Contraception and infertility Flashcards
What is contraception?
Any method to prevent pregnancy
How does contraception work?
- blocks transport of sperm to avoid fertilisation of oocyte
- disrupts the HPG axis to interfere with ovulation
- inhibiting implantation of the conceptus into endometrium
Where does the coil sit?
sits in the neck of the womb through the internal and external os
What is sub fertility?
Failure of conception in a couple having regular, unprotected sex for one year
What is regular sex?
2-3 times a week
What is primary infertility?
never been pregnant
What is secondary infertility?
has been pregnant in the past (including ectopic pregnancy and termination of pregnancy) are struggling to conceive again
What are the main causes of sub fertility?
- male problems (pre-testicular, testicular, post-testicular)
- ovulatory disorders
- tubal damage
- uterine or peritoneal disorders
- unknown reasons
What are some pre-testicular causes?
Endocrine problems affecting the HPG axis - hypothyroidism, diabetes, hyperprolactinoemia, hypothalamus dysfunction
What are some testicular causes?
Affecting sperm production and storgae
- genetic
- congenital
- infective
- antispermatogenic agents
- vascular
What are the genetic factors causing subfertility?
-Kleinfelter syndrome
-Y chromosome deletion
This decreases sperm production
What are the infective causes of subfertilty?
STI’s (affect more women)
What vascular causes of sub fertility?
testicular torsion and varicoele
What anti spermatogenic agents affect sub fertility?
Chemotherapy and drugs
What are the post-testicular causes of sub fertility?
- Obstructive causes like congenital (structure) or vasectomy)
- Coital problems like ejaculatory failure and erectile dysfunction
What factors affect women with sub fertility?
ovulatory disorders, uterine/peritoneal disorders, tubal damage
What ovulatory disorders can a woman have?
- hypothalamic-pituitary failure
- hypothalamic-pituitary-ovarian dysfunction
- Ovarian failure
What cause is most common?
hypothalamic-pituitary-ovarian-dysfunction
What care uterine and peritoneal disorders affecting sub fertility?
Physical reasons why implantation is not possible once fertilisation has occured
- Uterine fibroids
- endometirosis
- PID
- Ashermans syndrome
- Abdominal surgery
- abnormal structure of the uterus from issues of the mullerian ducts incorrectly developing (agenesis)
What tubal damage can affect sub fertility?
- cause disruption of the transport of the ovum from the ovary to the uterus
- endometirosis
- iatrogenic pelivc surgery
- chlamydia
- ectopic pregnancy
What investigation are important in men?
- semen analysis
- hormone levels (LH, FSH, testosterone)
- ultrasound of testes
- exclude STI
- karyotyping
What are you looking for in a sememn analysis?
sperm motility
sperm count
liquification studies
What investigations would you do in women?
- hormones (LH, FSH, progesterone, androgens)
- blood tests (prolactin and thyroid function)
- exclude STI
- Peliv USS
- tests to check tubal patency
How would you determine the potency of fallopian tubes?
do a hysterosalpinogram
What would a doctor advise a couple who can’t get pregnant?
- stop smoking
- reduce alcohol
- reduce stress levels
- healthy diet and lose weight
- regualr sex
When would you refer a couple to a fertility clinic?
A women of reproductive age who has not conceived after 1 year of unprotected vaginal sex in the absence of any known cause of infertility
When would you give an early referral to a fertility clinic?
- if the woman is older than 36 yrs
- known clinical cause of infertility
What kind of treatment can be given?
- treatments to restore fertility
- surgical treatments to restore fertility
- assisted reproduction techniques
What treatments can restore fertility?
- GnRH agonist
- drugs to stimulate follicular development and ovulation
What surgical treatments can restore fertility?
-laproscopy to remove endometriosis and fibroids
What is ART?
artificial semination / IVF (anything that deals with conception other than vaginal intercourse)
