contraceptives Flashcards
Primary Infertility
Lack of conception despite unprotected intercourse after 12 months (<35 years) ~OR~ 6 months (>35yrs)
Secondary Infertility
Inability of a woman to conceive who was previously able to do so.
Components Required for Normal Fertility
FEMALE
Female Favorable cervical mucus Patent fallopian tubes Normal ovarian function No obstruction between ovary & uterus Endometrium functional Adequate reproductive hormones
Components Required for Normal Fertility
MALE
Male
Testes produce sperm of normal quality, quantity, motility
Unobstructed genital tract
Normal genital tract secretions
Ejaculated sperm deposited in female genital tract to reach cervix
Causes of Infertility
Discovering which cause of infertility affects a particular couple is the basis of fertility care.
Causes are shared, almost equally, by men and women.
Mixed-factor infertility involves multiple causes, with some belonging to the man and some to the woman.
increases a woman’s risk of infertility?
Age Smoking Excess alcohol use Stress Poor diet Athletic training Being overweight or underweight Sexually transmitted infections (STIs) Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency
Infertility: Female Assessment
History and Physical Height, weight, BMI History of Infections, especially STI’s Menstrual History Cycle Regularity; ovulation Premenstrual and menstrual symptoms Bimanual exam of internal organs X-Ray: fallopian/uterine tubal patency Labs: urine and blood FSH (follicle-stimulating hormone) Estradiol Progesterone Supplements and Immunizations
Factors Affecting Males
Hormonal Disorders
Eg. Congenital, tumors, trauma, illnesses, drug use, obesity, diabetes
Testicular Factors
Eg. Congential, undescended, varicocele, hypospadias, STI’s,
trauma, torsion
Sperm Transport
Eg. Drug, STI’s, disfunctions r/t ejaculation
Idiopathic Male Infertility
10-15% men in prime reproductive age are affected
What increases a man’s risk of infertility?
Heavy alcohol use
Drugs
Smoking cigarettes
Age
Environmental toxins, including pesticides and lead
Health problems such as mumps, serious conditions like kidney disease, or hormone problems
Medicines
Radiation treatment and chemotherapy for cancer
Infertility: Male Assessment
History and Physical Semen Analysis (minimum of two samples) Hormone Analyses Testosterone Gonadotropins FSH LH (luteinizing hormone) Sperm Penetration Assay Scrotal or Transrectal Ultrasounds
Many types: IVF, donor eggs or sperm
Options vary with setting, maternal age
Does not always work Very expensive Insurance- diagnostics and IVF only in some states Often takes years Takes a toll.....physical and emotional
Nursing Care: Counseling
Need to know personal preferences religious beliefs health status, age, contraindications lifestyle - cost, number of partners, access to provider future childbearing plans
What percentage of pregnancies are planned?
Sexual History
Are you sexually active now?
Age at 1st sexual activity?
Are you presently sexually active with > 1 partner?
What is your sexual orientation?
Nonprescription
Behavioral methods Continuous abstinence Outercourse Fertility awareness Continuous breastfeeding Barrier Male (external) condom Female (internal) condom Sponge Spermicide
Prescription
Hormonal Pill Patch Ring Shot Implant Barrier Diaphragm & Caps IUD/IUS
Lactation Amenorrhea Method (LAM)
Breastfeeding exclusively
No menses
< 6 months PP
98% effective
Fertility Awareness Methods
Uses multiple methods to evaluate fertile times
fertility awareness
sympto- thermal
Abstinence when fertile
Basal Body Temperature
Biphasic pattern slight near ovulation 24- 36 hours after ovulation temp lasts at least 3-4 days after ovulation
Remember
Sperm live 48-72 hours
Ova live 12-24 hours
Symptom: Cervical Mucus
Progesterone
thick, sticky
scant amount - non-fertile
Estrogen
thin, stretchy
amount
rises near ovulation = fertile time
Rhythm Method
Calendar method
Ovulation occurs ~14 days before menses begins
Monitor cycle length for >6 mos
Requires regular, predictable cycles
Barrier Methods
Condoms
Diaphragm
Cervical cap
Sponge
Note: spermicide increases effectiveness
Hormonal Methods
Oral contraceptives Emergency contraception Vaginal ring Transdermal patch Injectable IUS: implants
Oral Contraceptives (OCs)
Estrogen & progestin combined pills
Have estrogen and progesterone side-effects
Most popular form of contraception
Progestin only - “mini pill”
No estrogen risks
Safe to use while breast feeding
OK for smokers
OC Actions
Estrogen inhibits FSH & LH release from anterior pituitary = no ovulation
Progestin makes cervical mucus non-receptive to sperm
OC Contraindications
Smoker > 35 years old (combined OCs) Early postpartum period History of blood clots effective if BMI high History of breast cancer Pregnancy
Depo-Provera
Injectable progestin - no estrogens Injection every 3 months Inhibits ovulation Changes cervical mucus Changes endometrium (less receptive to implanting ovum)
Emergency Contraception
NOT a regular method of birth control.
used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.
combination of oral contraception & IUD
Vaginal Ring (Nuva Ring)
Insert vaginal ring during first 5 days of menses
In vagina x 1 wk x 3
Remove x 1 wk
Insert new ring
Circulating hormone levels lower than oral contraceptives
Contraceptive patch (Ortho Evra)
Change weekly
Patch on x 3 weeks and then off x1 week
Risk of venous thromboembolism
Less effective with high BMI
