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Reproductive System > Contraception and Infertility > Flashcards

Contraception and Infertility Flashcards

1
Q

What 4 methods fall under ‘Natural Contraception’

A
  1. Abstinence
  2. Withdrawl Method
  3. Fertility awareness method
  4. Lactational Amenorrhoea
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2
Q

Explain the principles of Lactational amenorrhoea

A
  • Suckling during breastfeeding causes high levels of prolactin
  • Prolactin negatively feedsback to lower release of GnRH
  • Method only effective for 6 months and relies on exclusive breastfeeding
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3
Q

What kind of things are measured in the fertility awareness method of contraception?

A
  1. Cervical Secretions
  2. Basal body temperatures → temperature goes up at ovulation
  3. Legnth of menstrual cycle
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4
Q

What is barrier contraception? Give some examples?

A

Physical barriers to prevent entrance of sperm to the cervix

e.g male/ female condoms, diaphragms and caps

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5
Q

What are the main advantages of barrier contraception?

A
  • Protection from STI’s
  • Male condom is widely available
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6
Q

What are some of the main disadvantages of barrier contraception?

A
  • Not romantic
  • Can reduce sexual pleasure
  • Can expire
  • People can be allergic/ sensitive to latex
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7
Q

Which hormonal control contraception methods can be classes as ‘short acting’?

A
  • Combined Oestrogen and Progesterone
    • COCP
    • Vaginal Ring
    • Patches
  • Low Dose Progesterone only pill (POP)
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8
Q

Explain how the POP works?

A
  • Low dose of progesterone → not enough to inhibit ovulation
  • Thickens cervical mucus
  • Taken everyday without breaks
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9
Q

Why is there a higher risk of ectopic pregnancy with the progesterone only pill?

A

The pill does not inhibit ovulation and thick mucus can effect cilia making it hard for oocytes to move out of fallopian tube

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10
Q

Explain how the combined oral contraceptive works (COCP)

A
  • COCP combines oesterogen and progesterone to negatively feedback on the GnRH
    • Hypothalmus thinks it’s in the luteal phase so will prevent ovulation
  • Secondary aim: reduces endometrial receptivity to inhibit implantation
  • Secondary aim: thickens cervical mucus
  • Usually taken for 21 days with a 7 day break
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11
Q

What are the main advantages of the COCP?

A
  • 98% effective
  • Can relieve menstrual disorders
  • Reduces risk of ovarian cysts
  • Reduces risk of ovarian and endometrial cancer
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12
Q

What are the main disadvantages of the COCP?

A
  • No STI protection
  • Interact with other meds by CYP450
  • Contraindicated in those at high risk of Stroke, MI and High BMI as oestrogen is thomboembolic
  • Increased risk of breast cancer
  • Side effects: breakthrough bleeds, breast tenderness and mood disturbance
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13
Q

What advice would you give to a women who has missed her oral contraceptive pill?

A
  • If 1 pill missed: Take missed pill even if it means two pills taken in one day. Carry on as normal
  • If 2 pills missed (>48 hrs): taken the most recent forgotten pill (yesterdays) and leave other forgotten pills. Use barrier contraception. If there’s less than 7 pills left don’t have a break between packs
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14
Q

How does the DEPO PROVERA injection work?

A
  • High dose of progesterone given intramuscularly every 12 weeks
  • High doses of proegestone inhibit the positive feedback of oestrogen → no LH surge → no ovulation
  • Also thickens cervical mucus
  • Also thins the lining of the endometrium
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15
Q

What are the main disadvantages of the Depo Provera injection?

A
  • Need an appointment every 12 weeks
  • Contraindications and side effects
  • Delay in fertility returning of 18months - 2 years
  • No STI protection
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16
Q

How does the progestone implant work?

A
  • Small, flexible tube inserted under the skin secreting high dose progesterone
  • Inhibits ovulation by preventing the positive feedback of oestrogen → no LH surge → no ovulation
  • Secondary actions: thicken cervical mucus and prevent endometrial proliferation
  • Lasts for 3 years
17
Q

What are some of the disadvantages of the progesterone implant?

A
  • Amenorrhoea
  • Irregular bleeding/ spotting
  • Heavy periods
18
Q

What are the 2 main types of coil and how does each work?

A
  • Interuterine device (Copper coil)
    • Copper toxic to sperm and ovum
    • Causes endometrial inlammation preventing implantation
    • Changes consistency of cervical mucus
    • No effect on endometrial lining
    • Lasts 5-10 years
  • Intrauterine System (IUS)
    • Progesterone releasing coil → acts locally (not in systemic circulation)
    • lasts 3-5 years
    • Prevents implantation and reduces endometrial proliferation
    • Thickens cervical mucus
19
Q

Explain the 2 different types of sterilisation

A
  1. Vasectomy (males)
    • Vas deferens cut/ tied to prevent sperm entering ejaculate
  2. Tubal Ligation (females)
    • Fallopian tubes cut/blocked to stop ovum travelling from ovary to uterus
20
Q

What important things should be considered before sterilsation takes place?

A
  • Sterilisation is permanent
  • Should not be chosen if there is any doubt about having children in the future
21
Q

What are the the different types of emergency contraception?

A
  1. Emergency pill with levonorgestrel
    • must be used within 72 hours → the sooner the better
  2. Emergency pill with ulpristal acetate
  • can be used within 5 days but the sooner the better
    3. Emergency IUD up to 5 days after unprotected sex
22
Q

Define subfertility

A

A couple having regular, unprotected sex (every 2-3 days) who have been able to concieve within 1 year

23
Q

What is the difference between primary and secondary infertility?

A
  • Primary = never been pregnant
  • Secondary = pregnant in the past (including ectopics and terminations) but struggling to convieve again
24
Q

What are the different types of male infertility?

A
  1. Pre- testicular - issues effecting the HPG axis
  2. Testicular - issues with sperm production or storage
    • Chromosomal/ Congental absnormalities causing decreased sperm production
    • STIs
    • Vascular changes e.g. testicular torsion
    • Drugs e.g. chemotherapy
  3. Post- testicular - obstructive causes, erectile dysfunction, ejaculatory failure
25
Q

What are the 3 broad classes of ovulatory disorders?

A
  1. Hypothalmic PItuitary Failure (10%) - failure of GnRH to act on pituitary
  2. Hypothalmic - pituitary - ovarian dysfunction (85%) - failure of axis to respond to stimulation e.g. PCOS, Hyperprolactinaemic amenorrhoea
  3. Ovarian failure (5%) - failure of ovary to respond appropriately e.g Turner’s syndrome or early menopause
26
Q

What uterine and peritoneal disorders can lead to subfertility?

A

Any physical reason why implantation is not possible once fertilsation has occurred

  • Uterine fibroids
  • Conditions causing scarring/ adhesion
    • PID
    • Asherman’s syndrome
    • Endometriosis
    • Abdominal surgery
  • Abnormal uterine structures e.g septate or bicornate uterus from defect in mullerian duct
27
Q

What tubal damage disorders can lead to subfertility?

A

Conditions affecting fallopian tubes causing disruption of transport of the ovum from the ovary to the uterus

  • Endometriosis
  • Iatrogenic from pelvic surgery
  • Infection
  • Ectopic pregnancy
28
Q

What investigations would you like to do if a man presents with infertility?

A

Full clinical examination and history then…

  • Semen analysis: sperm count, motility, liquifaction studies
  • Hormone levels: LH, FHS, testosterone
  • Ultrasound testes
  • Exclude STI
  • Karyotyping
29
Q

What investigations would you like to do if a woman presents with infertility?

A
  • Hormone levels to assess whether ovulation is occuring- need to be appropriately timed
    • ​LH, FSH (day 2 of cycle)
    • Progesterone (day 21 of cycle)
    • Androgens
  • Systemic blood tests for prolactin and thyroid function
  • Swabs to exclude STI
  • Pelvic ultrasound
  • Test to check tubal patency
30
Q

What advice can a GP give to increase chances of concieving for men and women?

A
31
Q

When would someone be referred to a fertility clinic?

A

A woman of reproductive age who has not concieved after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility

32
Q

When would someone get an early referall to the infertility clinic?

A
  • Woman >36 years
  • Known clinical cause of infertility or a history of predisposing factors for infertility
33
Q

What fertility treatment can be offered by the fertility clinic?

A
  1. Medical treatment to restore fertility
  2. Surgical treatment
  3. Assisted reproductive technique
34
Q

Explain how the drug clomiphene works?

A
  • Clomiphene is a partial agonist of oestrogen receptors
  • It reduces the concentration of oestrogen receptors so the HPA is blinded to normal levels of oestrogen → negative feedback doesn’t occur
  • Causes surge in LH and FSH meaning follicles develop causing ovulation

Reproductive System (18 decks)

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