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3 - Reproduction > Contraception and Infertility > Flashcards

Contraception and Infertility Flashcards

1
Q

Give examples of natural contraception

A
  • Abstinence
  • Withdrawal method
  • Fertility awareness methods (phone apps)
  • Lactational amenorrhoea method
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2
Q

Abstinence A/D

A
  • Advantages - only 100% reliable method of contraception

- Disadvantages - well… good luck making it work

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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
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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
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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
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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
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7
Q

Give examples of hormonal control

A
  • Combined oral contraceptive pill (COCP)
  • Progesterone depot
  • Progesterone implant
  • Progestrogen only pill (POP)
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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
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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
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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
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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
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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
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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
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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
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15
Q

Examples of non-hormonal contraception preventing implantation

A
  • Intrauterine system (IUS)

- Intrauterine device (IUD)

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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

3 - Reproduction (17 decks)

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