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S5) Contraception and Infertility Flashcards

1
Q

What is contraception?

A

Contraception is any method to prevent pregnancy

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2
Q

Describe 3 different means of contraception

A
  • Blocking transport of sperm to avoid fertilisation of oocyte
  • Disrupting the HPG axis to interfere with ovulation
  • Inhibiting implantation of the conceptus into endometrium
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3
Q

Identify 6 broad methods of contraception

A
  • Natural
  • Barrier
  • Hormonal Control
  • Prevention of implantation
  • Sterilisation
  • Emergency contraception
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4
Q

Identify 4 forms for natural contraception

A
  • Abstinence
  • Withdrawal method
  • Fertility Awareness Methods
  • Lactational amenorrhoea method
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5
Q

What is abstinence?

A

Abstinence is the practice of refraining from sex

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6
Q

What are the advantages and disadvantages of abstinence?

A
  • Advantage: 100% reliable
  • Disadvantage: no sex
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7
Q

What does fertility awareness involve?

A

Fertility awareness involves the use of fertility indicators to identify fertile and infertile points of the menstrual cycle, looking at body to determine stage of menstrual cycle you’re in

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8
Q

Identify 3 different fertility awareness methods

A
  • Cervical secretions (thick)
  • Basal body temperatures
  • Length of menstrual cycle
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9
Q

Identify the advantages and disadvantages of fertility awareness methods

A
  • Advantages: no hormones/contraindications
  • Disadvantages: unreliable, no protection from STI’s
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10
Q

What does the withdrawal method involve?

A

The withdrawal method involves withdrawing the penis before ejaculation

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11
Q

Identify the advantages and disadvantages of the withdrawal method

A
  • Advantages: no devices/hormones
  • Disadvantages: unreliable, some sperm may be released in the pre-ejaculate, no protection from STI’s
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12
Q

What does the lactational amenorrhea method involve?

A
  • Breastfeeding delays the return of ovulation after childbirth
  • Suckling stimulus disrupts release of GnRH
  • Affects feedback cycle of HPG axis
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13
Q

How long is the lactational amenorrhea method effective for?

A

Up to 6 months after giving birth

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14
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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15
Q

Identify 2 forms of barrier contraception

A
  • Male/Female condoms
  • Diaphragm/Caps (caps that cover the surface)
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16
Q

What does barrier contraception involve?

A
  • Physical barriers prevent sperm entering the cervix
  • Can also used with spermicide (additional chemical barrier)
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17
Q

What are the advantages and disadvantages of barrier contraception?

A
  • Advantages: reliable, protection from STIs, widely available (male condom)
  • Disadvantages: disrupt romantic nature, reduce sexual pleasure, can expire, allergy/sensitivity to latex/ spermicide
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18
Q

Identify 4 forms of contraception involving hormonal control

A
  • Combined Oestrogen and Progestogen
  • Progesterone Depot
  • Progesterone Implant
  • Low dose progestogen
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19
Q

Identify 2 long-acting reversible contraceptives (LARC)

A
  • Progesterone Depot
  • Progesterone Implant
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20
Q

What is progestogen?

A

Progestogen is a synthetic form of progesterone

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21
Q

What is the role of progesterone in moderate/high doses?

A
  • Progesterone enhances the negative feedback of natural oestrogen – reducing LH and FSH secretion
  • No LH surge means no ovulation
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22
Q

What is the role of progesterone in lower doses?

A
  • Progesterone does not inhibit the LH surge
  • Ovulation is still likely
  • Cervical mucus thickens
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23
Q

What is the Combined Oral Contraceptive Pill?

A

COCP is a pill containing combination of synthetic oestrogen and progestogen

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24
Q

What is the principal action of the COCP?

A

Principal action: prevents ovulation

tricks body into thinking its In the luteal phase

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25
What are the secondary actions of the COCP?
- Reduces **endometrial receptivity** to inhibit implantation - Thickens **cervical mucus** to inhibit penetration of sperm
26
What are the advantages and disadvantages of COCP?
- **Advantages**: relieves menstrual disorders, reduces risk of ovarian and endometrial cancer - **Disadvantages**: no protection from STI's, interacts with other medications, side effects
27
Identify 4 clinical conditions which are at increased risk when on the COCP
- Breast and cervical cancer - Venous thromboembolism - MI - Stroke
28
What is the principal action of High Dose Progestogen contraception?
**Principal action:** prevents ovulation
29
What is the secondary action of High Dose Progestogen contraception?
- Thickens cervical mucus to inhibit penetration of sperm - Prevents endometrial proliferation
30
What are the advantages and disadvantages of the High Dose Progestogen injection?
- **Advantages**: reliable, used by women who can't use contraception with oestrogen - **Disadvantages**: appointment needed every 12 weeks, side effects, delay in fertility returning, no STI protection
31
What are the advantages and disadvantages of the High Dose Progestogen implant?
- **Advantages**: reliable, LARC, used by women who can't use contraception with oestrogen, natural fertility returns quickly - **Disadvantages**: minor procedure to insert, side effects, no STI protection
32
What is the principal action of Low Dose Progestogen?
- **Principal action:** thickens cervical mucus - Ovulation is usually not prevented
33
What are the advantages and disadvantages of the Low Dose Progestogen in the progestogen only pill?
- **Advantages**: quickly reversible, used where COCP is contraindicated - **Disadvantages**: common menstrual problems, interacts with other medication, risk of ectopic pregnancy, no STI protection
34
What is the intrauterine system (IUS)?
- **IUS** is a progestogen-releasing plastic device - Works for 3–5 years
35
What are the principal and secondary actions of the IUS?
- **Principal action:** prevents implantation and reduces endometrial proliferation - **Secondary action:** thickens cervical mucus
36
What is the intrauterine device (IUD)?
- **IUD** is a plastic device with added copper - Works for 5-10 years
37
What are the principal and secondary actions of the IUD?
- **Principal action**: copper is toxic to sperm and ovum - **Secondary action**: endometrial inflammatory reaction prevents implantation and changes consistency of cervical mucus
38
What are the advantages and disadvantages of the IUD and IUS?
- **Advantages**: convenient, long duration of action - **Disadvantages**: unpleasant insertion, risk of uterine perforation, menstrual irregularity, no STI protection
39
Identify 2 forms of sterilisation
- Vasectomy - Tubual ligation/clipping
40
How is a vasectomy performed?
- Vas deferens cut/tied to prevent sperm entering ejaculate - Performed under local anaesthetic
41
How is the success of a vasectomy confirmed?
- Post-operative semen analysis to confirm no sperm in ejaculate - Approx. 12-16 weeks after surgery
42
How is a tubual ligation performed?
- Fallopian tubes are cut/blocked to stop the ovum travelling from the ovary to the uterus - Performed under local/general anaesthetic
43
Identify 3 forms of emergency contraception
- Emergency IUD - Emergency pill with ulipristal acetate - Emergency pill with levonorgestrel
44
What is subfertility?
**Subfertility** is the failure of conception in a couple having regular, unprotected coitus for one year
45
What is primary infertility?
**Primary infertility** is when someone who has never conceived a child in the past has difficulty conceiving
46
Identify the 5 main causes of subfertility
- Male factors (30%) - Unexplained (25%) - Ovulatory disorders (25%) - Tubal damage (20%) - Uterine or peritoneal disorders (10%)
47
Identify 5 causes of male subfertility which relate to general health/systemic illness
- Hypothalamus/ pituitary dysfunction - Hypogonadism - Hyperprolactinoemia - Hypothyroidism - Diabetes
48
Identify 2 genetic causes for male subfertility
- Klinefelter syndrome - Y chromosome deletion
49
Identify 4 antispermatogenic agents
- Heat - Irradiation - Drugs - Chemotherapy
50
Identify 2 vascular causes of male subfertility
- Testicular torsion - Varicocele
51
Identify 2 coital problems which can lead to male subfertility
- Ejaculatory failure - Erectile dysfunction
52
Identify the 3 groups of different ovulatory disorders
- Hypothalamic-pituitary failure (10%) - Hypothalamic-pituitary-ovarian dysfunction (85%) - Ovarian failure (5%)
53
Identify 2 clinical conditions which result from hypothalamic-pituitary failure
- Hypothalamic amenorrhea - Hypogonadotrophic hypogonadism
54
Identify 2 clinical conditions which result from hypothalamic-pituitary-ovarian dysfunction
- Polycystic ovary syndrome - Hyperprolactinaemic amenorrhoea
55
Identify 2 clinical conditions which result from ovarian failure
- Premature ovarian failure - Primary ovarian insufficiency
56
Identify 3 uterine/peritoneal disorders
- Uterine Fibroids - Endometriosis - Pelvic Inflammatory Disease
57
Identify 3 events/conditions which could lead to tubal damage
* effects the Fallopian tube and the transport of the ovum - Endometriosis - Ectopic pregnancy - Pelvic surgery - Past pelvic infection *e.g. Chlamydia*
58
what is a long acting reversible contraception
* hormonal methods are not reliable * they are long lasting in the sense you don't have to take a pill everyday * does not provide any STI cover
59
factors for men causing infertility
* pre - testicular: effect HPG axis * testicular: to do with sperm storage or production → torsion, STI, drugs * post - testicular: obstructive causes → vasectomy or ejaculatory problems
60
what are some ovulatory disorders to prevent fertility
* failure of GnRH to act on pituitary * failure of axis to respond appropriately: PCOS, high prolactin * failure of ovary to respond appropriately: Turner's, early menopause
61
what are some investigations you can do to men to test for causes of infertility
* semen analysis: sperm count, motility * Hormone Levels: LH, FSH, testosterone * Ultrasound scan of testes * Exclude sti * karyotyping
62
what are some investigations you can do in women to access if ovulation is occurring
* LH, FSH (day 2) * progesterone (day 21) * androgens * systemic blood tests: Prolactin

SA reproductive (22 decks)

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