infertility and contraception

Question 1

3 meds that affect fertility in males

Answer 1

cimetidine, spironolactone, corticosteroids

Question 2

4 tests for male infertility

Answer 2

semen analysis, TSH, prolactin, karotype(r/o Klinefelter)

Question 3

most common cause of infertility

Answer 3

ovulatory disorders

Question 4

first test to obtain for infertility

Answer 4

semen analysis; to r/o male factors

Question 5

3 tests to confirm ovulation

Answer 5

basal body temp, ovulation prediction tests, progesterone levels

Question 6

luteal phase endometrial bx, FSH, prolactin, TSH

Answer 6

other tests for infertility

Question 7

what measures sperm survival

Answer 7

post coital testing

Question 8

what determines tubal patency and uterine abnormalities

Answer 8

hysterosalpingography

Question 9

what to give an anovulatory woman to promote ovulation

Answer 9

clomiphene 50-100mg for 5 days beginning on day 3,4,5 of cycle

Question 10

what percentage of women that are sexually active will become pregnant within a year

Answer 10

85%

Question 11

combined hormonal methods of contraception protect against what

Answer 11

endometrial and ovarian cancer

Question 12

what is lactational amenorrhea

Answer 12

delaying conception 6 months birth. breastfeeding exclusively and maintaining amenorrhea

Question 13

failure rates

• periodic abstinence
• calendar methods
• combined basal body temp and calendar method

Answer 13

• periodic abstinence 25%
• calendar methods 35%
• combined basal body temp and calendar method 25%

Question 14

• basal body temp

Answer 14

slight drop in temp occurs 24 to 36 hrs after ovulation; then rises by 0.3-0.48 degrees celcius.

Question 15

cervical mucus that is fertile

Answer 15

egg white

Question 16

symptothermal method

Answer 16

combines cervical mucus and basal body temp

Question 17

minipills

• hormone
• effective
• bleeding/disadvantage
• good for what population
• MOA

Answer 17

• progesterone only
• half as effective as combo pills
• may cause amenorrhea; take the same daily time
• over 40 y/o or lactating women
• thicken cervical mucus

Question 18

contraception for over 40 y/o or lactating women

Answer 18

mini pill

Question 19

less benign breast disease, anemia, PID, ovarian cysts

Answer 19

non contraceptive advantages

Question 20

ectopic PG, hirsutism, acne, endometriosis symptoms, dysmenorrhea/menorrhagia

Answer 20

non contraceptive protection

Question 21

disadvantages of non contraceptives

Answer 21

increased risk of clots- esp smokers over 35 y/o, abnormal lipids

Question 22

increased risk for breast cancer, HTN, cholelithiasis, benign liver tumors

Answer 22

non contraceptive disadvantages

Question 23

acne, nausea, HA, wt gain, bloating, intermenstrual bleeding, missed periods

Answer 23

side effects of birth control pills

Question 24

2 main contraindications to IUD use

Answer 24

multiple sex partners and nulliparity

Question 25

implanon MOA - hormone - effective for how long

Answer 25

progestin only; increases cervical mucus viscosity and inhibits ovulation. effective for 3 years

Question 26

Mirena

Answer 26

FB inflammation; progesterone leads to cervical mucus thickening and endometrial decidualization

Question 27

copper T

Answer 27

FB inflammation; copper has spermicidal effect

Question 28

2 increased risks of IUDs

Answer 28

risk of ectopic and pelvic infection

Question 29

5 absolute contraindications to IUD

Answer 29

pregnancy, undiagnosed vaginal bleeding, acute infection, past salpingitis, suspected gynecologic malignancy

Question 30

pregnancy, undiagnosed vaginal bleeding, acute infection, past salpingitis, suspected gynecologic malignancy

Answer 30

5 absolute contraindications to IUD

Question 31

nullparity, ectopic hx, STD hx, multiple sex partners, severe dysmenorrhea, uterine abnormalities, anemia, valvular heart disease, young age

Answer 31

relative contraindications to IUD

Question 32

nonoxynol-9 and octoxynol-3

Answer 32

common spermicides

Question 33

morning after pill - hormone - effectiveness

Answer 33

- high dose estrogen-progestin or progestin only; given within 72 hrs. effective up to 5 days after unprotected sex - 75%

Question 34

depo-provera - hormone - disadvantage

Answer 34

90 day and 30 day formulations; progestin only | - delayed fertility after discontinuation(up to 10 months)

Question 35

disadvantage of ortho evra patch | - hormone

Answer 35

clot risk; especially in smokers over 35 y/o | - estrogen and progestin

Question 36

nuvaring - hormone - disadvantage

Answer 36

- low dose progestin and estrogen | - increase vag discharge; spotting first 1-2 months

Question 37

OCP combo pill (4 MOA)

Answer 37

inhibit FSH/LH, supress ovulation, thicken cervical mucus, decidualize endometrium

Question 38

disadvantage of OCP

Answer 38

daily compliance, clot risk, breakthrough bleeding

Question 39

what birth control can improve acne

Answer 39

OCP combo pill

Question 40

infertility- increased FSH in male

Answer 40

primary HYPOgonadism (30-40%)

Question 41

infertility - decreased FSH and LH in male

Answer 41

secondary HYPOgonadism (2%)

Question 42

primary cause of amenorrhea/ovulatory dysfunction in infertility

Answer 42

hypothalmic/pituitary causes