INFERTILITY/CONTRACEPTION Flashcards
What is the definition of infertility?
Failure of a couple to conceive after 12 MONTHS in a woman under the age of 35
- After 6 months in a woman over the age of 6 months
- *85% of couples conceive within with 12 months, 95% with 24 months
What is the evaluation for female infertility?
FSH, TSH, prolactin, serum progesterone on day 21 (check ovulation)
Pelvic ultrasound
What is the evaluation for male infertility?
Semen analysis (sperm assessment, semen volume, and pH)
Collected 2-7 days after abstinence
*AT LEAST 2 samples collected 1-2 weeks apart
When would we initiate evaluation upon presentation?
woman over age 40
Women with oligomenorrhea/amenorrhea
Women w/ hx of chemotherapy, radiation tx, or advanced endometriosis
Women with known uterine/tubal dz
Woman with a male partner with hx of groin or testicular dz (mumps, chemo, or radiation)
if infertility is identified, what should you do?
Lifestyle modifications (smoking cessation, excess caffeine use, and alcoholism)
- Appropriate timing of coitus (every1-2 days around expected ovulation) - Referral for reproductive endocrinology and fertility
What are the options for sterilization? What is the rate of pregnancy?
Essure – metal coil inserted into the fallopian tube (3 month f/u with HSG)
Bilateral tubal ligation
Vasectomy (3 month f/u with 20 ejaculation)
Pregnancy less than 1%
What are other types of OCP’s?
pill, ring, patch
Estrogen and progestin
Pregnancy rate less than 9%
What are the 2 emergency contraception options?
Ulipristal (Ella)
Levonorgestrel (Plan B)
*Copper IUD and excess estrogen-progestin regimen
Why would a copper IUD be a poor choice?
If a woman has heavy or painful menses, iron def anemia, uterine anomaly, copper allergy
What is the active hormone in other IUD’s and LARC’s?
Progestin
