Intro To Contraception And Infertility Flashcards
What are some fertility indicators?
Cervical secretions
Basal body temp (goes up ovulation)
Length of menstrual cycle
What is lactational amenorrhoea method?
Breastfeeding delays the return of ovulation after childbirth
Suckling stimulus disrupts release of GnRH affects feedback cycle of HPG axis
Relies on exclusive breast feeding only effective up to 6 months after giving birth, must be amenorrheic
What are 4 methods of hormonal control?
Combined oestrogen and progesterone
- COCP
- vaginal ring
- patches
Progesterone depot
- high dose progesterone
- LARC
Progesterone implant
- high dose
- LARC
Low dose progesterone
-POP
Why do you get ovulation at low doses progesterone but not moderate/ high?
Moderate/ high enhances negative feedback of natural oestrogen -> reduces LH and FSH
Also inhibits positive feedback of oestrogen -> no Lh surge
At lower douses Lh surge not inhibited -> thicken cervical mucus
Positives of COPD?
98% effective
Can relive menstrual disorders
Reduces risk ovarian cyst
Reduced risk ovarian cancer and endometrial cancer
Negatives of COCP?
Contradiction: high BMI, migraine, breast cancer
Side effects
Increased risk of breast and cervical cancer, VTE, MI/ stroke
Negatives of progesterone injection?
App every 12 weeks
Delay in fertility return
Contradictions
Side effects
How does progesterone implant work?
Inhibits ovulation, thickens cervical mucus, prevents endometrial proliferation
Lasts for three years
1/3 no periods
1/3 normal periods
1/3 bleeding all the time
Progesterone only pill how does it work? And negatives
Chen’s cervical mucus
Ovulation is usually not presented
Risks of ectopic pregnancy
Interacts with other meds
Menstrual problems common
What is the intrauterine system?
Progesterone releasing plastic device 3-5yrs
Prevents implantation and reduces endometrial proliferation
Thickens cervical mucus
Helps with irregular/ heavy periods
What is the intrauterine device?
Plastic device with added copper 5-10yrs
Copper toxic to sperm and ovum
Endometrial inflammatory reaction preventing implantation and changes consistency of cervical mucus
Negatives of coils (IUS and IUD)
Insertion unpleasant
Risk of uterine perforation 1/500
Menstruated irregularity
Displacement/ expulsion may occur
Increased risk STI
How is a vasectomy done?
Vas deferens cut or tied to prevent sperm entering ejaculate
12-16 weeks post semen analysis
Failure rate 1/2000
Local anaesthetic
How is tubal ligation/ clipping done?
Fallopian tubes cut/ blocked to stop ovum travelling from ovary to uterus
Local/ general anaesthetic
Failure rate 1/200-500
Three types of emergency contraception
Emergency IUD - 5 days
Emergency pill with ulipristal acetate - 5 days
Emergency pill with levonorgestrel - 3 days
What’s the UKMEC?
UK medical eligibility criteria for contraceptive use
What is subfertility?
Failure of conception in a couple having regular, unprotected coitus for one year
What is primary and secondary infertility?
Primary - never conceived before
How common is subfertility?
1/7 couples
84% of couples will conceive naturally within one year regular unprotected sex
CouplEs who’ve been trying for more than 3 years likelihood of getting preferential next year is
Subfertility main causes
Male 30%
Unexplained 25%
Ovulatory 25%
Tubal damage 20%
Uterine/ peritoneal 10%
Other
40% cases both man and woman problem
Pre testicular causes of Male subfertility
Endocrine
Hypothalamus/ pituitary dysfunction
Hypogonadotropic hypogonadism
Hyperprolactinoemia
Hypothyroidism
Diabetes
Testicular causes of Male subfertility
Genetic: Klimefelter syndrome (XXY)
Y chromosome deletion
Immobile cilia syndrome
Congenital:
Cryptorchidism
Infective:
Stis
Antispermatigenic agents: Heat Irradiation Drugs Chemotherapy
Vascular:
Torsion
Varicocele
Post testicular causes of Male subfertility
Obstructive:
Congenital - structure
Acquired- infective
Vasectomy
Coital:
Ejactulatory failure
Erectile dysfunction
What are the three groups of ovulatory disorders that can lead to subfertility? Give examples of each
Group 1 - hypothalamic- pituitary failure 10%: hypothalamic amenorrhea, hypogonadotrophic hypogonadism
Group 2 - hypothalamic-pituitary- ovarian dysfunction 85%:
Polycystic ovary syndrome, hyperprolactinaemic amenorrhoea
Group 3 - ovarian failure 5%:
Congenital (Turners X0), premature ovarian failure/ primary ovarian insufficiency
What are some uterine/ peritoneal disorders that can lead to subfertility?
Uterine fibroids (Asherman syndrome), endometriosis, PID, previous surgery, cervical stenosis, Müllerian developmental abnormality e.g. agenesis, didelphys (duplication), bicornuate (two uteri sharing single cervix & vagina), septate (single uterus with fibrous band down centre)
What tubular damage can lead to subfertility?
Endometriosis, ectopic pregnancy, pelvic surgery, past pelvic infection e.g. chlamydia, Mullerian development anomaly e.g. agenesis of tubes
What examinations could you do on men and women if they present as sub-fertile?
Men: don’t usually examine without element history but if needed: testicular examination check descent/ swellings
Women: BMI, secondary sexual characteristics (breast exam), galactorrhoea, pelvic exam e.g. visual external inspection, insertion of speculum, bimanual exam determine size and character of uterus/ ovaries
What investigations could you do on men and women if they present as subfertile?
Men: semen analysis (sperm count, motility), blood test: anti-spermantibodies, FSH/ LH/ testosterone, penile/ urethral swabs, UUS testes, karyotype, cystic fibrosis
Women: blood test: follicular phase LH/ FSh (day 2), luteal phase progesterone (21), prolactin/ androgens/ TFTs. Cervical smear, vaginal/ cervical swabs, pelvic USS, test of tubal latency (hysterosalpingogram)
What is a hysterosalpingogram?
Insert dye into uterus and see how it moves through Fallopian tubes x-ray
Dye should move freely from ends of Fallopian tubes
(No spill of dye= swollen tubes)
Slide 38
When can you refer to a fertility clinic?
Women: reproductive age who has not conceived after 1yr unprotected vaginal sex in absence of known cause infertility
Early referral: >35yrs, known clinical cause infertility or history predisposing factors for infertility
Men: early referral: previous risks for infertility, significant systemic illness
3 fertility treatment categories once a diagnosis has been made
- medical treatment e.g drugs stimulate follicular development/ ovulation (clomiphene, GnRH agonist/ antagonist, gonadotrophins)
- surgical treatment e.g. Laparoscopy for ablation of endometriosis, removal of fibroids
- assisted reproduction techniques e.g. artificial insemination and IVF
