Contraceptives & Fertility Treatments Flashcards
What form do combined hormonal contraceptives (oestrogen and progesterone) come in
pill
patch
vaginal ring
What is the mode of action of combined hormonal contraceptives (oestrogen and progesterone)
primary mode - prevents ovulation
additionally - thickens cervical mucus and thins endometrium
What is the failure rate of the combined hormonal contraceptives (oestrogen and progesterone)
1% if used perfectly
9% in typical use
Advantages and disadvantages of the combined hormonal contraceptives (oestrogen and progesterone)
Pros
- may reduce PMS
- may improve acne
- reduced risk of ovarian, endometrial and colon cancer
Cons
- takes 7 days of use before its effective
- temporarily causes headaches, breast tenderness, mood changes
- hypertension
- increased risk of MI, stroke, breast cancer, also cervical cancer with long term us
- effectiveness altered by enzyme inducers, vomiting and diarrhoea
Mode of action of IUS
it is synthetic progesterone
thins endometrium
thickens cervical mucus
inhibits ovulation in some people
Failure rate of IUS
less than 1%
Disadvantages of IUS
- painful insertion requiring a speculum
- hormonal side effects (headache, breast tenderness, mood changes)
- irregular bleeding for up to 9 months
- expulsion (in less than 1 in 20)
Advantages of IUS
- stops periods (amenorrhoea) or gives lighter bleeds
- can improve dysnmenorrhoea (painful periods)
- may reduce pain from endometriosis
How long can the IUS be left in for
3-5 years
Mode of action of the implant
it is a synthetic progesterone
inhibits ovulation
thickens cervical mucus
Failure rate of the implant
less than 1% (0.3%)
A disadvantage of all hormonal contraceptives is
no STI protection
Mode of action of the injection
inhibits ovulation
thickens cervical mucus
thins endometrium
Failure rate of the injection
perfect use - less than 1%
typical use - 4%
Advantages and disadvantages of the injection
Pros - not affected by other medications - reduces bleeding, pain and PMS - non-intercourse related Cons - delay in return of fertility - up to 1 year - weight gain - long term use decreases bone mineral density (returns when stopped)
Advantages and disadvantages of the implant
Pros - non-intercourse related - immediate return of fertility - lasts 3 years - may help alleviate dysmenorrhoea (painful periods) Cons - affected by enzyme inducers - hormonal side effects (headache, breast tenderness, mood changes) - irregular menstrual bleeding
Mode of action of the progesterone only pill
it is synthetic progesterone
thins endometrium
thickens cervical mucus
inhibits ovulation in some people
Advantages and disadvantages of the progesterone only pill
Pros
- less risk factors/v. few contraindications
- may improve PMS and reduce dysmenorrhoea (painful periods)
- may reduce endometrial cancer risk
Cons
- memory dependent (same time each day
- hormonal side effects (headache, breast tenderness, mood changes)
- ectopic risk if pregnancy does occur
- functional ovarian cysts
Which patients might IVF be indicated in
tubal disease anovulatory (PCOS) unexplained infertility endometriosis no uterus (surrogacy) no eggs (egg donor)
What are the drawbacks of IVF
- expensive 3.5k
- very invasive
- could have multiple pregnancies
- ovarian hyperstimulation syndrome (OHSS)
- procedural risk - injury to bladder, bowel , vessels, infection
Which patients might IVF be indicated in
tubal disease anovulatory (PCOS) unexplained infertility endometriosis no uterus (surrogacy) no eggs (egg donor)
Describe the procedure of IVF
- Counselling & consent
- Suppress pituitary (GnRH antagonist) to stop premature LH surge
- Ovarian stimulation with HMG and rFSH so lots of follicle develop
- hCG given to trigger maturation of the oocyte, completion of M1 and leutinization
- Egg collection 34-36 hours after hCG given (transvaginal or transabdominal)
- Insemination in a petri dish or ICSI
- Embryo culture for 2,3, or 5 days
- Embryo transfer
- Luteal support
- Pregnancy test 2 weeks after transfer
Which patients might intra-cytoplasmic sperm injection (ICSI) be indicated in
- very low sperm count (cryptozoospermia)
- sperm with poor morphology or motility
- previous IVF with none/few eggs fertilized
Which patients might intrauterine insemination (IUI) be indicated in
- same sex couples and single women
- couples unable to have intercourse (physical disability or psychosexual problem)
- Male with HIV
- unexplained infertility, mild male factor, mild endometriosis
