.

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25
Q

Hormone-Containing Birth Control: Contraceptive Ring:

When can the ring be removed? How long can it be left out per day?

A

Ring can be removed for intercourse and left out for up to 2 hours per day.

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26
Q

Hormone-Containing Birth Control: Contraceptive Ring

Where is the ring located when in the body?

A

The location of the ring in the vagina is not important as long as it touches vaginal mucosa.

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27
Q

Hormone-Containing Birth Control: Contraceptive Ring

What can occur (wrong) with the ring? What should the nurse teach patients?

A

The ring can be dislodged during a bowel movement. The nurse should teach the patient to check placement of the ring after a bowel movement.

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28
Q

Hormone-Containing Birth Control: Contraceptive Patch #1

A contraceptive patch contains what?

When is it applied? What happens after?

A

A contraceptive patch contains estrogen and progestin and is applied weekly for 3 weeks. Followed by a patch-free week, which will cause a withdrawal bleed.

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29
Q

Hormone-Containing Birth Control: Contraceptive Patch #1

Where is the patch applied? Where should it not be applied?

A

The patch should be applied on the upper back, upper arm, upper buttock, or lower abdomen, but not on the breast.

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30
Q

Hormone-Containing Birth Control: Contraceptive Patch #1

What should a female do with the patch site? Why?

A

The female should rotate the site weekly to avoid skin irritation.

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31
Q

Hormone-Containing Birth Control: Emergency Contraception

How is emergency contraception available?

A

Emergency contraception (EC) is available as medication or a hormonal or copper intrauterine contraception (IUC).

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32
Q

Hormone-Containing Birth Control: Emergency Contraception

There are two primary options in the United States. What are they?

A

Levonorgestrel (Plan B):

Ulipristal (Ella):

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33
Q

Hormone-Containing Birth Control: Emergency Contraception

There are two primary options in the United States.

Levonorgestrel (Plan B): How is it available? When is it most effective?

A

Available over the counter or by prescription and is most effective when taken within 72 hours of unprotective intercourse.

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34
Q

Hormone-Containing Birth Control: Emergency Contraception

There are two primary options in the United States.

Levonorgestrel (Plan B): How does it work?

A

Works by preventing ovulation.

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35
Q

Hormone-Containing Birth Control: Emergency Contraception

Levonorgestrel (Plan B): How does it affect an established pregnancy?

A

Does not affect an established pregnancy.

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36
Q

Hormone-Containing Birth Control: Emergency Contraception

Ulipristal (Ella): How is it available? How soon must it be used to be effective?

A

Available by prescription only.

May be used within 120 hours of unprotected intercourse.

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37
Q

Hormone-Containing Birth Control: Emergency Contraception

Ulipristal (Ella): How does it work?

A

Works as a progestin blocker and may affect an existing pregnancy.

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38
Q

Hormone-Containing Birth Control: Emergency Contraception

Ulipristal (Ella): Who is it most effective in?

A

More effective in patients who weight over 165 pounds (75 kg).

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39
Q

Hormone-Containing Birth Control: Contraceptive Injection

What is an example?

A

Depot medroxyprogesterone acetate (DMPA, brand name: Depo Provera)

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40
Q

Hormone-Containing Birth Control: Contraceptive Injection

Depot medroxyprogesterone acetate (DMPA, brand name: Depo Provera): What is it?

A

is a progestin-only injection administered every 3 months until and unless pregnancy is desired.

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41
Q

Hormone-Containing Birth Control: Contraceptive Injection

What are benefits of this?

A

Benefits include less frequent, scant, or absent menses.

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42
Q

Hormone-Containing Birth Control: Contraceptive Injection

How does DMPA work?

A

DMPA works by suppressing follicle-stimulating hormone and luteinizing hormone, therefore inhibiting follicle maturation and ovulation.

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43
Q

Hormone-Containing Birth Control: Contraceptive Injection

When should a female start DMPA?

A

Optimally, a female should start DMPA within 7 days of the start of her last menstrual cycle.

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44
Q

Hormone-Containing Birth Control: Contraceptive Injection

What are concerns with DMPA?

A

Concerns with DMPA include weight gain.

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45
Q

Hormone-Containing Birth Control: Contraceptive Implant

How is the implant placed? Where?

A

A 4-cm rod of nonestrogen etonogestrel is inserted under the skin of the inner upper arm.

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46
Q

Hormone-Containing Birth Control: Contraceptive Implant

How long is it approved for? How much can it release?

A

Although approved for use for 3 years, implant time-releases etonogestrel for at least 5 years.

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47
Q

Hormone-Containing Birth Control: Contraceptive Implant

How does it work?

A

Works by creating changes to cervical mucus and to fallopian tube motility that impede fertilization.

Also suppresses follicle maturation and ovulation.

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48
Q

Hormone-Containing Birth Control: Contraceptive Implant

What is a common side effect?

A

Unscheduled bleeding is a common side effect.

49
Q

Hormone-Containing Birth Control: Contraceptive Implant

When do a majority of patients ovulate after implant removal?

A

A majority of patients ovulate within a month of removal.

50
Q

Hormone-Containing Birth Control: Intrauterine Contraception #1

What are they?

A

Intrauterine contraception (IUCs or IUDs) are T-shaped plastic devices wrapped in copper or containing progestin that are inserted into the uterus.

51
Q

Hormone-Containing Birth Control: Intrauterine Contraception #1

What is the probability of getting pregnany after 1 year of use?

A

The probability of getting pregnant after 1 year of use less than 1% with an IUC.

52
Q

Hormone-Containing Birth Control: Intrauterine Contraception #1

How does the copper IUC inhibit fertilization?

A

The copper IUC inhibits fertilization by inhibiting sperm motility, capacitation, survival, and phagocytosis.

53
Q

Hormone-Containing Birth Control: Intrauterine Contraception #1

When can it be inserted in?

A

The copper IUC can be inserted as emergency contraception within 5 to 7 days of unprotected intercourse.

54
Q

Hormone-Containing Birth Control: Intrauterine Contraception #1

What does the progestin IUD cause?

A

The progestin IUD also causes inhospitable changes to the cervical mucus, endometrial atrophy, and variable effects on ovulation.

55
Q

Hormone-Containing Birth Control: Intrauterine Contraception #1

What is there no evidence of?

A

There is no evidence of any ICU acting as an abortifacient or disrupting an existing pregnancy.

56
Q

Intrauterine Contraception #2

What is a side effect of IUCs? (both copper and progestin)

A

The side effect of IUCs is a change in bleeding patterns.

57
Q

Intrauterine Contraception #2

What is a side effect of the copper IUCs?

A

The copper IUC may result in longer, crampier, and heavier bleeding while the

58
Q

Intrauterine Contraception #2

What is a side effect of progestin IUCs?

A

progestin IUC may cause spotting, unscheduled bleeding, and amenorrhea.

59
Q

Intrauterine Contraception #2

What is there a risk of occurring with IUCs?

A

Risks include perforation of the IUC at the time of insertion.

Spontaneous expulsion of the IUC may occur (typically within the first year of use).

60
Q

Intrauterine Contraception #2

What should patients report?

A

Patients should report new acute cramping, which may indicate the IUC has slipped into the cervix.

61
Q

Intrauterine Contraception #2

What is no longer done by patients with IUCs?

A

Patients used to be advised to check for string placement monthly to verify placement, but this is not longer recommended teaching.

62
Q

Intrauterine Contraception #2

Which each IUC placement, what is done? What does this do?

A

With IUC placement, patients are screened for STIs.

With this practice, the incidence for pelvic inflammatory disease is the same for patients with IUCs as for patients without them.

63
Q

Barrier Methods of Birth Control: Male Condom

How effective are male condoms? What are they the best at?

A

Male condoms are generally less effective as contraceptives but the best protection against STIs (other than abstinence).

64
Q

Barrier Methods of Birth Control: Male Condom

With typical use, the male condom has what failure rate?

A

With typical use, the male condom has a contraception failure rate of 18% over 1 year.

65
Q

Barrier Methods of Birth Control: Male Condom

When should a new condom be used?

A

A new condom should be used with each episode of oral, rectal, or vaginal sex with a partner whose STI status is unknown.

66
Q

Barrier Methods of Birth Control: Male Condom

When should the condom be applied?

A

The condom should be applied prior to genital contact.

67
Q

Barrier Methods of Birth Control: Male Condom

What should be done if the condom is placed upside down?

A

If the condom is placed upside down (evident when the condom cannot be unrolled), a new condom should be used to minimize the risk of STI exposure.

68
Q

Barrier Methods of Birth Control: Male Condom

What should be done with condoms after use?

A

Condoms should be removed and discarded immediately after ejaculation.

69
Q

Barrier Methods of Birth Control: Female Condom

How does the female or internal condom compare to the male condom?

A

The female or internal condom is expensive and more cumbersome than a male condom.

70
Q

Barrier Methods of Birth Control: Female Condom

What does the female condom contain?

A

The female condom contains two semirigid rings attached to the opening of a nitrile tube.

71
Q

Barrier Methods of Birth Control: Female Condom

How is the female condom placed?

A

Placement of the female condom is similar to the placement of a tampon.

72
Q

Barrier Methods of Birth Control: Female Condom

When should a new female condom be used?

A

A new female condom should be used with each episode of rectal or vaginal sex.

73
Q

Barrier Methods of Birth Control: Diaphragm

What is it? What does it not protect against?

A

The diaphragm is a flexible saucer that is placed into the vagina to cover the cervix. It does not protect against STIs.

74
Q

Barrier Methods of Birth Control: Diaphragm

What is the diaphragm failure rate?

A

The diaphragm has a 12% failure rate within a year.

75
Q

Barrier Methods of Birth Control: Diaphragm

When should fit be checked?

A

Fit should be checked if the patient gives birth, has a miscarriage or abortion, or gains or loses more than 10 pounds (4.5 kg).

76
Q

Barrier Methods of Birth Control: Diaphragm

How often should diaphragms be replaced?

A

Diaphragms should be replaced every 2 years.

77
Q

Barrier Methods of Birth Control: Diaphragm

How popular is the diaphragm? Why?

A

The diaphragm has decreased in popularity due to easier methods of contraception.

78
Q

Barrier Methods of Birth Control: Contraceptive Sponge

What is it? How is it available?

A

A contraceptive sponge is a 2-inch round, spermicide-infused, foam disk that fits over the cervix, and is available over the counter.

79
Q

Barrier Methods of Birth Control: Contraceptive Sponge:

What is its failure rate? (birth and no birth)

A

The sponge has a 12% failure rate over 1 year in patients who have never given birth and a 24% failure rate in patients who have given birth.

80
Q

Barrier Methods of Birth Control: Contraceptive Sponge:

What must be done prior to insertion?

A

Prior to insertion, the patient wets the sponge, squeezes it, and inserts it with the fingers into the top of the vagina.

81
Q

Barrier Methods of Birth Control: Contraceptive Sponge

When may the sponge be place? How long can it stay in?

A

The sponge may be placed up to 24 hours before sexual intercourse but should stay in no more than 30 hours.

82
Q

Barrier Methods of Birth Control: Cervical Cap

What is it similar to? How?

A

Cervical cap is similar to the diaphragm, holds spermicide against the cervix to prevent passage of sperm.

83
Q

Barrier Methods of Birth Control: Cervical Cap

What is its failure rate? (birth and no birth)

A

The cervical cap has a 16% failure rate over 1 year in patients who have never given birth and a 32% failure rate in patients who have given birth.

84
Q

Barrier Methods of Birth Control: Cervical Cap

What do the sizes depend on?

A

Three sizes depending on if patient has never been pregnant; had an abortion, miscarriage or cesarean; or gave birth vaginally

85
Q

Barrier Methods of Birth Control: Cervical Cap

When may it be inserted? When should it be removed?

A

May be inserted up to 6 hours prior to sex and should removed 6 to 48 hours after intercourse.

86
Q

Barrier Methods of Birth Control: Spermicide or Contraceptive Gel

What are the two types?

A

Spermicide

Contraceptive gel

87
Q

Barrier Methods of Birth Control: Spermicide or Contraceptive Gel

Spermicide- what is it?

A

Over-the-counter jelly, cream, or suppository that kills sperm

88
Q

Barrier Methods of Birth Control: Spermicide or Contraceptive Gel

Spermicide- when should it be inserted?

A

Should be inserted 10 minutes prior to intercourse

89
Q

Barrier Methods of Birth Control: Spermicide or Contraceptive Gel

Spermicide- What is the failure rate?

A

20% failure rate if used alone

90
Q

Barrier Methods of Birth Control: Spermicide or Contraceptive Gel

Contraceptive gel: How is it gotten?

A

Prescription only

91
Q

Barrier Methods of Birth Control: Spermicide or Contraceptive Gel

Contraceptive gel: What does it do?

A

Does not skill sperm but alters pH of vagina to decreased sperm motility

92
Q

Barrier Methods of Birth Control: Spermicide or Contraceptive Gel

Contraceptive gel: What is the failure rate?

A

About 14% failure rate

92
Q

Natural Family Planning (NFP): What else is it known as?

A

NFP also known as fertility awareness, rhythm method, and timed intercourse

93
Q

Natural Family Planning (NFP): What does it rely on?

A

relies on the predictability of fertile and infertility of the menstrual cycle to avoid contraception.

94
Q

Natural Family Planning (NFP)

What methods are there?

A

Methods include the standard days, cervical secretion (thinning cervical mucus), symptothermal (a slight temperature decrease just before ovulation), and symptohormonal (measuring hormones in urine) methods.

95
Q

Natural Family Planning (NFP)

How does the standard days method work?

A

Using the standard days method, a couple avoids intercourse on days 8 through 19 of the menstrual cycle.

96
Q

Abortion #1

How many pregnancies are unintended?

In 2019, how many pregnancies ended in abortion?

A

Half of all pregnancies are unintended. In 2019, approximately 21% of pregnancies ended in abortion.

97
Q

Abortion #1

Who are most abortions performed on?

A

Most abortions are performed on women in their 20s.

98
Q

Abortion #1

What are reasons for an abortion?

A

Reasons patients cite for abortion include inability to afford care for a child, not wanting to be a single parent, or problems with the partner.

99
Q

Abortion #1:

When are the majority of abortion performed? (What gestational age)

A

The majority of abortions (79%) are performed prior to 9 weeks (92.7% are completed prior to 13 weeks gestation).
Abortion #1

100
Q

Abortion #1:

What do nurses do prior to an abortion?

A

Prior to an abortion, nurses take a thorough health history and attempt to determine if the patient is seeking an abortion due to coercion.

101
Q

Abortion #1

What should nurses do in these situations? (When patients seek options)

A

If a patient is seeking other options, nurses should answer questions but not be directive.

102
Q

Abortion #2:

Medical abortions can be performed when?

A

Medical abortions can be performed within 77 days of conception.

103
Q

Abortion #2:

What is a common regimen for a medical abortion?

A

A common regimen for a medical abortion includes 200 mg of mifepristone followed by 800 mcg of misoprostol 6 hours later.

104
Q

Abortion #2:

What is a surgical abortion? What is it called

A

Surgical abortion is typically done by uterine aspiration and is also called dilation and curettage.

105
Q

Abortion #2:

What is done in a later abortion?

A

Later abortion is generally by dilation and evacuation.

106
Q

Abortion #2:

What should the nurse observe for in patients? What should they be monitoring?

A

The nurse should observe patients for signs of hemorrhage and intraabdominal bleeding by monitoring vital signs, pain, and bleeding, for at least 30 minutes after the procedure.

107
Q

Abortion #2:

What should patients females who are RH negative be given?

A

Females who are Rh negative should be given Rho (D) immune globulin if they have a medical or surgical abortion.

108
Q

Infertility

A

Infertility is defined as lack of pregnancy after 12 months of well-timed intercourse (6 months if the patient is over 35 years old).

109
Q

Infertility is related to what?

A

Infertility may be related to male factors or female factors.

110
Q

Infertility: Clomid

A

Clomiphene citrate (Clomid) is a selective estrogen receptor modulator and common first-line medication to induce ovulation.

111
Q

Infertility: Clomid

When is Clomiphene citrate (Clomid) started?

A

Clomiphene citrate is usually started 5 days after the start of menses.

112
Q

Infertility: Clomid

How is the risk of miscarriage or ectopic pregnancy compared with spontaneous pregnancies?

A

The risk of miscarriage or ectopic pregnancy is the same as with spontaneous pregnancies.

113
Q

Infertility: Clomid

How is the risk of multiple gestation in clomiphene citrate compared to spontaneous pregnancies?

A

The risk of multiple gestation is increased 9% with clomiphene citrate compared to spontaneous pregnancies.

114
Q

Artificial Reproductive Technology (ART)

What is it used for?

A

ART is used to treat infertility due to male, female, or mixed or unknown causes.

115
Q

Artificial Reproductive Technology (ART)

What is Intrauterine insemination?

A

Intrauterine insemination is a procedure where sperm is washed and then introduced into the upper uterine cavity.

116
Q

Artificial Reproductive Technology (ART)

What is IVF used for?

A

In vitro fertilization (IVF) is used to treat infertility due to tubal factors, severe male factors, uterine, or ovarian factors.

117
Q

Artificial Reproductive Technology (ART)

What occurs in IVF?

A

With IVF, ovaries are stimulated and eggs retrieved by ultrasound-guided follicle aspiration and then mixed with cleaned sperm.

118
Q

Artificial Reproductive Technology (ART)

When can successful fertilization be identified?

A

Successful fertilization can be identified after 17 hours and transplanted into the uterus or frozen.