infertility and contraception Flashcards
3 meds that affect fertility in males
cimetidine, spironolactone, corticosteroids
4 tests for male infertility
semen analysis, TSH, prolactin, karotype(r/o Klinefelter)
most common cause of infertility
ovulatory disorders
first test to obtain for infertility
semen analysis; to r/o male factors
3 tests to confirm ovulation
basal body temp, ovulation prediction tests, progesterone levels
luteal phase endometrial bx, FSH, prolactin, TSH
other tests for infertility
what measures sperm survival
post coital testing
what determines tubal patency and uterine abnormalities
hysterosalpingography
what to give an anovulatory woman to promote ovulation
clomiphene 50-100mg for 5 days beginning on day 3,4,5 of cycle
what percentage of women that are sexually active will become pregnant within a year
85%
combined hormonal methods of contraception protect against what
endometrial and ovarian cancer
what is lactational amenorrhea
delaying conception 6 months birth. breastfeeding exclusively and maintaining amenorrhea
failure rates
- periodic abstinence
- calendar methods
- combined basal body temp and calendar method
- periodic abstinence 25%
- calendar methods 35%
- combined basal body temp and calendar method 25%
- basal body temp
slight drop in temp occurs 24 to 36 hrs after ovulation; then rises by 0.3-0.48 degrees celcius.
cervical mucus that is fertile
egg white
symptothermal method
combines cervical mucus and basal body temp
minipills
- hormone
- effective
- bleeding/disadvantage
- good for what population
- MOA
- 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
contraception for over 40 y/o or lactating women
mini pill
less benign breast disease, anemia, PID, ovarian cysts
non contraceptive advantages
ectopic PG, hirsutism, acne, endometriosis symptoms, dysmenorrhea/menorrhagia
non contraceptive protection
disadvantages of non contraceptives
increased risk of clots- esp smokers over 35 y/o, abnormal lipids
increased risk for breast cancer, HTN, cholelithiasis, benign liver tumors
non contraceptive disadvantages
acne, nausea, HA, wt gain, bloating, intermenstrual bleeding, missed periods
side effects of birth control pills
2 main contraindications to IUD use
multiple sex partners and nulliparity
implanon MOA
- hormone
- effective for how long
progestin only; increases cervical mucus viscosity and inhibits ovulation. effective for 3 years
Mirena
FB inflammation; progesterone leads to cervical mucus thickening and endometrial decidualization
copper T
FB inflammation; copper has spermicidal effect
2 increased risks of IUDs
risk of ectopic and pelvic infection
5 absolute contraindications to IUD
pregnancy, undiagnosed vaginal bleeding, acute infection, past salpingitis, suspected gynecologic malignancy
pregnancy, undiagnosed vaginal bleeding, acute infection, past salpingitis, suspected gynecologic malignancy
5 absolute contraindications to IUD
nullparity, ectopic hx, STD hx, multiple sex partners, severe dysmenorrhea, uterine abnormalities, anemia, valvular heart disease, young age
relative contraindications to IUD
nonoxynol-9 and octoxynol-3
common spermicides
morning after pill
- hormone
- effectiveness
- high dose estrogen-progestin or progestin only; given within 72 hrs. effective up to 5 days after unprotected sex
- 75%
depo-provera
- hormone
- disadvantage
90 day and 30 day formulations; progestin only
- delayed fertility after discontinuation(up to 10 months)
disadvantage of ortho evra patch
- hormone
clot risk; especially in smokers over 35 y/o
- estrogen and progestin
nuvaring
- hormone
- disadvantage
- low dose progestin and estrogen
- increase vag discharge; spotting first 1-2 months
OCP combo pill (4 MOA)
inhibit FSH/LH, supress ovulation, thicken cervical mucus, decidualize endometrium
disadvantage of OCP
daily compliance, clot risk, breakthrough bleeding
what birth control can improve acne
OCP combo pill
infertility- increased FSH in male
primary HYPOgonadism (30-40%)
infertility - decreased FSH and LH in male
secondary HYPOgonadism (2%)
primary cause of amenorrhea/ovulatory dysfunction in infertility
hypothalmic/pituitary causes
