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Reproductive System > Lec 8 - Contraception & Infertility > Flashcards

Lec 8 - Contraception & Infertility Flashcards

1
Q

What are methods contraceptions use to prevent pregnancy?

A
  1. Blocking transport of sperm to avoid fertilisation of oocyte.
  2. By disrupting the HPG axis to interfere with ovulation.
  3. By inhibiting implantation of the conceptus into endometrium.
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2
Q

What are contraceptive methods with no user failure?

A
  • These you do not have to remember to use them.
    1. contraceptive injection
    2. implant
    3. intrauterine systen (IUS)
    4. Intrauterine device (IUD)
    5. Female and male sterilisation.
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3
Q

What are contraceptive methods with user failure?

A
  • These you have to remember to use.
    1. contraceptive patch
    2. Contraceptive vaginal ring
    3. Combined pill
    4. Progesterone-only pill
    5. Male condom
    6. female condom
    7. Diaphragm/ cap with spermacide
    8. Natural family planning
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4
Q

What is an implant and how long do they last?

A

-Implant is a small flexible rod that is put under the skin of the upper arm and releases progestogen.

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5
Q

What is an IUS and how long do they last?

A
  • IUS is a small T-shaped progestogen-releasing plastic device that is put into the uterus.
  • Lasts around 3-5 years.
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6
Q

What is an IUD and how long do they last?

A
  • IUD is a small plastic and copper device which is put into the uterus.
  • Can stay in for 5-10 years.
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7
Q

What are some examples of natural contraceptive methods?

A
  • Abstinence
  • Withdrawal method
  • Fertility awareness methods
  • Lactational amenorrhoea method.
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8
Q

What is the process of the lactational amenorrhoea method?

A
  • Breastfeeding delays the return of ovulation after childbirth.
  • –> The suckling stimulus distrupts the release of GnRH.
  • ——-> This affects the feedback cycle of HPG axis.
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9
Q

What does the lactational amenorrhoea method depend on?

A
  • relies on exclusive breastfeeding.
  • It is only effective up to 6 months after giving birth.
  • The female must be amenorrheic.
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10
Q

What are the advantages and disadvantages of the lactational amenorrhoea method?

A

Advantages
- No hormones/ contraindications

Disadvantages

  • unreliable
  • No STI prevention
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11
Q

What does the fertility awareness method involve?

A

it involves the use of fertility indicators to identify fertile and infertile points of the menstrual cycle such as:

  1. cervical secretions
  2. Basal body temperatures
  3. Length of menstrual cycle.
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12
Q

What are the advantages and disadvantages of fertility awareness methods?

A

Advantages
- There are no hormones/ contraindications

Disadvantages

  • Unreliable
  • No protection from STIs.
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13
Q

What are the advantages and disadvantages of abstinence?

A

Advantages

- Only 100% reliable method of contraception

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14
Q

What are the advantages and disadvantages of the withdrawal method?

A

Advantages
- No devices or hormones

Disadvantages

  • Not reliable
  • —> Need willpower to withdraw on time.
  • —> Some sperm may be released in the pre-ejaculate
  • —> There is no protection for STIs.
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15
Q

What is the withdrawal method?

A

This is withdrawing before ejaculation

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16
Q

What are some examples of barrier contraceptives?

A
  • male/ female condoms
  • diaphragm/ caps
  • These act as physical barriers as they prevent the entrance of sperm into the cervix.
  • They can also be used with spermicide and act as an additional chemical barrier.
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17
Q

What are the advantages and disadvantages of barrier contraceptives?

A

Advantages

  • reliable - 98%
  • protection from STIs
  • male condom is widely available.

Disadvantages

  • distrusts the romantic nature of sexual intercourse
  • reduces sexual pleasure
  • danger of expiring
  • allergy/ sensitivity to latex/ spermicide
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18
Q

What is progestogen?

A

This is synthetic progesterone.

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19
Q

What are some examples of hormonal control?

A
  1. Combined oestrogen and progestogen
    - COCP
    - Vaginal ring
    - Patches
  2. Progesterone Depot
    - High dose progestogen
  3. Progesterone implant
    - High dose progestogen
  4. Low dose Progestogen
    - POP
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20
Q

What are some examples of hormonal control?

A
  1. Combined oestrogen and progestogen
    - COCP
    - Vaginal ring
    - Patches
  2. Progesterone Depot
    - High dose progestogen
  3. Progesterone implant
    - High dose progestogen
  4. Low dose Progestogen
    - POP
  • the progesterone depot and implant are long acting reversible contraception.
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21
Q

What is the role of Progesterone in the HPG axis?

A
  1. At moderate/ high doses, progesterone enhances the negative feedback of natural oestrogen
    - –> This will reduce LH and FSH secretion.
  2. At moderate/ high doses, progesterone inhibits the positive feedback of oestrogen
    - –> This results in no LH surge and therefore no ovulation.
  3. At lower doses, progesterone does not inhibit the LH surge, so ovulation is still likely.
    - –> lower dose of progesterone will thicken cervical mucus.
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22
Q

What are the stages of the HPG axis?

A
  1. Hypothalamus, which releases GnRH to the AP.
  2. The anterior pituitary then secretes FSH and LH to the ovaries.
  3. Granulosa cells secrete inhibin whilst theca cells secrete oestrogen.
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23
Q

What is the combined oral contraceptive pill?

A

It is a pill containing a combination of synthetic oestrogen and progestogen.
- It tricks the body into thinking it is in the luteal phase of the cycle.

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24
Q

What is the principal action of the COCP?

A

Prevents ovulation

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25
Q

What is the secondary action of the COCP?

A
  1. reduces endometrial receptivity to inhibit implantation.

2. Thickens cervical mucus to inhibit penetration of sperm.

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26
Q

When should COCP be taken?

A
  • taken for either 21 days followed by a 7 day break.

- taken for 21 days with 7 days of a placebo pill

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27
Q

What is the effectiveness of COCP if taken correctly?

A

98%

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28
Q

What are the advantages and disadvantages of COCP?

A

Advantages

  • 98% effective
  • can relieve menstrual disorders
  • reduces the risk of ovarian cysts
  • reduces risk of ovarian cancer and endometrial cancer —> as it is thinning out the endometrium lining, it reduces the risk of endometrial hypoplasia.

Disadvantages

  • No protection from STIs.
  • Contraindications such as BMI, migraine and breast cancer
  • side effects such as breakthrough bleeding, breast tenderness and mood disturbance
  • increased risk of breast and cervical cancer, VTE, MI/stroke
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29
Q

What is the principle action of the progestogen injection?

A

Prevents ovulation

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30
Q

What is the secondary action of the progestogen injection?

A
  1. thickens the cervical mucus to inhibit penetration of sperm.
  2. prevents endometrial proliferation.
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31
Q

What is the progestogen injection?

A

It is an intramuscular injection that is given at intervals.

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32
Q

What is the effectiveness of the progestogen injection if taken correctly?

A

more than 99%

33
Q

What are the advantages and disadvantages of the progestogen injection?

A

Advantages

  • Reliable —> it eliminates the risk of user failure.
  • it does not disrupt sexual intercourse
  • it can be useful for women who can’t use contraception that contains oestrogen.

Disadvantages

  • Appointment is needed every 12 weeks
  • Contraindications and side effects
  • There is a delay in fertility returning
  • There is no STI protection.
34
Q

What is the progestogen implant and how long does it last?

A
  • It is a small flexible tube about 40mm long and it is inserted under the skin.
  • lasts for 3 years
35
Q

What is the principal action of the progestogen implant?

A

It inhibits ovulation

36
Q

What is the secondary action of the progestogen implant?

A
  1. It thickens the cervical mucus.

2. It prevents the endometrial proliferation.

37
Q

What is the effectiveness of the progestogen implant?

A

More than 99%

38
Q

What are the advantages and disadvantages of high dose progestogen?

A

Advantages

  • reliable –> eliminates the risk of user failure.
  • it is a long acting reversible contraceptive
  • It can be useful for women who can’t use contraception that contains oestrogen.
  • Natural fertility returns quickly when removed.

Disadvantages

  • could be uncontrolled bleeding
  • minor procedure to start
  • there are side effects
  • NO STI protection
39
Q

How often should the progestogen only pill be taken?

A

taken every day without a break

40
Q

What kind of dose is the progestogen only pill?

A

It is a low dose progestogen.

41
Q

What is the principal action of POP?

A

Thickens the cervical mucus.

42
Q

What is the effectiveness of POP if taken correctly ?

A

99% effective.

43
Q

What are the advantages and disadvantages of POP?

A

Advantages

  • quickly reversible
  • It does not interrupt sexual intercourse
  • It can be used where the COCP is contraindicated.

Disadvantages

  • It is user dependent
  • Menstrual problems are common.
  • It interacts with other medication
  • There is a risk of ectopic pregnancy
  • No protection from STIs.
44
Q

What is the principal action of IUS?

A
  1. It prevents implantation

2. It reduces endometrial proliferation.

45
Q

What is the secondary action of IUS?

A

It thickens cervical mucus.

46
Q

What is the principal action of IUD?

A

Copper is toxic to sperm and ovum

47
Q

What is the secondary action of the IUD?

A
  • Endometrial inflammatory reaction which prevents implantation and changes the consistency of cervical mucus.
48
Q

What are the advantages and disadvantages of IUS and IUD?

A

Advantages

  • It is convenient
  • Have a long duration of action.

Disadvantages

  • Insertion may be unpleasant
  • Risk of uterine perforation is around 2 in 1000.
  • there is menstrual irregularity.
  • doesn’t prevent STI
  • displacement/ expulsion may occur.
49
Q

What happens in a vasectomy?

A

The vas deferens is cut or tied to prevent sperm entering ejaculate.
- It is performed under local anaesthetic.

50
Q

How is a vasectomy tested for effectiveness?

A

Have to confirm the success by post-operative semen analysis to confirm no sperm in ejaculate, approx 12-16 weeks after surgery.

51
Q

What happens in tubal ligation/ clipping?

A

The Fallopian tubes are cut or blocked to stop the ovum from travelling from the ovary to the uterus.
- It can be done under local or general anaesthetic.

52
Q

What is the failure rate of tubal ligation/ clipping?

A

1 in 200/500 depending on which method.

53
Q

Define subfertility.

A

This is the failure of conception in a couple having regular unprotected coitus for one year.

54
Q

What is primary infertility?

A

This is when someone who’s never conceived a child in the past has difficulty conceiving.

55
Q

What is secondary infertility?

A

This is when someone has had one or more pregnancies in the past but is having difficulty conceiving again.

56
Q

What is the percentage of couples that will conceive naturally within one year if they have regular unprotected sex?

A

84%

57
Q

What is the likelihood of getting pregnant naturally within the next year for couples who have been trying to conceive for more that 3 years?

A

25%

58
Q

What are the main sub fertility causes?

A
  1. factors in the male - 30%
  2. Unexplained infertility - 25%
  3. ovulatory disorders - 25%
  4. Tubal damage - 20%
  5. uterine or peritoneal disorders - 10%
  6. other - coital problems and concurrent health problems.
59
Q

What are the pre testicular male causes of sub fertility?

A

Endocrine

  • Hypothalamus/ pituitary dysfunction
  • Hypogonadotropic hypogonadism
  • Hyperprolactinoemia
  • Hypothyroidism
  • Diabetes
60
Q

What are the testicular male causes of sub fertility?

A
  1. Genetic
    - Klinefelter syndrome (XXY)
    - Y chromosome deletion
    - Immotile cilia syndrome
  2. Congenital
    - Cryptorchidism.
  3. Infective
    - STIs
  4. Antispermatogenic agents
    - Heat
    - Irradiation
    - Drugs
    - Chemotherapy
  5. Vascular
    - Torsion
    - Varicocele
61
Q

What are the post testicular male causes of sub fertility?

A
  1. Obstructive
    - congenital - structured
    - acquired - infective
    - vasectomy
  2. Coital problems
    - Ejaculatory failure
    - Erectile dysfunction
62
Q

What are the three groups that ovulatory disorders can be classified into?

A

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
  • premature ovarian failure/ primary ovarian insufficiency.
63
Q

What are some uterine/ peritoneal disorders?

A
  1. Uterine fibroids
  2. Asherman syndrome
  3. Endometriosis
  4. Pelvic inflammatory disease
  5. previous surgery
  6. cervical stenosis
64
Q

Define agenesis.

A

This is failure for the uterus or tubes to form.

65
Q

Define didelphys.

A

This is the complete duplication of the uterus, cervix and vagina.

66
Q

Define Bicornuate

A

This is when two uteri are sharing a single cervix and vagina.

67
Q

Define septate

A

This is a single uterus with a fibrous band going down the centre of the uterus.

68
Q

What conditions can result in tubal damage?

A
  1. endometriosis
  2. ectopic pregnancy
  3. pelvic surgery
  4. past pelvic infection such as chlamydia
  5. Mullerian developmental anomaly —> agenesis
69
Q

What questions might the GP ask a male?

A
  1. general health
  2. if father already
  3. alcohol/ smoking
  4. surgical history such as previous surgery to the testes.
  5. drug history
  6. sexual health history
  7. sexual dysfunction
70
Q

What questions might the GP ask a female?

A
  1. age
  2. general health
  3. drug history
  4. obstetric/ gynaecologist history
  5. alcohol/ smoking
  6. menstrual cycle - length and predictability of cycle and age of menarche.
  7. surgical history - tubal or pelvic surgery.
  8. sexual health history - PID or STIs.
71
Q

What examination would the GP do for male?

A
  1. if one is needed then a testicular examination can be done to check for descent and swellings etc.
72
Q

What examination would the GP do for female?

A
  1. BMI
  2. signs of secondary sexual characteristics such as breast examination and galactorrhea.
  3. pelvic examination
    - visual external inspection
    - insertion of the speculum —> This is the insertion of a plastic tube being opened up to see the cervix into the vagina.
    - bimanual examination to determine the size and character of the uterus and ovaries.
73
Q

What investigations might the GP do for male?

A
  1. semen analysis —> sperm count and motility.
  2. blood test
    - anti-spermantibodies
    - FSH/LH/ testosterone
  3. penile/ urethral swabs
  4. USS testes
  5. Karyotype
  6. Cystic fibrosis
74
Q

What investigations might the GP do for female?

A
  1. Blood test
    - follicular phase LH and FSH at day 2
    - —-> would be high if there was ovarian failure.
    - luteal phase progesterone at day 21.
    - Prolactin, androgens, TFTs
  2. Cervical smear
  3. vaginal/ cervical swabs to rule out STI
  4. pelvic USS to see if there are any cysts in the ovary.
  5. Tests of tubal patency - Hysterosalpingogram.
75
Q

What happens in a Hysterosalpinogram?

A
  1. A speculum is put into the vagina.
  2. It shoots dye into the uterus.
  3. It travels along the Fallopian tube and out the cavity.
  4. X rays are then taken to see the dye.
76
Q

What advice may a GP give to male to increase fertility?

A
  1. stop smoking
  2. reduce alcohol intake.
  3. reduce stress levels
  4. healthy diet
77
Q

What advice may a GP give to female to increase fertility?

A
  1. stop smoking
  2. reduce alcohol intake.
  3. reduce stress levels
  4. loose weight
  5. regular sexual intercourse
78
Q

When is early referral to fertility clinic given to women?

A
  • women is above 36

- when there is a known clinical cause of infertility or a history of predisposing factors for infertility.

79
Q

What are the Types of fertility treatment?

A
  1. medical treatment to restore fertility
    - –> e.g includes use of drugs to stimulate follicular development and ovulation such as Clomiphene, GnRH agonist/ antagonist and gonadatrophins.
  2. Surgical treatment to restore fertility
    - examples include laparoscopy for ablation of endometriosis and removal of fibroids.
  3. Assisted reproduction techniques (ART)
    - this is any treatment that deals with means of conception other than vaginal intercourse.
    - –> e.g artificial insemination and IVF

Reproductive System (8 decks)

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