Contraception & Infertility

Question 1

What is family planning?

Answer 1

directed at helping couples achieve their fertility goals

Question 2

How is family planning associated with maternal mortality?

Answer 2

• reduces maternal mortality by preventing unplanned pregnancies, spacing births (at least 12 months), and managing pregnancy timing
  
  • lowers risks of complications like preeclampsia, hemorrhage, and infections

Question 3

What are the functions of Ovulation Suppression Methods?

Answer 3

• Inhibits ovulation (inhibits release of GnRH from the hypothalamus and LH from the pituitary)
• Thickens cervical mucus (blocks sperm entry)
• Causes atrophy of the endometrium (unfavorable for implantation)
• Most hormonal birth control

Question 4

What are contraindications for Estrogen Use?

Answer 4

• Migraines with aura
• Thromboembolism (h/o DVT or PE)
• HTN (no matter if controlled or uncontrolled)
• Stroke (CVA)
• Myocardial infarction (MI)
• Smoking cigarettes at age of 35 or older.

Question 5

List Tier 1 Contraceptives.

Answer 5

• Sterilization
• LARC (Long-acting reversible contraceptive)
  
  • IUD (Intrauterine Device)
  • Implant

Question 6

Describe sterilization

Contraceptive

Answer 6

• utilizes either coagulation, silicone rubber bands and/or clips
• most commonly used method
• considered to be permanent

Question 7

Describe LNG IUD

Answer 7

• Progesterone only
• T-shaped device inserted into uterine cavity
• Small amount of hormone daily to suppress ovulation
• Thickens cervical mucus
• Keeps uterine lining thin

Question 8

Describe Copper (Paragard) IUD

Answer 8

• Non-hormonal
• T-shaped device inserted into uterine cavity
• Copper damages sperm prior to fertilization

Question 9

What are benefits of LNG?

Answer 9

• Reduces menstrual blood loss
• Reduces dysmenorrhea
• Suppresses endometrial thickening, thus decreasing risk of endometrial cancer

Question 10

What are benefits of Paragard IUD?

Answer 10

• Only contraceptive IUD available that contains NO hormones
• Effective immediately after insertion
• Can be used as emergency contraceptive method

Question 11

Describe Implants.

Answer 11

• Lasts 3 years
• Progesterone only
• Small, flexible rod placed under skin in upper arm
• May cause irregular and unpredictable menses (most common cause of discontinuation)

Question 12

List Tier 2 Contraceptives.

Answer 12

• Pill
• Patch
• Ring
• Injectable

Question 13

Describe Combined Oral
Contraceptives (COCs)

Contraceptive

Answer 13

• Contains Estrogen and Progesterone
• 21-24 days of “active” pills, 3-7 days of placebo
• Stabilizes endometrium for less breakthrough bleeding (BTB)
• Reduces risk of endometrial and ovarian cancer
• Does NOT prevent STIs
• Side effects: nausea, BTB, breast tenderness

BTB = breakthrough bleeding

Question 14

Describe Progesterone Only Pills (POPs)

Contraceptive

Answer 14

• “Mini Pill”
• No estrogen
• Thickens cervical mucus
• Can be used while breastfeeding
• Same time every day!

Question 15

Describe Patch

Contraceptive

Answer 15

• Estrogen + Progesterone
• 1 transdermal patch per week
• Must alternate sites (upper body, lower abdomen, buttocks), avoid breast/chest)

Question 16

Describe NuvaRing

Answer 16

• Estrogen + Progesterone
• Inserted once a month, self administered, into vaginal canal
• Stays 3 weeks then removed for 1, can be continuous
• Suppresses ovulation
• Has local effect
• Discrete, easy, can improve vaginal flora

Question 17

Describe Emergency Contraception.

Answer 17

• Can be either pills or IUD (Plan B or Ella)
• Used after unprotected sex or if method failed (broken condom)
• May be used up to 5 days after unprotected sex, sooner taken the better

Question 18

Describe Injectables.

Answer 18

• Progesterone only
• IM injection every 3 months or 12 weeks
• May delay return to fertility (6-12mo)

Question 19

List Tier 3 Contraceptives.

Answer 19

Barrier methods:

• Condoms
• Spermicide
• Diaphragm
• Sponge, Cervical Caps

Question 20

Describe Condoms.

Answer 20

• Can breakdown with heat and age, can cause allergy
• Only method to prevent pregnancy AND reduce risk of STI

Question 21

List Tier 4 Contraceptives.

Answer 21

• Lactational amenorrhea
• Cervical mucus
• Basal body temperature
• Calendar
• Withdraw penis before ejaculation

Question 22

Describe Lactational
Amenorrhea

Contraceptive

Answer 22

• Temporary for new moms
• Must meet these conditions:
  
  • Before bleeding has returned
  • Required exclusive breastfeeding day and night
  • Baby is less than 6 months old

Question 23

What is infertility?

Answer 23

prolonged time to conceive

Question 24

What are Female Factors Associated with Infertility?

Answer 24

• Hormonal and ovulatory factors
• Tubal and peritoneal factors
• Uterine factors
  
  • Developmental anomalies
  • Endometritis
• Vaginal-cervical factors

Question 25

What are Male Factors Associated with Infertility?

Answer 25

• Undescended testes
• Hypospadias
• Varicocele (varicose vein of the scrotum)
• Low testosterone levels
• Azoospermia: no sperm cells produced
• Oligospermia: few sperm cells produced

Question 26

List Assisted Reproductive Therapy
(ART)

Answer 26

• Intrauterine Insemination (IUI)
• In Vitro Fertilization–Embryo Transfer (IVF-ET)
• Gamete or zygote intrafallopian transfer (GIFT/ZIFT)
• Oocyte, Sperm, Embryo Donation
• Surrogate Embryo host

IUI - Sperm is placed directly into the uterus
IVF-ET - eggs are harvested from a woman’s ovaries and fertilized with sperm in a laboratory dish
G/ZIFT - Both eggs and sperm are placed directly into the woman’s fallopian tubes