Contraception Flashcards
People who are concerned about their fertility should be informed that over 80% of couples in the general population will conceive
within a year if woman <40yrs, no contraception and have regular sexual intercourse
what is the cumulative pregnancy rate after 2 years?
over 90%
what percent of women aged under 40 years will conceive within 6 cycles of intrauterine insemination?
50%
what is the cumulative pregnancy rate in IUI within 12 cycles?
75%
male and female fertility decreases with?
age
what is the frequency and timing of sexual intercourse?
vaginal sexual intercourse every 2 to 3 days
women trying to become pregnant should be informed that drinking no more than?
1-2 units of alcohol once or twice per week and avoiding episodes of intoxication
men should be informed that ———- is detrimental to semen quality
excessive alcohol
men and women should be advised to avoid?
smoking
women who have a BMI of over ——– should be informed that they are likely to take longer to conceive
30
men who have a BMI of 30 or over should be informed that are likely to have?
reduced fertilty
what is the recommended dose of folic acid supplementation in women intending to become pregnant, before conception and unto 12 weeks gestation?
0.4mg
women who are taking anti-epileptic medication or have diabetes what is the dose of folic acid?
5mg
semen analysis should show: semen volume: pH; Sperm concentration: total sperm number: total motility (percentage of progressive motility) vitality: sperm morphology (percentage of normal forms)
1.5ml or more
7.2 or more
15 million spermatozoa per ml or more
40% or more motile or 32% or more with progressive motility
58% or more live spermatozoa
4% or more
when do you repeat semen analysis tests?
3 months after
total antral follicle count of less than or equal to —– and greater than —— for a high response to predict likely ovarian response to gonadotrophin stimulation in IVF?
4 and 16
anti-Müllerian hormone of less than or equal to—— pmol/l for a low response[5] and greater than or equal to ——— pmol/l for a high response to measure ovarian response to gonadotrophin stimulation in IVF
5.4, 25
follicle-stimulating hormone greater than ——– IU/l for a low response and less than ———- IU/l for a high response to measure ovarian response to GS in IVF
8.9, 4
if cycle is of 28 days then measure serum progesterone level on
day 21
if cycle is 35 days long then measure serum progesterone level on
day 28
serum progesterone level of 16nm/l
repeat, if consistently low refer to specialist
16-30nmol/l progesterone level
repeat
what indicates ovulation in regards to serum progesterone level?
> 30nmol/l
when do you measure serum progesterone?
7 days prior to expected next period
what is the commonest cause of infertility?
male factor 30%
which of the following contraceptive do the FSRH recommend should be discontinued after the age of 50 years?
depo-provera injections (injectable contraceptives)
delay of return of fertility of up to 1 year for women >40 using which type of contraceptive?
deep-provera
non-hormonal methods of contraception <50 years
stop contraception after 2 years of amenorrhoea
non hormonal methods of contraception >50
stop contraception after 1 year of amenorrhoea
COCP can be continued to —- years
50
COCP can be switched to non-hormonal or progestegen -only method after —- years?
50
implant, POP, IUS can be continued beyond —– years
50
if ammenorrhoeic and using impact, POP, IUS check —– and stop after 1 year if —–>=—-u/; or stop at —– years
FSH, FSH, 30, 55 years
if not amenorrhoeic and using implant, POP, IUS then consider
investigating abnormal bleeding pattern
if prescribing HRT then consider —– for additional contraception
POP
1 missed COCP pill
take the last pill (can be two pills in a day), no additional contraception needed
if 2 or more pills missed
take the last pill even if it means taking two pills in one day and leave out any earlier missed pills and then continue taking pills daily, use condoms or abstain from sex until taken 7 days in a row
if more than 2 pills missed in week 1 (days 1-7)
emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if 2 or more pills are missed in weeks 2 (days 8-14)
after 7 consecutive days of taking the COCP there is no need for emergency contraception
if 2 or more pills are missed in week 3 (days 15-21)
finish the pills in the her pack and start the new pack the next day (thus omitting the pill free interval)
where is the most appropriate place to insert the implant?
subnormal, non-dominant arm just overlying the tricep
if you can’t find implantable contraceptive?
it is radiopaque and therefore easier to locate
how does the implantable contraceptive work?
main mechanism - preventing ovulation. They also thicken the cervical mucus
how long does the implantable contraception take to work?
additional contraceptive methods are needed for the 1st seven days if not inserted on day 1-5 of a women’s menstrual cycle
what is the main adverse effect of implantable contraception?
irregular-heavy bleeding
who interacts with efficacy of implantable contraceptive?
enzyme inducing drugs such as certain anti-epileptic and rifampicin medication
which condition represents an unacceptable risk if implantable contraceptives are to be used?
current breast cancer
what is an absolute contraindication for someone starting COCP?(3)
migraine with aura
breastfeeding <6 weeks postpartum
age 35 smoking 15 cigarettes or more
when do you refer to a specialist a couple who has been having regular intercourse for——- months?
12 months
what is the first line fertility in males?
semen analysis
what is the first line fertility test in females?
mid-luteal progesterone level to confirm ovulation
early referral to infertility services in females with the following risk factors? (5)
age above 35 amenorrhoea previous pelvic surgery previous STI abnormal genital examination
early referral to infertility services in males with the following risk factors? (5)
previous surgery on genitalia previous STI varicocele significant systemic illness abnorma genital examination
the age of consent for sexual activity in the UK is?
16 years
COCP increased Risk of which cancers?
breast and cervical
COCP protective against which cancers?
ovarian and endometrial cancer
Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted
5 days after having ulipristal
levonorgesterol can be taken within —- hours of unprotected sexual intercourse (UPSI)?
72hrs, but take as soon as possible as efficacy decreases with time
Levonorgestrel mode of action
acts both to stop ovulation and inhibit implantation
when should levonorgestetrel dose be doubled?
for those with a BMI >26 or weight over 70kg
ulipristal is a
progesterone receptor modulator - inhibits ovulation
ulipristal can be taken up to
120 hours after intercourse
IUD as emergency contraception must be inserted within
5 days of UPSI or 5 days after the likely ovulation date
how does IUD work as emergency contraceptive?
inhibit fertilisation or implantation
common adverse effect of POP?
irregular bleeding
if POP is commenced up to and including day 5 of the cycle it provides
immediate contraception otherwise additional contraception should be used for the first 2 days
missed POP pills <3 hours
continue as normal
missed POP pills > 3 hours
take missed pill as possible and continue with rest of pack and use extra precautions until pull taking has been re-established for 48 hours
for cerazette what period is allowed for missed pills?
12 hours
injectable contraceptives given every 12 weeks
every 12 weeks
for a patient with a past history of breast cancer which contraceptive method I best?
copper coil
postpartum COCP use?
after 6 weeks even if breastfeeding
what two hormones does the vaginal ring contain?
oestrogen and progesterone
