Contraception And Subfertility

Question 1

What types of contraception are there?

Answer 1

Natural,
Barrier,
Hormonal control,
Prevention of implantation,
Sterilisation,
Emergency contraception.

Question 2

What natural methods of contraception are there?

Answer 2

Abstinence,
Withdrawal,
Fertility awareness,
Lactational amenorrhea.

Question 3

What limitations are there to lactational amenorrhea?

Answer 3

Must breastfeed exclusively,

Must have complete amenorrhea - spotting indicates possible ovulation

Question 4

What barrier contraceptives are there?

Why are these unique?

Answer 4

Condoms
Diaphragms/cervical caps. Often used with spermicide
Only contraception that helps prevent STIs (other than abstinence)

Question 5

What is the mechanism of action of the combined oral contraceptive pill?
How is it taken?

Answer 5

Prevents ovulation by lengthening the luteal phase.

Taken for 21 days with a 7 day break (placebo pills).

Question 6

What might contraindicate use of the COCP?

Answer 6

Raised BMI, migraines, breast cancer. Increases the risk of breast cancer, stroke and cardiovascular disease.

Question 7

What clinical benefits does the COCP have?

Answer 7

Can relieve menstrual disorders,

Decreases risk of ovarian and endometrial cancers.

Question 8

How does the progestogen only pill work?

How is it taken?

Answer 8

Thickens cervical mucus (ovulation still occurs)

Taken daily with no breaks.

Question 9

What disadvantages does the mini pill have?

Answer 9

May cause menstrual irregularity, increases risk of ectopic pregnancy.

Question 10

How often is IM progestogen injection given?

What disadvantage is specific to it?

Answer 10

Every 12 weeks.

Takes a while for fertility to occur after stopping use.

Question 11

How long does the progestogen implant last for?

What are the main disadvantages?

Answer 11

Up to 3 years.

Menstrual irregularity and complications with insertion and removal.

Question 12

How does the IUS work?

Answer 12

Locally Progestogen releasing coil - prevents implantation and thickens mucus. Ovulation still occurs.

Question 13

How does the IUD work?

Answer 13

Copper is toxic to sperm and ovum, so prevents fertilisation.

Question 14

What are disadvantages of the coil?

Answer 14

Mentsrual irregularity, displacement may occur, complications with insertion.

Question 15

What is vasectomy?

What must be done afterwards?

Answer 15

Vas deferens cut or tied to prevent sperm entering ejaculate.
Post vasectomy semen analysis 12 weeks post.

Question 16

What is tube ligation/clipping?

Answer 16

Fallopian tubes occluded to prevent ovum transport. Under local or general anaesthetic.

Question 17

What emergency contraception options are there?

Answer 17

Levonorgestrel - morning after pill. High dose progestogen.
Ulipristal acetate - selective progesterone receptor modulator that delays ovulation
Copper IUD.

Question 18

What is subfertility?

Answer 18

A couple having regular (every 2-3 days) unprotected sex who have failed to conceive after 1 year.

Question 19

What is primary fertility?

What is secondary fertility?

Answer 19

Primary - never been pregnant

Secondary - previous pregnancy (including terminations), now failing to conceive.

Question 20

How prevalent is infertility?

Answer 20

Affects approximately 1 in 7 couples

Question 21

What three types of causes are there for male infertility?

Answer 21

Pretesticular,
Testicular,
Post testicular.

Question 22

What types of infertility affect women?

Answer 22

Ovulatory disorder,
Uterine and peritoneal disorder,
Tubal damage.

Question 23

When should you consider referral to secondary care for subfertility?

Answer 23

After 1 year of failure to conceive of history is normal.

6 months in women older than 36 or if known cause/predisposing factors

Question 24

What medical treatments may increase fertility?

Answer 24

Clomifene - induces ovulation,
Laparoscopy could help remove tubal occlusion.
Assisted reproductive therapy eg IVF.