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Repro > Conception and birth control > Flashcards

Conception and birth control Flashcards

1
Q

What % of semen comes from the seminal vesicles, prostate and cowpers/ bulbourethral glands?

A

60% seminal vesicles
25% from prostate
<5% from cowpers glands

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2
Q

What is the composition of the fluid from seminal vesicles, prostate and cowpers glands?

A

Seminal vesicles secrete an alkaline fluid with fructose, prostaglandins and clottting factors
Prostate secretes milkly, slighly acidic fluid with proteolytic enzymes, citiric acid (prevents clotting) and phosphatase
The cowpers gland secertes an alkaline fluid with lubricates the urethra ready for ejaculation

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3
Q

Describe the excitement phase of the male sexual response

A
  • Stimulants are tactile and phychogenic (sensory afferents are from the penis and peritoneum)
  • The efferents are from the pelvic nerve which branches into the cavernous nerve which provides autonomic stimulation to the corpora and the pudendal nerve which supplies somatic innervation
  • Paraympathetics release NO at junctions with arteries and stimulate some endothelial cells to also release NO
  • This NO causes vasodilation and sinusoidal relaxation
  • This causes swelling of the penis, which is limited by the tunica albergenia and causes compression of veins which further increases erectile size
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4
Q

Describe the plateua, emission& ejaculation and reolution phases of the male sexual response

A
  • plateau: parasympathetic stimulation maintained and sympathetic surpressed to maintain an erection, cowpers glands secrete fluid
  • emission and ejaculation: sympathetic stimulation takes over, semen move into urethra, smooth muscle in prostate, vas and seminal vesicles contract, IUS contracts to prevent retrograde flow, perineal and pelvic floor muscles contract rhythmically and expel the semen
  • resolution: the haemodynamic changes reverse
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5
Q

What happens to semen after ejaculation?

A
  • Theyre deposited at the cervix
  • they coagulate so theyre not lost in the tract
  • if cervical mucus is thin and alkaline (in follicular phase of menstrual cycle), sperm will enter the uterus
  • sperm will become capacitated and swim up fallopian tubes towards the ovum
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6
Q

What is the fertile window?

A

The three day period leading up to ovulation when sperm must be deposited, the sperm can survive for 48-72 hrs but the ovum will only be viable for 6-24 hrs

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7
Q

What 6 categories can contraceptives be categorised into?

A
  1. natural
  2. barrier
  3. hormonal control
  4. prevention of implantation
  5. sterilisation
  6. emergency
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8
Q

What 4 methods of natural contraception are there and what is their common advantage??

A
  • Abstinance
  • withdrawal
  • fertility awareness (monitoring cycle lengths, body temps and cerivcal secretions)
  • lactational amenorrhoea method (prolactin due to breast feeding inhibits GnRH)
    All of them are hormone free so have no side effects or contra indications
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9
Q

What are the disadvantages of withdrawal, fertility awareness and lactational amenorrhoea methods of contraception?

A

Very unreliable

No protection from STIs

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10
Q

What are the advantages to condoms ?

A 
98% reliable if used correctly
protect from STIs
Widely available
no hormones and so side effects 
spermicide can be used inconjunction
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11
Q

What are the disadvantages to condoms?

A
  • less pleasure
  • distrupt natural flow of sex
  • expire
  • allergies to latex
  • incorrect use
  • can be expensive
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12
Q

How does the combined oral contraceptive pill (COCP)/ patches/ ring work?

A

They prevent FSH and LH release by causing high levels or progesterone and oestrogen. This means no follicles can be stimulated to develop- so stops ovulation. It also prevents implantation and thickens cervical mucus. At the end of each month there is a rest week, where O and P levels will drop as you stop taking the pill, this causes the endometrium to be shed and you build it back up again

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13
Q

Give 2 adv and 2 disadv of the COCP

A

Adv: 98% effective when taken properly, can relieve menstrual disorders, reduces risk of ovarian and endometrial cancer
Disadv: user dependant, may interact w/ other meds, many side effects, increase breast and cervical cancer risk, increase risk of thrombus, no protection from STIs

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14
Q

How does a progesterone depot work?

A

You get injected with a high dose of progesterone every 12 weeks. This is inhibits FSH and LH so you dont get any ovulation. It also thickens cervical mucus and prevents endometrial proliferation (no oestrogen).

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15
Q

How do progesterone implants work?

A

Releases high dose progesterone via a tube placed under the skin, it lasts for around 3 yrs. Works in same way as progesterone injections- prevents ovulation as well as endometrial proliferation and thickens cervical mucus.

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16
Q

What are the adv and disadv for the progesterone injections?

A

ADV: no risk of user failure, doesnt distrupt intercourse, usually stops periods
Disadv: need to come in every 12 weeks, side effects, fertility may not return for up to a yr afterwards, no STI protection

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17
Q

What are the adv and disadv for the progesterone implant?

A

Adv: no user failure, can be used when oestrogen cant, fertility returns quickly when stopped
Disadv: minor procedure to insert, side effects, no STI protection, variable effects on periods

18
Q

Low does low dose progesterone work (mini pill)?

A

Thickens cervical mucus so sperm cannot enter and may prevent endometrial proliferation. Dose is not high enough to inhibit FSH and LH and as a result ovulation is not normally prevented

19
Q

What are the advantages and disadv to the mini pill?

A

ADV: quickly reversible, doesnt interrupt intercourse, can be used when oestrogen cant, 99% effective when used properly
Disadv:: have to take every day without break or fail, menstrual problems are common, interacts with other medications, risk of ectopic pregnancies, no STI protection

20
Q

What is the difference between the intrauterine system (IUS) and the intrauterine device (IUD)?

A 
IUS= progesterone releasing device which stays in uterus and lasts for 3-5yrs
IUD= Copper wire device in uterus, which lasts for 5-10 yrs
21
Q

How do the IUD and IUS work?

A

IUS= progesterone inhibits inplantation, endometrial proliferation and thickens cervical mucus
IUD=copper is toxic to sperm and ovum so kills them, also thickens cervical mucus

22
Q

What are the adv and disadv to the IUS and IUDs?

A

Adv: convient, long duration, IUS tend to cause less heavy periods or even top them all together, both over 99% effective
Disadv: painful to insert, 2/1000 risk of uterine perforation, IUD may cause heavier bleeding, no STI protection, may displace and this can be painful

23
Q

How are M and F sterilised?

A

M- vastectomy (cut/ tie the vas under local anaesthetic)

F- tubual ligation/ clipping (block fallopian tubes under local or general anesthetic)

24
Q

What are the Adv and Disadv to sterilisation techniques?

A

Adv- permanent, no short or long term serious side effects, males can be done at a GP practice
Disadv: irreversible, failure rate 1/2000 for men and 1/200- 500 for women

25
Q

Whats the advantage of using an emergency IUD over emergency contraceptive pills?

A

The IUD can stay in and be used as long term method of contraception, the pills are short term only.
Like emergency pil with ulipristal acetate in, it can be used up to 5 days after unprotected sex. the pill with levonorgestrel is only effective for 3 days after.

26
Q

Define infertility and explain the difference between primary and secondary infertility

A

Failure of conception in a couple having regular unprotected sex for one year.
Primary is if theyve never had a baby before.
Secondary is if they have but cant concieve now.

27
Q

State the 4 main female causes of infertility

A
  • idiopathic
  • ovulatory disorders
  • tubal damage/ obstruction
  • endometriosis
  • Uterine/ peritoneal disorders
  • other health problems (smoking, drinking, drugs ect)
28
Q

Give 3 ovulatory disorders leading to infertility

A
  • hypothalamic/ pituitary failure- usually present w/ amenorrhagia or hypogonadism before infertility
  • hypothalamic- pituitary- ovarian dysfunction - polycystic ovary syndrome, hyperprolactinaemia
  • Ovarian failure- congenital, ovarian insufficiency
29
Q

Give 3 uterine/ peritoneal disorders causing infertility

A
  • fibroids
  • endometrosis
  • PID
  • previous surgery
  • STIs
  • cervical stenosis
  • mullerian duct developmental abnormality (agenesis, didelphys (duplication of everything) ect)
30
Q

Give 3 causes of tubual damage which may lead to infertility?

A
  • endometrosis
  • ectopic pregnancy
  • pelvic surgery
  • PID
  • STIs
  • agenesis
31
Q

How common are infertility issues?

A

1 in 7 couples have them. In most couples with infertility issues there is a problem in both the man and woman

32
Q

What may cause infertility in a man?

A
  • General health (smoking, drinking ect)
  • endocrine disorders
  • hypothyroidism
  • diabetes
  • genetic diseases (kleinfelters, Y chromosome deletion etc)
  • STIs
  • Heat, radiation, drugs and chemo affecting spermatogenesis
  • testicular torsion and varicocele
  • congenital structural issues and vastectomies
  • ejaculatory failure and erectile dysfunction
33
Q

When should a couple be refered to a fertility clinic?

A

only after a year of regular unprotected sex, may be earlier if varicocele, women over 36 or known past problem

34
Q

What is the basis of polycystic ovary syndrome? How does it tend to present?

A

Excess androgen secretion from ovaries due to high LH or high insulin. This causes increased follicle stimulation, which become cystic, which is why it gets its name. It presents with amenorrohea, infertility, hirstusim (male pattern hair growth in women), achne, depression and obesity.

35
Q

Why do ppl with polycystic ovary syndrome tend to have low FSH but high LH?

A

Low FSH because inhibin is being release from the granulosa cells which are being stimulated by the high androgens. LH is high because the oestrogen level is very high so has positive feedback effect

36
Q

What is endometriosis?

A

Ectoptic endometrial tissue dispersed @ various sites across the body- mainly in peritoneal cavity.

37
Q

Other than infertility, what may the symptoms of endometriosis be?

A

Varied:

  • bloating
  • lethargy
  • constipation
  • haematuria
  • dysuria
  • lower back pain
  • severe period pain
38
Q

How is endometriosis treated?

A

combined oral contraceptive pill

39
Q

How does viagra work?

A

Inhibits cGMP breakdown, so more nitric oxide produced for vasodilation

40
Q

Describe the physiological changes in a female which facilitate coitus

A

Parasympathetic stimulation leads to dilation of the vaginal opening, lubrication, lengthening and widening of the inner 2/3 of vagina, batholin/ greater vestibular glands secrete fluid to lubricate vestible and vaginal opening.

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