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ESA 3 - Reproductive System > Contraception And Infertility > Flashcards

Contraception And Infertility Flashcards

1
Q

What is contraception?

A

Any method to prevent pregnancy.

  • Blocking transport of sperm to avoid fertilisation of oocyte
  • Disrupt the HPG axis to interfere with ovulation
  • Inhibiting implantation of the conceptus into the endometrium.
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2
Q

What categories can the methods of contraception be split into?

A 
Natural 
Barrier 
Hormonal control
Prevention of implantation 
Sterilisation 
Emergency contraception
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3
Q

Natural methods of contraception

A

Abstinence - only 100% reliable method but not great (obvs)

Withdrawal method - No devices or hormones but not reliable as: willpower, pre-ejaculate and no STI projection

Fertility awareness method - no hormones or devices but unreliable and no STI protection

Lactation amenorrhoea method - breastfeeding delays the return of ovulation after childbirth as suckling disrupts release of GnRH. BUT, relies exclusively on breast feeding and only effective fo 6 months.

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4
Q

Barrier methods of contraception

A

Male / female condoms

Diaphragm / caps

Good as reliable and protection this STIs

Bad as Disrupts romantic

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5
Q

Hormonal control - short acting

A

Combined Oestrogen and Progesterone

  • COOP
  • Vaginal ring
  • Patches

Low dose progesterone
-POP

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6
Q

LARC

A

Depot

Implant

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7
Q

What is the difference between low and high dose progesterone?

A

Low - thicken mucus

High - prevents ovulation

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8
Q

How does the pill work?

A

Prevent ovulation

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9
Q

What are the advantages and disadvantages of the combined oral contraceptive pill?

A 
Good:
98% effective 
Can relieve menstrual disorders 
Reduce risk of ovarian cysts 
Reduce risk of ovarian cancer and endometrial cancer

Bad:
Contraindications - BMI, migraine with aura. Breast cancer
Side effects - breakthrough bleeding, breast tenderness, mood disturbance
Increased risk of - breast and cervical cancer, VTE, MI / stroke

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10
Q

High dose progestogen - Deposed Provera

A

Intramuscular injection given at intervals

Prevents ovulation and thicken mucus

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11
Q

High dose progestogen - Implant

A

Inhibits ovulation. Also, thicken cervical mucus and prevents endometrial proliferation.

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12
Q

POP

A

Taken every day without a break

Thicken cervical mucus - ovulation not prevented

Good:
Quickly reversible

Bad:
User dependant - cant be late
Menstrual problems are common 
Interacts with other meds 
Risk of ectopic pregnancy 
No STI protection
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13
Q

Coil

A

IUS - progestogen releasing plastic device which works for 3-5 year by preventing implantation and reducing endometrial proliferation. It also thickens cervical mucus

IUD - plastic device with added copper that works for 5-10 years because copper is toxic to the sperm and the ovum. It also causes endometrial inflammatory reactions which prevent implantation and changes the consistency of cervical mucus.

Good: Convenient and work for ages

Bad: Insertion may be unpleasant, Risk of perforation, menstrual irregularity, not prevent STI (make them worse), displacement / expulsion may occur.

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14
Q

Sterilisation

A

Vasectomy - Vas deferents cut or tied to prevent sperm entering ejaculate.

Tubal ligation / clipping - Fallopian tubes cut or blocked to stop the ovum travelling from the ovary to the uterus.

Can be done under local but mostly general anaesthetic.

PERMANENT

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15
Q

Emergency contraception

A

Levonestrogel - within 3 days - quicker the better

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16
Q

Define sub-fertility

A

failure of conception in a couple having regular (2-3 time per week), unprotected coitus for one year

17
Q

What is the difference between primary and secondary infertility?

A

Primary = Never conceived a child in the past and has difficulty conceiving

Secondary = One or more pregnancies in the past but difficulty conceiving (inc. abortion and ectopic pregnancy)

18
Q

What are the main causes of subfertility?

A 
Males - 30%
Unexplained - 25%
Ovulating - 25%
Tubal damage - 20%
Uterine or peritoneal disorders - 10%
Other - coital problems, concurrent health problems.

40% of cases - problems found in both men and women.

19
Q

What are some Male causes of infertility?

A

Endocrine - hyper/hypothyroidism, diabetes

Testicular - genetic (Klinefeter), Congenital, Infective, Antispermatogenic agents (chemo), vascular

Post-testicular - Obstructive (vasectomy), coital problems (ejaculatory failure, erectile dysfunction)

20
Q

Ovulating disorders

A

Group 1 - 10% - HPO failure
Group 2 - 85% - HPO dysfunction (PCOS)
Group 3 - 5% - Ovarian failure (turners)

21
Q

Uterine / Peritoneal disorders

A

Uterine fibroids

Endometriosis

Pelvic inflammatory disease

22
Q

Tubal damage

A

Endometriosis

  • Ectopic pregnancy
  • Pelvic surgery
  • Past pelvic infection e.g. chlamydia
23
Q

What questions would GP ask couple if subfertility?

A

Males:

  • Health
  • Kids
  • Alcohol / smoking
  • Surgical history
  • Drug history
  • Sexual heath and dysfunction

Females:

  • Age
  • General health
  • Drug history
  • Obs / gynae
  • Menstrual cycle
  • Surgical history
  • Sexual health history
24
Q

What examinations would a GP do if subfertility?

A

Males:
Not really done but sometimes testis incase varicoele

Females:
BMI
Secondary sexual charateristics (boobs, pubic hair)
Pelvic exam - visual external expection, insertion of speculum, bimanual examination to determine size and character or uterus and ovaries.

25
Q

What investigation would a GP do if subfertility?

A

Males:
Semen analysis
Blood tests
Penile / urethral swabs

Females:
Blood test - LH,FSH, Luteal phase progesterone, Prolactin, androgens 
Cervical smear 
Vaginal / cervical swabs 
Pelvic USS
Test of tubal patently
26
Q

What advice would a GP give if subfertility?

A

Both:
Stop smoking, reduce alcohol intake, reduce stress levels, healthy diet and regular sex.

Women: Loose weight

REASSURANCE

27
Q

When do you refer to a fertility clinic?

A

A women of reproductive age who has not conceived after one year of unprotected vaginal sexual intercourse, in the absence of any known causes of infertility.

Early if:

  • Over 36
  • Known clinical cause of infertility or history of predisposing factors.
28
Q

What are the three main types of fertility treatment?

A

Medical treatment to restore fertility - e.g. drugs -Clomiphene

Surgical treatment to restore fertility

Assisted reproduction techniques (ART) -e.g. IVF

ESA 3 - Reproductive System (20 decks)

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