L12: contraception & infertility Flashcards
List the different types of natural contraception
Abstinence
Withdrawal method
Fertility awareness method
Lactational amenorrhoea
Describe the advantages and disadvantages of abstinence
Advantages: 100% effective
Disadvantages: not an option for most, unprepared if/when sexually active
Describe the advantages and disadvantages of the withdrawal method
‘withdrawal’ occurs before ejaculation
Advantages: no devices/hormones
Disadvantages: unreliable, some sperm in pre-ejaculate & no STI protection
Describe the advantages and disadvantages of fertility awareness methods
Includes monitoring basal body temperature, avoiding intercourse around time of ovulation & monitoring of cervical mucus
Advantages: no hormones/contraindications
Disadvantages: time-consuming, unreliable, no STI protection & not suitable for all
What is lactational amenorrhoea? What are the pros and cons?
Breastfeeding after childbirth to avoid pregnancy – can be used effective for up to 6 months postnatally provided: exclusive breastfeeding & complete amenorrhoea
Advantages: no hormonal/contraindications
Disadvantages: unreliable after 6 months, no STI protection, not suitable for all
Describe the advantages and disadvantages of barrier contraception
Provide physical +/- chemical barrier to sperm entering the cervix (condoms)
Advantages: reliable, STI protection
Disadvantages: disrupts intercourse, risk of dislodging, allergy/sensitivity to latex
Describe the combined oral contraceptive pill (COCP)
Contains combination of synthetic oestrogen and progestogen
Usually taken for 21 days with a 7 day break OR 21 days and 7 placebo pills
Main action: prevent ovulation
Secondary action: reduces endometrial receptivity to implantation & thickens cervical mucus
Describe the advantages and disadvantages of the combined oral contraceptive pill
Advantages: reliable, can relieve menstrual disorders, decreases risk of ovarian and endometrial cancer & decreases acne severity in some
Disadvantages: user dependant, no STI protection, medication interaction, raised BMI people can’t use, breast tenderness, mood disturbance, increased risk of CVS disease & stroke
Describe the progestogen-only pill
Low dose progestogen Main action: thicken cervical mucus Other action: reduced cilia activity in fallopian tubes Ovulation NOT prevented Taken daily with no breaks
Describe the advantages and disadvantages of the progestogen-only pill
Advantages: reliable, can be used if COCP contraindicated
Disadvantages: no STI protection, strict timing, menstrual irregularities & increased risk of ectopic pregnancy
Describe the progestogen injection
LARC
Main actions: inhibit ovulation, thicken cervical mucus, thin endometrial lining
Given IM every 12 weeks
Describe the advantages and disadvantages of the progestogen injection
Advantages: reliable, no known medication interactions & can be used if oestrogen contraindicated and raised BMI
Disadvantages: no STI protection, not rapidly reversible & menstrual irregularities
Describe the progestogen implant and its pros and cons
Small subcutaneous tube inserts in the arm
LARC
Main actions: inhibit ovulation, thicken cervical mucus & thin endometrial lining
Advantages: reliable, lasts for up to 3 years, can be used if oestrogen contraindicated and raised BMI & fertility returns faster than injection
Disadvantages: no STI protection, menstrual irregularities & complications with insertions and removal
Describe intrauterine system
Progestogen-releasing coil – local (Mirena coil)
Main action: prevents implantation and reduces endometrial proliferation & thickens cervical mucus
Ovulation usually continues
Describe intrauterine device
Copper-containing coil
Main action: copper toxic to ovum and sperm, preventing fertilisation
Secondary action: cervical mucus changes, endometrial inflammatory reactions inhibit implantation
Describe the advantages and disadvantages of the coils
Advantages: convenient, effective, LARC & IUS for treatment of menorrhagia
Disadvantages: no STI protection, complications with insertion-perforation, menstrual irregularities & displacement/expulsion may occur
Describe sterilisation in the male and female
Vasectomy – vas deferens snipped/tied to prevent sperm entering ejaculate
Tubal ligation/clipping – fallopian tube occluded to prevent ovum transport
Describe the advantages and disadvantages of sterilisation
Advantages: permanent
Disadvantages: no STI protection, regret & not easily reversed
Describe the different types of emergency contraception
Levonorgestrel – ‘morning after pill’, high dose progestogen & ovulation inhibited
Ulipristal acetate – selective progesterone receptor modulator, inhibits/delays ovulation
Copper IUD
Define subfertility
A couple who are having regular, unprotected coitus, who have failed to conceive within 1 year
Define primary infertility
Never been pregnant
Define secondary infertility
Previous pregnancy (including ectopic and terminations) but struggling to conceive again
List male causes of infertility
Pre-testicular: ED, hypogonadotropic hypogonadism, hyperprolactinemia, hypothyroidism & diabetes
Testicular: STIs, drugs, torsion, varicocele
Post-testicular: vasectomy, sexual dysfunction, hypospadias
Describe ovulatory disorders leading to infertility
Group 1: hypothalamic-pituitary failure eg. hypothalamic amenorrhoea
Group 2: hypothalamic-pituitary-ovarian dysfunction eg. PCOS
Group 3: ovarian failure eg. turner’s syndrome
Describe uterine and peritoneal disorders leading to infertility
Physical reasons why implantation fails:
1) Uterine fibroids
2) Conditions causing scarring/adhesions eg. PID & endometriosis
3) Mullerian developmental anomalies
Give examples of tubal damage which could lead to infertility
Conditions affecting fallopian tube -> disrupted transport of ovum Endometriosis Ectopic pregnancy Pelvic surgery PID
Describe investigations to do for infertility
Male: semen analysis, bloods, STI screen & ultrasound of testes
Females: bloods, STI screen & pelvic ultrasound
Describe specialist management options for infertility
Medical treatment – ovulation induction eg. clomifene
Surgical treatment – to rx tubal occlusions eg. laparoscopy
Assisted reproductive technology – means of conception other than normal coitus eg. intrauterine insemination, IVF etc
