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Reproductive System > Contraception + Infertility > Flashcards

Contraception + Infertility Flashcards

1
Q

What is contraception?

A

Any method that is used to prevent a pregnancy

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2
Q

Ways contraception can work

A
  • blocking sperm transport
  • disruption of HPG axis
  • inhibit implantation of conceptus into endometrium
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3
Q

What are the categories of contraception?

A

Natural
Barrrier
Hormonal
IUD/IUS
Sterilisation
Emergency contraception

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4
Q

Types of natural contraception

A

Abstinence
Withdrawal method
Fertility awareness methods
Lactational amenorrhoea method

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5
Q

Advantages and disadvantages of abstinence

A

Advantages:
- 100% effective

Disadvantages:
- not an option for most
- unprepared if/when sexually active

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6
Q

Advantages and disadvantages of withdrawal method

A

Advantages:
- no devices or hormones

Disadvantages:
- unreliable
- some sperm in pre-ejaculate
- no STI protection

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7
Q

What is fertility awareness methods of contraception?

A

Monitoring:
- cervical secretions
- changes in cervix
- basal body temp
- ‘calendar method’

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8
Q

Advantages and disadvantages of fertility awareness methods of contraception

A

Advantages:
- no hormones/contraindications

Disadvantages:
- time consuming
- unreliable
- no STI protection
- not suitable for all

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9
Q

What is the lactational amenorrhoea method of contraception?

A
  • Effective for up to 6 months postnatally if woman is exclusively breastfeeding + complete amenorrhoea
  • Lactation delays the onset of ovulation, due to high levels of prolactin which lowers the release of GnRH
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10
Q

Advantages and disadvantages of lactational amenorrhoea method

A

Advantages:
- no hormonal/contraindications

Disadvantages:
- unreliable after 6 months
- no STI protection
- not suitable for all

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11
Q

Describe the combined oral contraceptive pill
Including its actions

A
  • pill containing combination of synthetic oestrogen + progesterone
  • usually taken for 21 days with a 7 day break
  • main action: prevents ovulation
  • secondary action: reduces endometrial receptivity to implantation + thickens cervical mucous
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12
Q

Advantages and disadvantages of combine oral contraceptive pill

A

Advantages:
- reliable if used correctly
- can relieve menstrual disorders
- reduces risk of ovarian + endometrial cancers
- decreases acne severity in some

Disadvantages:
- user dependant
- no STI protection
- medication interaction
- contraindications: raised BMI, migraines with aura, breast cancer
- side effects: menstrual irregularities, breast tenderness, mood disturbance
- increased risk of CV disease, stroke, breast + cervical cancer

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13
Q

Contraindications of combined oral contraceptive pill

A

High BMI
Migraine with aura (vision impact)
Breast cancer

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14
Q

Impact of high levels of progesterone

A

Inhibits ovulation
- reduces FSH + LH secretion pre-ovulation
- inhibits positive feedback of high oestrogen > no LH surge > no ovulation

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15
Q

Impact of lower levels of progesterone

A
  • does not inhibit LH surge > can still ovulate
  • thickening cervical mucous
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16
Q

Describe the progesterone only pill
Including its actions

A
  • low dose progesterone
  • taken daily with no breaks
  • main action: thickens cervical mucous
  • secondary action: reduced cilia activity in fallopian tubes
  • ovulation is NOT prevented
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17
Q

Advantages and disadvantages of progesterone only pill

A

Advantages:
- reliable if used correctly
- can be used id COCP contraindicated

Disadvantages:
- no STI protection
- strict timing > user dependent
- menstrual irregularities
- increased risk of ectopic pregnancy if pregnancy occurs

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18
Q

Describe the progestone injection
Including its actions

A
  • high dose progesterone
  • long acting contraception
  • given IM every 12 weeks
  • e.g. Depo-Provera
  • main action: inhibits ovulation, thickens cervical mucous, thin endometrial lining
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19
Q

Advantages and disadvantages of progesterone injection

A

Advantages:
- reliable
- no known medication interaction
- can be used if oestrogen contraindications and raised BMI

Disadvantages:
- no STI protection
- not rapidly reversible (can take 18 months for fertility to return)
- menstrual irregularities

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20
Q

Describe the progesterone implant
Including its actions

A
  • high dose progesterone
  • long acting contraception
  • nexplanon
  • main action: inhibits ovulation, thickens cervical mucus, thins endometrial lining
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21
Q

Advantages and disadvantages of progesterone implant

A

Advantages:
- reliable
- lasts for up to 3 years
- can be used if oestrogen contradindicated or raised BMI
- fertility retunes faster than injection

Disadvantages:
- no STI protection
- menstrual irregularities
- complications with insertion + removal
- procedure needed

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22
Q

What are the types of intrauterine contraceptions?

A

Intrauterine system IUS
Intrauterine device IUD (copper coil)

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23
Q

Describe the intrauterine system
Including its actions

A
  • low dose progesterone releasing coil
  • e.g. Mirena
  • main action: prevents implantation, reduced endometrial proliferation , thickens cervical mucous
  • ovulation normally continues
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24
Q

Describe the IUD (copper coil)
Including its actions

A
  • copper containing coil
  • main action: cooper toxin to ovum + sperm which prevents fertilisation
  • secondary action: cervical mucous changes, endometrial inflammatory reactions inhibit implantation
  • often causes heavy bleeding
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25
Q

Advantages and disadvantages of intrauterine contraceptives

A

Advantages:
- convenient
- reliable
- long acting contraceptive
- IUS treatment for Menorrhagia

Disadvantages:
- no STI prevention
- IUD can cause heavy periods
- menstrual irregularities
- complications with insertion (perforation)
- displacement may occur

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26
Q

Describe sterilisation method of contraception

A

Vasectomy or tubal ligation
Permanent

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27
Q

Describe tubal ligation/clipping

A
  • fallopian tube occluded to prevent ovum transport
  • under local/general anaesthetic
28
Q

Describe a vasectomy

A
  • vas deferens snipped or tied to prevent sperm entering ejaculate
  • under local anaesthetic
  • must do post vasectomy semen analysis
29
Q

Types of emergency contraception

A

Levonorgestrel (morning after pill)
Ulipristal acetate (EllaOne)
Copper IUD

30
Q

Describe the morning after pill (levonorgestrel)

A
  • high dose progesterone
  • inhibits ovulation
  • up to 72 hours post unprotected sexual inter course
31
Q

How long can the morning after pill be used after UPSI?

A

Up to 72 hours

32
Q

Describe the ulipristal acetate (EllaOne)

A
  • selective progesterone receptor modulator
  • inhibits/delays ovulation
  • up to 120 hours post UPSI
33
Q

How long can ulipristal acetate (EllaOne) be used after UPSI?

A

Up to 120 hours

34
Q

How long can the copper IUD be used as emergency contraception?

A

Up to 5 days post ovulation

35
Q

What is used to help clinicians decide what contraptives they can safely recommend?

A

UKMEC

36
Q

Types of barrier contraceptives

A

Condoms
Diaphragms/cervical caps
Spermicides

37
Q

Advantages and disadvantages of barrier contraceptives

A

Advantages:
- reliable if used correctly
- STI protection

Disadvantages:
- disrupts intercourse
- risk of dislodging
- allergy to latex

38
Q

Define infertility

A

Failure to achieve a pregnancy after 12 months or ore of regular (2-3 times a week) unprotected sexual intercourse

39
Q

Define primary infertility

A

Never been pregnant

40
Q

Define secondary infertility

A

Previous pregnancy (including ectopic + terminations) but struggling to conceive

41
Q

Define subfertility

A

Describes any form of reduced fertility that results in prolonged duration of unwanted lack of conception

42
Q

Causes of infertility

A
  • unknown
  • male causes
  • female cases: ovulatory causes or tubal factors or uterine + peritoneal disorders
43
Q

Types of male causes of infertility

A

Pre testicular
Testicular
Post testicular

44
Q

Pre testicular causes of male infertility

A

Hypogonadotropic hypogonadism
Thyroid disorders

45
Q

Testicular causes of male infertility

A
  • genetic: Klinefelter syndrome XXY (testis don’t descend)
  • congenital: cryptorchidism
  • infective: mumps
  • antispermatogenic agents e.g. chemo
  • vascular: torsion, varicocele
46
Q

Post testicular causes of male infertility

A

Obstructive:
- congenital: absent vas
- acquired: infective, vasectomy

Coital problems
- sexual dysfunction
Hypospadias

47
Q

What is hypospadias?

A

Congenital condition where the urethral opening is lower than normal

48
Q

Types of ovulatory disorders

A
  • hypothalamic pituitary failure: hypothalamic amenorrhoea, hypogonadotropic hypogonadism
  • hypothalamic pituitary ovarian dysfunction: PCOS (most common cause) , high prolactin
  • ovarian failure: premature ovarian failure, congenital e.g. Turner’s syndrome 45XO
49
Q

Causes of tubal damage causing female infertility

A

PEPE
- PID
- Ectopic pregnancy
- Pelvic surgery
- Endometriosis
- agenesis of fallopian tubes

50
Q

Uterine + peritoneal disorders that can cause female infertility

A
  • uterine fibroids
  • conditions causing scarring/adhesions: e.g. endometriosis, PID, previous surgery, Asherman syndrome
  • mullerian development anomalies
51
Q

Female examination for investigating infertility

A
  • BMI
  • secondary sexual characteristics
  • acne
  • Hirsutism (excess hair)
  • pelvic/abdominal exam + swab
52
Q

Advice to patients experiencing infertility

A
  • smoking cessation
  • reduce alcohol intake
  • lifestyle changes e.g. stress
  • regular intercourse
  • weight loss
  • reassurance
53
Q

Investigation of male infertility

A
  • semen analysis
  • bloods: LH/FSH, testosterone
  • STI screen
  • ultrasound scan testes
  • karyotyping
54
Q

Investigations of female infertility

A
  • FSH/LH day 2
  • mid luteal phase progesterone (day 21)
  • TFTs, prolactin levels, androgens
  • STI screen
  • pelvic ultrasound scan
  • hysterosalphinogram
  • laparoscopy
55
Q

When should you consider early referral to secondary care in infertility?

A

Woman is >35 after 6/12months
If cause if known

56
Q

Management options of infertility

A
  • medical treatment: ovulation induction e.g. clomifene
  • surgical treatment: tubal occlusions e.g. laparoscopy
  • assisted reproductive technology: IVF, intrauterine insemination
57
Q

When should you consider referral to secondary care in infertility?

A

If history, exam and investigation are normal in both partners and not conceive after 1 year

58
Q

What is placenta accreta?

A

Invasion of conceptus that is too deep

59
Q

What percentage of couples will conceive naturally within 1 year with regular unprotected intercourse?

A

84%

60
Q

Relationship between dopamine and prolactin

A

Dopamine inhibits prolactin

61
Q

What is measured in a semen analysis?

A
  • semen volume
  • total sperm count
  • sperm conc.
  • total + progressive motility
  • vitality
  • sperm morphology
62
Q

What is a hysterosalphinogram?

A

Dye inserted into uterus (hystero) and imaging is used to see if the dye spread through the uterine tubes (salphino) to see if there is a blockage

63
Q

Most common cause of male infertility

A

Abnormal semen analysis

64
Q

What is the most common cause of female infertility?

A

Anovulation

65
Q

Primary vs secondary anovulation

A
  • Primary: ovary has never been able to ovulate
  • Secondary: ovary had normal function in past but is now unable to ovulate normally
66
Q

Causes of secondary anovulation

A

PCOS
Emotional stress
Pregnancy
Hyperprolactinaemia

67
Q

Causes of primary anovulation

A

Dygenetic gonads
Hypothalamic dysfunction
Hypothyroidism

Reproductive System (20 decks)

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