Lecture 12 - Contraception And Fertility Flashcards by Callum Donoher

What are the 3 main methods of contraception?

Blocking sperm transport (cervical mucus)
Disrupting HPG axis preventing OVULATION
Inhibiting implantation of conceptus into endometrium (thinning endometrium)

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What are the categories of contraception?

Natural
Barrier
Hormonal
Intrauterine (IUD/IUS)
Sterilisation
Emergency contraception

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What are some natural methods of contraception?

Abstinence
Withdrawal
Fertility awareness methods
Lactational amenorrhoea

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What are the advantages of abstinence as a contraception method?

100% effective

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What are the disadvantages for abstinence as a method of contraception?

Not an option for most

Unprepared when sexually active

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What are the advantages and disadvantages of using the withdrawal method for contraception?

Adv:
-no devices or hormones

Disadvantage:
-unreliable (some sperm in pre-ejaculate)
-No STI protection

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What is the natural fertility awareness method of contraception??

By using cervical secretions and basal body temperature changes can work out what stage in the cycle they’re at and therefore when they’re most fertile or not

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What happens to the basal body temperature at ovulation?

Lots of progesterone produced by the corpus luteum, this leads to an increase in Basal Metabolic Rate which increases the body temperature

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What are the advantages and disadvantages of using the fertility awareness methods as contraception?

Adv:
-no hormonal/contraindications

Disav:
-time consuming
-unreliable
-no sti protection
-not suitable for everyone

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How do cervical secretions change during the cycle?
What hormones are high in these phases?

Follicular phase;
-high oestrogen
-thin alkaline cervical mucus

Luteal phase:
-high progesterone
-thick sticky acidic cervical mucus

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How does lactational amenorrhoea work as contraception?

When lactating up to 6 months postnatal Prolactin levels are very high
Prolactin inhibits GnRH release
This inhibits production of sex hormones

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

Adv:
-no hormonal/contraindications

Disadvantage:
-unreliable after 6 months
-No STI protection
-not suitable for all

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What are some barrier methods of contraception?

Condoms
Diaphragms/cervical caps
Spermicides

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What are the advantages and disadvantages of the barrier method of contraception?

Adv:
Reliable (if used correctly)
-STI protection

Disadvantage:
-disrupts intercourse
-risk of dislodging
-allergy to latex

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What does the combined oral contraceptive pill contain? (COCP)

Oestrogen and progesterone

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What is the main action of how the combined oral contraceptive pill works?

What is its secondary actions?

STOPS OVULATION

Secondary:
-thins endometrium
-thickens cervical mucus

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What are the advantages of the Combined oral contraceptive pill?

Reliable
Can relieve menstrual disorders (can take back to back to prevent periods helping with endometriosis)
Decreased risk of ovarian cancer (less ovulation) and endometrial cancer (reduced proliferation of endometrium)
Reduced acne severity

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What are the disadvantages of using the combined oral contraceptive pill (COCP)?

User dependant
No STI protection
Medication interaction
Contraindications (raised BMI, migraines, breast cancer)
Side effects = menstrual irregularities, breast tenderness and mood disturbance
Inc risk of CV disease, stroke, VTE, breast and cervical cancer

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What is the action of high dose progesterone?

Enhances negative feedback of oestrogen
So low oestrogen means low FSH and LH
This prevents the LH surge leading to ovulation

Prevents ovulation by preventing LH surge

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What is the action of lower levels of progesterone?

Thickens cervical mucus

Ovulation still occurs since the progesterone is not high enough to inhibit oestrogen enough to prevent LH surge

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What are the levels of progesterone in the progesterone only pill (POP)?

Low dose progesterone taken daily

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What is the main method of action of the progesterone only pill if its low dose progesterone?

Thickens cervical mucus

Secondary:
Reduced cilia activity in fallopian tubes
OVULATION is NOT prevented

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What are the advantages of the progesterone only pill?

Reliable
Can be used if the COCP contraindicated

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What are the disadvantages of the progesterone only pill?

No STI protection
Strict timing
Menstrual irregularities
Inc risk of Ectopic pregnancy

The progesterone causes menstrual side effects (mood swings, acne)

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What is the progesterone injection?

High dose progesterone (LARC) Long acting reversible contraception Given IM every 3months

What are the main actions of the progesterone injection?

INHIBITS OVULATION (inhibits LH surge by inhibiting oestrogen) Thickens cervical mucus Thins endometrial lining

What re the advantages of the progesterone injection?

Reliable No medical interactions Cn be used if oestrogen contraindicated and raised BMI

What are the disadvantages of the progesterone injection?

No STI protection Can take 18months for fertility to return Menstrual irregularities (spotting, acne, mood swings)

How does the progesterone implant work?

High dose progesterone (Long acting reversible contraception) Inhibits OVULATION Thickens cervical mucus Thins endometrial lining

What are the advantages of the progesterone implant?

Reliable Last up to 3 years Can be used if oestrogen contraindicated and raised BMI Fertility returns faster than injection

What are the disadvantages of the progesterone implant?

No STI protection Menstrual irregularities Complication with insertion and removal (infection risk)

How does the Mirena (IUS) work?

A progesterone releasing coil (low level progesterone) Prevents implantation: Thickens cervical mucus Thins endometrium

How does the IUD work?

Copper coil is toxic to the ovum and sperm preventing fertilisation The coil causes a constant endometrial inflammatory response which prevents implantation

What are the advantages and disadvantages of Intrauterine contraceptives?

Adv: -convenient -effective -LARC (3 to 10ths) -IUS can treat menorrhagia Disadvantage: -No STI protection -complications with insertion (perforation) -menstrual irrregularities -displacement

What are the 2 types of sterilisation methods of contraception?

Vasectomy Tubal ligation/clipping

What is a vasectomy?

Vas deferens snipped to prevent sperm entering ejaculate

What are the advantages and disadvantages of sterilisation?

Adv: -permanent Disadvantage: -permanent -infection risk

What are the 3 types of emergency contraception?

Levonorgestrel ((morning after pill = high dose progesterone) EllaOne (acts like progesterone stopping LH surge) Copper IUD (stops implantation)

What is the definition of infertility?

The failure to achieve a pregnancy after 12 months or more of regular (2-3 times a week) unprotected sexual intercourse

What is primary infertility? What is secondary infertility?

Primary = never been pregnant Secondary = previous pregnancy but struggling to conceive

What is subfertility?

Gerenally describes any form of reduced fertility that results in a prolonged duration of unwanted lack of conception

What are some causes of infertility?

Unidentifiable Male causes Ovulation causes Tubul factors Uterine and peritoneal disorders

What are the 3 types of male causes for infertility?

Pre-testicular Testicular Post-testicular

What is a pre-testicular cause of male infertility?

Hypogonadotrpopic hypogonadism Thyroid disorders

What is a testicular cause of male infertility?

Klinefelter syndrome (XXY) Cryptorchidism (testes not descending) Infective (mumps) Antispermatogenic agents like chemo Vascular (Torsion or varicocele)

What are some post testicular causes of male infertility?

Absent vas Infective Vasectomy Coital problems: -sexual dysfunction -hypospadias

What is hypospadias?

Congenital urethral opening is lower down

What are the 3 types of ovulation disorders?

Group I: hypothalamic pituitary failure Group II: hypothalamic pituitary ovarian dysfunction Group III: ovarian failure

What are some examples of Group I Hypothalamic pituitary failure?

Stress Weight loss Hypothalamic amenorrhoea Hypogonadotropic hypogonadism

What are some examples of Group II Hypothalamic pituitary ovarian dysfunction?

PCOS High prolactin (breast feeding, certain meds, tumours)

What are some examples of Group III Ovarian failure?

Premature ovarian failure Turner’s syndrome (45X0)

What can cause tubal damage leading to infertility?

Endometriosis Ectopic pregnancy Pelvic surgery Pelvic inflammatory disease (PID) They all cause scarring Mulllerian developmental anomaly (agenesis)

What are some uterine and peritoneal disorders?

Uterine fibroids Condtions causing scarring/adhesions: -endometriosis -PID -Previous surgery -ashermans syndrome

What is asherman syndrome?

Scarring of endometrial lignin

What examinations are done in women with suspected infertility?

BMI Secondary sexual characteristics Hirsutism, Acne (PCOS)? Pelvic/abdominal exam and swabs

What advice can be given to patients with infertility issues?

Smoking cessation Reduce alcohol intake Lifestyle changes Regular intercourse Weight loss

What investigations can be done in men to check for infertility?

Semen analysis Bloods (LH/FSH and testosterone) STI screen Ultrasound scan testes Karyotyping

What investigations can be done to check for infertility in women?

FSH/LH (day 2) Midluteal phase progesterone (DAY 21) Thyroid function tests, prolactin levels and androgens STI Pelvic ultrasounds Hysterosalpingogram Laparoscopy

What is a hysterosalpingogram?

Where dye is inserted into the female tract and is used to view the uterus and the fallopian tubes

When may you consider referring somebody to secondary care with infertility?

Normal history and exam and not conceived in a year Early referral if: Woman > 35 after 6months of trying Or Known cause

How can infertility be managed?

Medical treatment - ovulation induced by Clomifene Surgical treatment - removal of tubul occlusions (laparascopy) Assisted Reproductive Techonology

What factors are assessed in semen analysis?

Semen vol Total sperm count Total motility Progressive motility

What is the physiological basis of viagra?

Vasodilation/stimulation of parasympathetics Due to the viagra decreasing the rate of degradation of cGMP meaning the affects of NO last longer

When would the most previous ovulation have occured if the person started bleeding today?

14 days ago

What day is progesterone the highest?

Lecture 12 - Contraception And Fertility Flashcards

(65 cards)