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SA reproductive > S5) Contraception and Infertility > Flashcards

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
Q

What are the secondary actions of the COCP?

A
  • Reduces endometrial receptivity to inhibit implantation
  • Thickens cervical mucus to inhibit penetration of sperm
26
Q

What are the advantages and disadvantages of COCP?

A
  • Advantages: relieves menstrual disorders, reduces risk of ovarian and endometrial cancer
  • Disadvantages: no protection from STI’s, interacts with other medications, side effects
27
Q

Identify 4 clinical conditions which are at increased risk when on the COCP

A
  • Breast and cervical cancer
  • Venous thromboembolism
  • MI
  • Stroke
28
Q

What is the principal action of High Dose Progestogen contraception?

A

Principal action: prevents ovulation

29
Q

What is the secondary action of High Dose Progestogen contraception?

A
  • Thickens cervical mucus to inhibit penetration of sperm
  • Prevents endometrial proliferation
30
Q

What are the advantages and disadvantages of the High Dose Progestogen injection?

A
  • 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
Q

What are the advantages and disadvantages of the High Dose Progestogen implant?

A
  • 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
Q

What is the principal action of Low Dose Progestogen?

A
  • Principal action: thickens cervical mucus
  • Ovulation is usually not prevented
33
Q

What are the advantages and disadvantages of the Low Dose Progestogen in the progestogen only pill?

A
  • Advantages: quickly reversible, used where COCP is contraindicated
  • Disadvantages: common menstrual problems, interacts with other medication, risk of ectopic pregnancy, no STI protection
34
Q

What is the intrauterine system (IUS)?

A
  • IUS is a progestogen-releasing plastic device
  • Works for 3–5 years
35
Q

What are the principal and secondary actions of the IUS?

A
  • Principal action: prevents implantation and reduces endometrial proliferation
  • Secondary action: thickens cervical mucus
36
Q

What is the intrauterine device (IUD)?

A
  • IUD is a plastic device with added copper
  • Works for 5-10 years
37
Q

What are the principal and secondary actions of the IUD?

A
  • Principal action: copper is toxic to sperm and ovum
  • Secondary action: endometrial inflammatory reaction prevents implantation and changes consistency of cervical mucus
38
Q

What are the advantages and disadvantages of the IUD and IUS?

A
  • Advantages: convenient, long duration of action
  • Disadvantages: unpleasant insertion, risk of uterine perforation, menstrual irregularity, no STI protection
39
Q

Identify 2 forms of sterilisation

A
  • Vasectomy
  • Tubual ligation/clipping
40
Q

How is a vasectomy performed?

A
  • Vas deferens cut/tied to prevent sperm entering ejaculate
  • Performed under local anaesthetic
41
Q

How is the success of a vasectomy confirmed?

A
  • Post-operative semen analysis to confirm no sperm in ejaculate
  • Approx. 12-16 weeks after surgery
42
Q

How is a tubual ligation performed?

A
  • Fallopian tubes are cut/blocked to stop the ovum travelling from the ovary to the uterus
  • Performed under local/general anaesthetic
43
Q

Identify 3 forms of emergency contraception

A
  • Emergency IUD
  • Emergency pill with ulipristal acetate
  • Emergency pill with levonorgestrel
44
Q

What is subfertility?

A

Subfertility is the failure of conception in a couple having regular, unprotected coitus for one year

45
Q

What is primary infertility?

A

Primary infertility is when someone who has never conceived a child in the past has difficulty conceiving

46
Q

Identify the 5 main causes of subfertility

A
  • Male factors (30%)
  • Unexplained (25%)
  • Ovulatory disorders (25%)
  • Tubal damage (20%)
  • Uterine or peritoneal disorders (10%)
47
Q

Identify 5 causes of male subfertility which relate to general health/systemic illness

A
  • Hypothalamus/ pituitary dysfunction
  • Hypogonadism
  • Hyperprolactinoemia
  • Hypothyroidism
  • Diabetes
48
Q

Identify 2 genetic causes for male subfertility

A
  • Klinefelter syndrome
  • Y chromosome deletion
49
Q

Identify 4 antispermatogenic agents

A
  • Heat
  • Irradiation
  • Drugs
  • Chemotherapy
50
Q

Identify 2 vascular causes of male subfertility

A
  • Testicular torsion
  • Varicocele
51
Q

Identify 2 coital problems which can lead to male subfertility

A
  • Ejaculatory failure
  • Erectile dysfunction
52
Q

Identify the 3 groups of different ovulatory disorders

A
  • Hypothalamic-pituitary failure (10%)
  • Hypothalamic-pituitary-ovarian dysfunction (85%)
  • Ovarian failure (5%)
53
Q

Identify 2 clinical conditions which result from hypothalamic-pituitary failure

A
  • Hypothalamic amenorrhea
  • Hypogonadotrophic hypogonadism
54
Q

Identify 2 clinical conditions which result from hypothalamic-pituitary-ovarian dysfunction

A
  • Polycystic ovary syndrome
  • Hyperprolactinaemic amenorrhoea
55
Q

Identify 2 clinical conditions which result from ovarian failure

A
  • Premature ovarian failure
  • Primary ovarian insufficiency
56
Q

Identify 3 uterine/peritoneal disorders

A
  • Uterine Fibroids
  • Endometriosis
  • Pelvic Inflammatory Disease
57
Q

Identify 3 events/conditions which could lead to tubal damage

A
  • effects the Fallopian tube and the transport of the ovum
  • Endometriosis
  • Ectopic pregnancy
  • Pelvic surgery
  • Past pelvic infection e.g. Chlamydia
58
Q

what is a long acting reversible contraception

A
  • 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
Q

factors for men causing infertility

A
  • 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
Q

what are some ovulatory disorders to prevent fertility

A
  • 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
Q

what are some investigations you can do to men to test for causes of infertility

A
  • semen analysis: sperm count, motility
  • Hormone Levels: LH, FSH, testosterone
  • Ultrasound scan of testes
  • Exclude sti
  • karyotyping
62
Q

what are some investigations you can do in women to access if ovulation is occurring

A
  • LH, FSH (day 2)
  • progesterone (day 21)
  • androgens
  • systemic blood tests: Prolactin

SA reproductive (22 decks)

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