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Week 15: Infertility > Contraception > Flashcards

Contraception Flashcards

1
Q

Names of the phases for

  1. Follicles
  2. Uterine lining
A
  1. Follicular, luteal

2. Menstrual/atretic, proliferative, secretory

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2
Q

Histology of the endometrium in the proliferative phase

A

Endometrial stroma thickens
Glands elongate
No crowding
More stroma than glands

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3
Q

Histology of the endometrium in the secretory phase

A

Endometrial stroma becomes loose and edematous
Blood vessels become thickened and twisted
Endometrial glands become tortuous
More glands than stroma

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4
Q

4 Natural methods of contraception

A

Withdrawal
Fertility awareness
Basal body temperature
Cervical mucus

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5
Q

Fertility awareness method of contraception

A

Using cycle length and signs of ovulation to predict and avoid intercourse on fertile days so egg and sperm never meet

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6
Q

Basal body temp method of contraception

A

Increase in body temperature follows the LH surge as progesterone levels rise
Elevation in temperature restrospectively predicts ovulation and signifies the end of the fertile period
Chart this over time, and avoid intercourse just before temp increases

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7
Q

Cervical mucus methods of contraception

A

Prior to ovulation, estradiol causes cervical secretions that favor sperm motility, passage through the cervical canal and sperm maturation (these are copious, thin, stretchy, clear mucus)
Post ovulation, progesterone results in mucus that impedes sperm motility (scant, thick, tenacious mucus)

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8
Q

4 places in the female repro system that contraception can work

A

Ovulation
Fallopian tube
Implantation
Entry of semen

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9
Q

Tubal ligation

A

Sterilization process that blocks the fallopian tube patency so that sperm and egg never meet
Salpingectomy (removal of tubes) is not reversible but does reduce risk of ovarian cancer

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10
Q

Vasectomy

A

Prevents the entry of semen
Interruption of the vas deferens
Sperm and egg never meet

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11
Q

What stage do barrier methods work at?

A

Prevent the entry of semen

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12
Q

What stages do combined hormonal contraception work at?

A 
All of them!
Ovulation (main one)
Fallopian tube
Implantation
Entry of semen
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13
Q

What is the MOA of combined hormonal contraceptives (general)

A

Inhibits gonadotropin secretion via negative feedback on pituitary and hypothalamus

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14
Q

MOA of
1. Ethinyl estradiol (1)
2. Progesterone (4)
in the combined hormonal contraceptives

A
  1. Inhibits FSH release (inhibits FSH follicular recruitment and prevents ovulation)
  2. Primarily suppresses LH release (prevents ovulation), endometrium not receptive to ovum, cervical mucus thick and impervious, reduced tubal peristalsis
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15
Q

Function of

  1. High levels of progesterone
  2. Continuous levels of progesterone
A
  1. Stabilizes/causes the thickening of the endometrium

2. Prevents endometrial growth

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16
Q

Combined hormonal contraceptives can come in what 3 forms?

A

Oral contraceptive pills
Transdermal patch
Vaginal ring

17
Q

Where do progesterone only hormonal contraceptives work?

A 
All 4 sites again
Ovulation (less prominent)
Fallopian tube
Implantation
Entry of semen
18
Q

4 MOAs for progesterone contraceptives

A

Suppresses LH release (prevents ovulation about 40% of the time)
Endometrium not receptive to ovum
Cervical mucus thick and impervious
Reduced tubal peristalsis

19
Q

Intrauterine device MOA

A

Chronic inflammatory changes within endometrium and fallopian tubes
Become toxic to sperm and ova (prevents fertilization, discourages implantation)

20
Q

Levonorgestrel releasing IUD MOA

A

Progesterone IUD
Changes in cervical mucus
Thinning and glandular trophy of endometrium
Prevents ovulation

21
Q

What contraceptions work at

  1. Ovulation
  2. Fallopian tube
  3. Implantation
  4. Entry of semen
A
  1. Hormonal contraception
  2. Tubal ligation, hormonal contraception
  3. Hormonal contraception, IUD
  4. Barrier methods, vasectomy, hormonal contraception, coitus interruptus
22
Q

2 hormonal forms of emergency contraception

A 
Levonorgestrel (ex: PlanB - use within 5 days, effectiveness decreased if BMI over 25)
Ulipristal acetate (ex: Ella - use within 5 days, effectiveness decreased if BMI over 30)
23
Q

What is the most effective form of emergency contraception?

A

Copper T IUD
Use within 7 days of unprotected intercourse
First line is BMI over 30

24
Q

Levonorgestrel

A 
Emergency contraception
Multifactorial MOA (interferes with ovulation, affects fallopian tube contractility, inhibits sperm binding to zona pellucida)
25
Q

Ulipristal acetate

A 
Emergency contraception
Multifactorial MOA (interferes with follicle rupture)
No effect on endometrium
26
Q

Copper IUD

A

Most effective form of emergency contraception
Copper ions are toxic to sperm and ova
Affects fallopian tube and myometrial contractility
Inhibits implantation IF a blastocyst reaches the uterus

Week 15: Infertility (9 decks)

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