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Reproductive System > Contraception and Infertility > Flashcards

Contraception and Infertility Flashcards

1
Q

What is subfertility

A

Failure of conception in a couple who have regular (2/3 times a week), unprotected coitus for one year

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2
Q

What are the main causes of subfertility

A

Factors in males

Unexplained

Ovulatory disorders

Tubal disorders

Uterine or peritoneal disorders

Other - e.g coital or concurrent health problems

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3
Q

Name some male causes of infertility

A

Hypothyroidism

Diabetes

General health/systemic illness

Genetic

Infective

Chemotherapy/drugs

Vascular problems

Coital problems

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4
Q

Name some ovulatory disorders of infertility

A

Hypothalamic-pituitary failure - hypothalamic amenorrhea or hypogonadotropic hypogonadism

Hypothalamic-pituitary-ovarian dysfunction - polycystic ovary syndrome, hyperprolactinaemia amenorrhea

Ovarian failure - congenital, premature ovulatory failure

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5
Q

Name some uterine disorders of infertility

A

Uterine fibroids

Asherman’s syndrome

Endometriosis

Pelvic inflammatory disease

Previous surgery

Cervical stenosis

Mullerian developmental abnormality - agenesis, didelphys, bicornuate, septate

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6
Q

Name some tubal disorders of infertility

A

Endometriosis

Ectopic pregnancy

Pelvic surgery

Past pelvic infections

Mullerian developmental abnormality - agenesis

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7
Q

Name the broad methods of contraception

A

Natural

Barrier

Hormonal control

Prevention of implanation

Sterilisation

Emergancy contraception

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8
Q

Name the natural methods of contraception

A

Abstinence

Withdrawal method

Fertility awareness methods - use fertility indicators to determine fertile and infertile points of the menstrual cycle

Lactation amenorrhea method - prolactin released from breastfeeding disrupts GnRH release -> inhibits HPG axis. Only effective up to 6mths after giving birth but cycle does restart 21 days after birth

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9
Q

Name some barrier methods of contraception

A

Female and male condoms

Diaphragm caps

Only method that protect against STIs

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10
Q

Name some methods of contraception that use hormonal control

A

Combined oestrogen and progesterone - COCP, vaginal ring, patches

Progesterone depot

Progesterone implant

Low dose progesterone

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11
Q

Progesterone can be given as a method of contraception. How does progesterone prevent pregnancy if given in high and if given in low doses

A

High progesterone doses enhance negative feedback of oestrogen so there is reduced LH and FSH secretion so there is no LH production and no LH surge -> no ovulation

Low progesterone causes thickening of the mucosa but ovulation is still likely

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12
Q

Describe how the COCP works, how to take it and name some advantages and disadvantages of it

A

COCP contains progesterone and oestrogen and tricks the body into believing it is in the luteal phase -> prevents ovulation. Also reduces endometrial receptivity to inhibit implantation and thickens cervical mucosa

Take for 21 days then either 7 days break or 7 days placebo

Advantages - can relieve menstrual disorders, reduces risk of ovarian cysts and reduces risk of endometrial and ovarian cancer

Disadvantages - side effects, contraindications (BMI, migraines, breast cancer), increases risk of breast and cervical cancer

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13
Q

Describe how progesterone depot works and what the advantages and disadvantages are

A

In progesterone depot, an injection of progesterone (high concentration) is given every 12 weeks to prevent ovulation. Also thickens mucosa and prevents endometrial proliferation

Advantages - used for women who cannot use contraceptives containing oestrogen, reliable as eliminates user failure

Disadvantages - appointment needed, side effects, contraindications, delay in fertility returning

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14
Q

Describe how progesterone implant works and the advantages and disadvantages it has

A

Progesterone implant is a small tube inserted under the skin that inhibits ovulation, thickens cervical mucosa and prevents endometrial proliferation

Advantages - eliminates user failure, used for women who cannot use oestrogen contraception, fertility returns quicker than progesterone depot

Disadvantages - minor procedure required, side effects

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15
Q

Describe how the POP works and what its advantages and disadvantages are

A

Progesterone only pill (POP) is a pill taken every day without a break. Causes thickening of cervical mucosa. Is a low dose of progesterone

Advantages - quickly reversible, used when COCP contraindicated

Disadvantages - user depenent, menstrual problems are common, risk of ectopic pregnancy

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16
Q

Name some inhibition implantation methods of contraception and what the advantages and disadvantages are

A

Intrauterine system

Intrauterine device

Advantages - convenient and have long durations

Disadvantages - insertion may be umpleasant, may take time to settle, risk of uterine perforation, displacement or expulsion may occur, can cause menstrual irregularity

17
Q

Describe how the intrauterine system works

A

IUS is a progesterone releasing device that sits in the neck of the uterus

Prevents implantation, reduces endometrial proliferation and thickens cervical mucus
Can control heavy and painful bleeding

18
Q

Describe how the intrauterine device works

A

IUD is a platic device with added copper

Copper is toxic to sperm and ovum

Causes endometrial inflammatory reaction to prevent implantation

Changes consistency of cervical mucus

Can cause heavy and painful periods

19
Q

Name some sterilisation methods of contraception

A

Vasectomy - vas deferens cut or tied to prevent sperm entering ejaculate. Confirmed by post-op semen analysis

Tubal ligation/clipping - fallopian tubes cut or blocked to stop ovum travelling to uterus

Sterilisation is permanent under NHS

20
Q

What is the missed pill rule

A

Missed pill rule describes what to do if a contraceptive pill is missed

21
Q

What should a woman do if she misses one pill

A

Take the pill she missed the day before, even if it means taking two pills in one day

Then carry on as normal

22
Q

What should a women do if she forgets to take a pill for more than 48hrs

A

She should take the most recent forgotten pill and leave the other forgotten pill

If < 7 pills left, don’t have a break and start the next pack straight away

If > 7 pills left, finish the pack -> take 7 day break as normal before starting the new pack

Use extra protection for the next 7 days

Reproductive System (20 decks)

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