Contraception and Infertility Flashcards
1
Q
Give examples of natural contraception
A
- Abstinence
- Withdrawal method
- Fertility awareness methods (phone apps)
- Lactational amenorrhoea method
2
Q
Abstinence A/D
A
- Advantages - only 100% reliable method of contraception
- Disadvantages - well… good luck making it work
3
Q
Withdrawal method A/D
A
- Withdrawing before ejaculation
- Advantages - no devices/hormones
- Disadvantages - not reliable
- Some sperm may be released in the pre-ejaculate
- No protection for STI’s
- Some sperm may be released in the pre-ejaculate
4
Q
Fertility awareness methods description and A/D
A
- Phone apps
- Use of fertility indicators to identify fertile and infertile points of menstrual cycle
- Based on cervical secretions, basal body temperatures, length of menstrual cycle
- Advantages - no hormones/contraindications
- Disadvantages - unreliable, no protection from STI’s
5
Q
Lactational amenorrhoea method description and A/D
A
- Breastfeeding delays the return of ovulation after childbirth
- Increased prolactin shuts down HPG axis
- Relies exclusively on breast feeding
- Only effective up to 6 months after giving birth
- Advantages - no hormones/contraindications
- Disadvantages - unreliable, no STI prevention
6
Q
Barrier contraception A/D
A
- Male/female condoms
- Diaphragm/caps
- Advantages - 98% reliable if used correctly
- Protection from STI’s
- Male condom widely available
- Disadvantages - reduced sexual pleasure
- Danger of expiring
- Allergy/sensitivity to latex/spermicide
- Danger of expiring
7
Q
Give examples of hormonal control
A
- Combined oral contraceptive pill (COCP)
- Progesterone depot
- Progesterone implant
- Progestrogen only pill (POP)
8
Q
Explain the action of COCP
A
- Pill containing synthetic oestrogen and progestogen
- Principal action - prevents ovulation
- Tricks HPG axis to be in luteal phase
- Secondary action - reduces endometrial receptivity to inhibit implantation
- Thickens cervical mucus to inhibit penetration of sperm
- Taken for either 21 days followed by 7 days break or taken 21 days with 7 days of placebo pill
9
Q
COCP A/D
A
- Advantages
- 98% reliability
- Can relieve menstrual disorders
- Heavy/irregular bleeding
- Painful period
- Reduces risk of ovarian cancer and endometrial cancer
- Disadvantages
- User dependent
- Interaction with other medications
- Contraindications and side effects
- Do not take with heart or blood pressure problems
- Oestrogen is thrombotic - could form blood clot
- Increased risk of breast and cervical cancer, MI/stroke
- No protection from STIs
10
Q
Explain the action of long-activing reversible contraception
A
- Include progesterone depot and progesterone implant
- High dose progestogen
- Enhance negative feedback of oestrogen pre-ovulation - reduce LH and FSH secretion
- Progesterone inhibits positive feedback of oestrogen at ovulation - no LH surge and no ovulation
11
Q
Progesterone depot A/D
A
- Intramuscular injection given at intervals
- Actions same as pill
- Advantages - 99% effective
- Reliable - eliminates risk of user failure
- Does not disrupt sexual intercourse
- Stop most period types
- Useful for women who can’t use contraception containing oestrogen (high BP patients)
- Disadvantages
- Appointment needed every 12 weeks
- Contraindications and side effects - low weight can cause osteoporosis
- Delay in fertility returning - up to 1 year
- No STI protection
12
Q
Progesterone implant A/D
A
- Small flexible tube about 40mm long is inserted under the skin
- Lasts for 3 years
- Actions same as pill
- Advantages - more them 99% effective
- Reliable - eliminates risk of user failure
- Long-acting reversible contraception
- Useful for women who cannot use contraception that contains oestrogen
- Natural fertility returns quickly when removed
- Disadvantages
- Minor procedure to insert
- Side effects
- No STI protection
- Only stops some period problems
13
Q
Explain the principle of progestogen only pill (POP)
A
- Lower progesterone doses do not inhibit LH surge - ovulation likely
- Lower dose will thicken cervical mucus
- Taken every day without a break
- Principal action - thicken cervical mucus
14
Q
Progestogen only pill A/D
A
- Advantages - more than 99% effective
- Quickly reversible
- Does not disrupt sexual intercourse
- Can be used where the COCP is contraindicated
- Disadvantages
- User dependant
- Menstrual problems are common
- Interacts with other medication
- Risk of ectopic pregnancy - not inhibiting ovulation
- Does not protect from STIs
15
Q
Examples of non-hormonal contraception preventing implantation
A
- Intrauterine system (IUS)
- Intrauterine device (IUD)
16
Q
Explain the action of intrauterine system
A
- Progestogen-releasing plastic device
- Works for 3-5 years
- Principal action - prevents implantation and reduces endometrial proliferation
- Secondary action - thickens cervical mucus
17
Q
Explain the action of intrauterine device
A
- Plastic device with added copper
- Works for 5-10 years
- Principal action - copper is toxic to sperm and ovum
- Secondary action - endometrial inflammatory reaction preventing implantation and changes consistency of cervical mucus
- Does not stop bleeding - can even bleed more so do not use for heavy bleeding patients
18
Q
IUS and IUD A/D
A
- Advantages - convenient
- Long duration of action
- 99% effective
- Disadvantages
- Insertion may be unpleasant
- Risk of uterine perforation ~2/1000 insertions
- Menstrual irregularity
- Does not protect STIs
-
Displacement/expulsion may occur - into cervix, out of uterus
19
Q
Explain the principle of vasectomy
A
- Vas deferens cut/tied to prevent sperm entering ejaculate
- Performed under local anaesthetic
- Must confirm success by post-operative semen analysis to confirm no sperm in ejaculate (3 months after surgery)
- Failure rate - 1 in 2000
20
Q
Explain tubual ligation
A
- Fallopian tubes cut or blocked to stop the ovum travelling from the ovary to the uterus
- Can be done under local or general anaesthetic
- Failure rate - 1 in 200/500 (depending on method)
21
Q
Sterilisation A/D
A
- Sterilisation is permanent with no long or short term serious side effects
- Should not be chosen if in any doubt about having children in the future
22
Q
Give examples of emergency contraception
A
- Emergency IUD
- Emergency pill with ulipristal acetate
- Emergency pill with levonorgestrel
23
Q
State the categories of contraception
A
- Natural
- Barrier
- Hormonal control
- Implantation prevention
- Sterilisation
- Emergency contraception
24
Q
Define subfertility
A
Failure of conception in a couple having regular, unprotected coitus for one year
25
Q
Differentiate between primary and secondary infertility
A
- Primary infertility - when someone who’s never conceived a child in the past has difficulty conceiving
- When the ovary does not function properly
- Eg. Dysgenetic gonads, hypothalamic dysfunction, hypothyroidism
- Secondary infertility - when someone has had one or more pregnancies in the past, but is having difficulty conceiving again (includes abortion and ectopic pregnancies)
- When the ovary has become unable to function
- Eg. Hyperprolactinaemia, polycystic ovarian syndrome (PCOS), pregnancy, emotional stress
26
Q
What is the most common cause of infertility in male and female
A
- Male - abnormal semen analysis
- Female - anovulation
27
Q
What are common treatment options for infertility
A
- Medical treatment to restore fertility
- Eg. Drugs to stimulate follicular development and ovulation
- GnRH agonist/antagonist, gonadotrophins
- Surgical treatment to restore fertility
- Eg. Laparoscopy, varicocele repair
- Assist reproduction techniques (ART)
- Treatment that creates conception other than vaginal intercourse
- Eg. IVF
- Treatment that creates conception other than vaginal intercourse
