Contraception And Subfertility Flashcards
What types of contraception are there?
Natural, Barrier, Hormonal control, Prevention of implantation, Sterilisation, Emergency contraception.
What natural methods of contraception are there?
Abstinence,
Withdrawal,
Fertility awareness,
Lactational amenorrhea.
What limitations are there to lactational amenorrhea?
Must breastfeed exclusively,
Must have complete amenorrhea - spotting indicates possible ovulation
What barrier contraceptives are there?
Why are these unique?
Condoms
Diaphragms/cervical caps. Often used with spermicide
Only contraception that helps prevent STIs (other than abstinence)
What is the mechanism of action of the combined oral contraceptive pill?
How is it taken?
Prevents ovulation by lengthening the luteal phase.
Taken for 21 days with a 7 day break (placebo pills).
What might contraindicate use of the COCP?
Raised BMI, migraines, breast cancer. Increases the risk of breast cancer, stroke and cardiovascular disease.
What clinical benefits does the COCP have?
Can relieve menstrual disorders,
Decreases risk of ovarian and endometrial cancers.
How does the progestogen only pill work?
How is it taken?
Thickens cervical mucus (ovulation still occurs)
Taken daily with no breaks.
What disadvantages does the mini pill have?
May cause menstrual irregularity, increases risk of ectopic pregnancy.
How often is IM progestogen injection given?
What disadvantage is specific to it?
Every 12 weeks.
Takes a while for fertility to occur after stopping use.
How long does the progestogen implant last for?
What are the main disadvantages?
Up to 3 years.
Menstrual irregularity and complications with insertion and removal.
How does the IUS work?
Locally Progestogen releasing coil - prevents implantation and thickens mucus. Ovulation still occurs.
How does the IUD work?
Copper is toxic to sperm and ovum, so prevents fertilisation.
What are disadvantages of the coil?
Mentsrual irregularity, displacement may occur, complications with insertion.
What is vasectomy?
What must be done afterwards?
Vas deferens cut or tied to prevent sperm entering ejaculate.
Post vasectomy semen analysis 12 weeks post.
What is tube ligation/clipping?
Fallopian tubes occluded to prevent ovum transport. Under local or general anaesthetic.
What emergency contraception options are there?
Levonorgestrel - morning after pill. High dose progestogen.
Ulipristal acetate - selective progesterone receptor modulator that delays ovulation
Copper IUD.
What is subfertility?
A couple having regular (every 2-3 days) unprotected sex who have failed to conceive after 1 year.
What is primary fertility?
What is secondary fertility?
Primary - never been pregnant
Secondary - previous pregnancy (including terminations), now failing to conceive.
How prevalent is infertility?
Affects approximately 1 in 7 couples
What three types of causes are there for male infertility?
Pretesticular,
Testicular,
Post testicular.
What types of infertility affect women?
Ovulatory disorder,
Uterine and peritoneal disorder,
Tubal damage.
When should you consider referral to secondary care for subfertility?
After 1 year of failure to conceive of history is normal.
6 months in women older than 36 or if known cause/predisposing factors
What medical treatments may increase fertility?
Clomifene - induces ovulation,
Laparoscopy could help remove tubal occlusion.
Assisted reproductive therapy eg IVF.
