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Reproductive System > Contraception And Infertility > Flashcards

Contraception And Infertility Flashcards

1
Q

What is the role of progesterone at low doses?

A

Does NOT inhibit the LH surge
Ovulation still likely
Thickens the cervical mucus

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2
Q

What is the role of progesterone at moderate/high dose before ovulation?

A

Enhances the negative feedback of oestrogen

Decrease LH and FSH

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3
Q

What is the role of moderate/high progesterone at ovulation?

A

Inhibits the positive feedback of oestrogen
No LH surge
No ovulation

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4
Q

Describe methods for natural contraception

A

Cervical secretion - increased mucus at most fertile
Length of menstrual cycle
Basal body temperature - progesterone slightly elevates temp just after ovulation

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5
Q

What is the effect of breast feeding on ovulation?

A

Delays the return of ovulation
Up to 6 months post-partum
Suppresses GnRH release

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6
Q

What are the advantages to natural contraception?

A

No added hormones

No contraindications

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7
Q

What are the advantages of barrier methods?

A

Help prevent STIs

Diaphragm/caps can be inserted anytime before intercourse

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8
Q

What are the disadvantages of barrier methods?

A

Allergies/sensitivity to latex
Females condoms not as widely available
Local reactions to spermicide

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9
Q

Describe the action of and how to take the COCP

A

Oestrogen and progesterone together - prevent ovulation and decrease endometrial receptivity to implantation and thickens cervical mucus
21 days then 7 day break (or dummy pill)

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10
Q

What are the advantages of COCP?

A

Can relieve menstrual disorders

Reduces risk of ovarian cysts and cancer

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11
Q

What are the disadvantages of COCP?

A

User dependent
Side effects: breakthrough bleeding, breast tenderness and mood disturbance
Increased risk of DVT, MI
Many contraindications

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12
Q

How long does the progesterone injection last?

A

8 - 13 weeks

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13
Q

What are the advantages of the progesterone injection?

A

Convenient

Can relieve menstrual disorders

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14
Q

What are the disadvantages of progesterone injection?

A

Altered/irregular bleeding common
Delayed return of fertility up to 1 year after stopping
Not quickly reversible
Small loss of bone mineral density

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15
Q

Describe the progesterone implant

A

4 cm flexible rod
Inserted subdermally in upper arm
Lasts up to 3 years

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16
Q

What are the advantages of the progesterone implant?

A

Long duration of action
Convenient
Can relieve menstrual disorders

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17
Q

What are the disadvantages of progesterone implant?

A

Small procedure required
Local adverse effects can occur
Changes in bleeding pattern
Can migrate to another location

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18
Q

Describe the progesterone only pill

A

Lower dose progesterone
Taken every day
Thickens cervical mucus making in impenetrable to sperm
Ovulation usually not prevented

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19
Q

What are the 2 different types of coil?

A 
Intrauterine system (IUS) - progesterone 
Intrauterine device (IUD) - copper
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20
Q

Describe the IUS

A

Progesterone release to decrease endometrial proliferation to prevent implantation
Small plastic device
Lasts 3 - 5 years

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21
Q

What are the disadvantages of the IUS?

A

Insertion may be unpleasant
Displacement/expulsion may occur
Menstrual irregularity common in first 6 months
Risk of uterine perforation

22
Q

What is the action of IUD?

A

Release copper
Copper is toxic to sperm and ovum
Therefore prevents fertilisation
Copper causes inflammatory endometrial reaction to prevent implantation

23
Q

How long does the IUD last?

A

5 - 10 years

24
Q

What are the advantages of IUD?

A

Convenient
Long duration
Can be used as emergency contraception

25
Q

Describe a vasectomy

A

Vas deferens interrupted
Under local anaesthetic
Most confirm post-op with a semen analysis

26
Q

What are the advantages of sterilisation?

A

No hormonal side effects

Permanent

27
Q

What are the disadvantages of sterilisation?

A

Permanent - not for people in any doubt about wanting children
Failure rates quite high

28
Q

Define infertility

A

Failure of conception in a couple having regular, unprotected coitus for one year

29
Q

When looking at infertility cases, how do we define regular coitus?

A

2 or more times a week

30
Q

What percentage of couples get pregnant after 12 cycles?

A

80%

31
Q

What is the difference between primary and secondary infertility?

A

Primary - no previous pregnancy

Secondary - has had a previous pregnancy, whether successful or not

32
Q

Approximately how many couples have difficulty conceiving?

A

1 in 7

33
Q

What might we do on examination of an infertile woman?

A

BMI
Look for secondary sexual characteristics
Galactorrhoea
Pelvic exam - any abnormalities noted

34
Q

What percentage of cases of infertility are due to the male?

A

30%

35
Q

What are the general causes of infertility in women?

A

Ovulatory disorders
Tubal damage
Unexplained
Uterine or perineal disease

36
Q

What is the most common male cause of infertility?

A

Idiopathic oligospermia

37
Q

Give some examples of causes of infertility in men

A 
Oligospermia 
Varicocele 
Abnormal sperm production eg.testicular disease
Hypothalamic/pituitary dysfunction 
Ductal obstruction 
Failure to deliver sperm to vagina
38
Q

How do we treat hypothalmic-pituitary causes of ovulatory disorders?

A

GnRH therapy

39
Q

What can we give to induce ovulation? For example in PCOS

A

Clomiphene citrate

40
Q

Describe some of the pathophysiology of PCOS

A 
Increased androgens 
Increased LH to FSH ratio
Insulin resistance
Multiple small ovarian cysts (12+) 
Anovulation with oligomenorrhoea or amenorrhoea
41
Q

Give some clinical features of PCOS

A 
Hirsutism 
Acne
Obesity 
Oligomenorrhoea
Psych Sx = mood swings, anxiety etc
42
Q

What are the categories in the Rotterdam Criteria to diagnose PCOS?

A

12+ follicles on USS
Oligo- or anovulation
Clinical/biochemical signs of hyperandrogenism
Exclusion of other causes of androgen excess

43
Q

What are the most likely causes of tubal damage?

A 
Past pelvic infection
Previous pregnancy 
Pelvic surgery 
Endometriosis
Mullerian development anomaly
44
Q

Name some uterine/peritoneal diseases that can cause infertility

A 
Endometriosis 
Asherman's syndrome 
Uterine fibroids
Cervical stenosis 
Cervical hostility
45
Q

What is endometriosis?

A

Presence of endometrial tissue in sites other than the uterine cavity
10-15% of women have it

46
Q

What are the clinical features of endometriosis?

A

Dysmenorrhea
Dyspaureunia
Chronic pelvic pain
Infertility

47
Q

How might we manage endometriosis?

A

Contraceptive pill to regulate periods
Anti-inflammatory
IVF possibly

48
Q

What would we investigate for an infertile woman?

A 
Follicular phase LH and FSH
Luteal phase progesterone 
Prolactin, androgens, TFTs
Cervical smear
Pelvic USS
Tests of tubal potency - dye and x-ray
49
Q

What investigations might we do for an infertile man?

A 
Sperm analysis - volume, count, pH, motility 
Antiserum antibodies
LH, FSH, testosterone
USS
Karyotype 
Cystic fibrosis?
Testicular biopsy
50
Q

How do clomifene citrate work?

A

Reduces negative feedback of oestrogen

Increases GnRH and FSH

Reproductive System (17 decks)

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