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Reproductive system > L12: contraception & infertility > Flashcards

L12: contraception & infertility Flashcards

1
Q

List the different types of natural contraception

A

Abstinence
Withdrawal method
Fertility awareness method
Lactational amenorrhoea

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2
Q

Describe the advantages and disadvantages of abstinence

A

Advantages: 100% effective
Disadvantages: not an option for most, unprepared if/when sexually active

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3
Q

Describe the advantages and disadvantages of the withdrawal method

A

‘withdrawal’ occurs before ejaculation
Advantages: no devices/hormones
Disadvantages: unreliable, some sperm in pre-ejaculate & no STI protection

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4
Q

Describe the advantages and disadvantages of fertility awareness methods

A

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

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5
Q

What is lactational amenorrhoea? What are the pros and cons?

A

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

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6
Q

Describe the advantages and disadvantages of barrier contraception

A

Provide physical +/- chemical barrier to sperm entering the cervix (condoms)
Advantages: reliable, STI protection
Disadvantages: disrupts intercourse, risk of dislodging, allergy/sensitivity to latex

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7
Q

Describe the combined oral contraceptive pill (COCP)

A

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

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8
Q

Describe the advantages and disadvantages of the combined oral contraceptive pill

A

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

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9
Q

Describe the progestogen-only pill

A 
Low dose progestogen 
Main action: thicken cervical mucus 
Other action: reduced cilia activity in fallopian tubes 
Ovulation NOT prevented 
Taken daily with no breaks
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10
Q

Describe the advantages and disadvantages of the progestogen-only pill

A

Advantages: reliable, can be used if COCP contraindicated
Disadvantages: no STI protection, strict timing, menstrual irregularities & increased risk of ectopic pregnancy

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11
Q

Describe the progestogen injection

A

LARC
Main actions: inhibit ovulation, thicken cervical mucus, thin endometrial lining
Given IM every 12 weeks

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12
Q

Describe the advantages and disadvantages of the progestogen injection

A

Advantages: reliable, no known medication interactions & can be used if oestrogen contraindicated and raised BMI
Disadvantages: no STI protection, not rapidly reversible & menstrual irregularities

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13
Q

Describe the progestogen implant and its pros and cons

A

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

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14
Q

Describe intrauterine system

A

Progestogen-releasing coil – local (Mirena coil)
Main action: prevents implantation and reduces endometrial proliferation & thickens cervical mucus
Ovulation usually continues

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15
Q

Describe intrauterine device

A

Copper-containing coil
Main action: copper toxic to ovum and sperm, preventing fertilisation
Secondary action: cervical mucus changes, endometrial inflammatory reactions inhibit implantation

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16
Q

Describe the advantages and disadvantages of the coils

A

Advantages: convenient, effective, LARC & IUS for treatment of menorrhagia
Disadvantages: no STI protection, complications with insertion-perforation, menstrual irregularities & displacement/expulsion may occur

17
Q

Describe sterilisation in the male and female

A

Vasectomy – vas deferens snipped/tied to prevent sperm entering ejaculate
Tubal ligation/clipping – fallopian tube occluded to prevent ovum transport

18
Q

Describe the advantages and disadvantages of sterilisation

A

Advantages: permanent
Disadvantages: no STI protection, regret & not easily reversed

19
Q

Describe the different types of emergency contraception

A

Levonorgestrel – ‘morning after pill’, high dose progestogen & ovulation inhibited
Ulipristal acetate – selective progesterone receptor modulator, inhibits/delays ovulation
Copper IUD

20
Q

Define subfertility

A

A couple who are having regular, unprotected coitus, who have failed to conceive within 1 year

21
Q

Define primary infertility

A

Never been pregnant

22
Q

Define secondary infertility

A

Previous pregnancy (including ectopic and terminations) but struggling to conceive again

23
Q

List male causes of infertility

A

Pre-testicular: ED, hypogonadotropic hypogonadism, hyperprolactinemia, hypothyroidism & diabetes
Testicular: STIs, drugs, torsion, varicocele
Post-testicular: vasectomy, sexual dysfunction, hypospadias

24
Q

Describe ovulatory disorders leading to infertility

A

Group 1: hypothalamic-pituitary failure eg. hypothalamic amenorrhoea
Group 2: hypothalamic-pituitary-ovarian dysfunction eg. PCOS
Group 3: ovarian failure eg. turner’s syndrome

25
Q

Describe uterine and peritoneal disorders leading to infertility

A

Physical reasons why implantation fails:

1) Uterine fibroids
2) Conditions causing scarring/adhesions eg. PID & endometriosis
3) Mullerian developmental anomalies

26
Q

Give examples of tubal damage which could lead to infertility

A 
Conditions affecting fallopian tube -> disrupted transport of ovum 
Endometriosis 
Ectopic pregnancy
Pelvic surgery
PID
27
Q

Describe investigations to do for infertility

A

Male: semen analysis, bloods, STI screen & ultrasound of testes
Females: bloods, STI screen & pelvic ultrasound

28
Q

Describe specialist management options for infertility

A

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

Reproductive system (20 decks)

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