S5) Contraception and Infertility Flashcards
What is contraception?
Contraception is any method to prevent pregnancy
Describe 3 different means of contraception
- Blocking transport of sperm to avoid fertilisation of oocyte
- Disrupting the HPG axis to interfere with ovulation
- Inhibiting implantation of the conceptus into endometrium
Identify 6 broad methods of contraception
- Natural
- Barrier
- Hormonal Control
- Prevention of implantation
- Sterilisation
- Emergency contraception
Identify 4 forms for natural contraception
- Abstinence
- Withdrawal method
- Fertility Awareness Methods
- Lactational amenorrhoea method
What is abstinence?
Abstinence is the practice of refraining from sex
What are the advantages and disadvantages of abstinence?
- Advantage: 100% reliable
- Disadvantage: no sex
What does fertility awareness involve?
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
Identify 3 different fertility awareness methods
- Cervical secretions (thick)
- Basal body temperatures
- Length of menstrual cycle
Identify the advantages and disadvantages of fertility awareness methods
- Advantages: no hormones/contraindications
- Disadvantages: unreliable, no protection from STI’s
What does the withdrawal method involve?
The withdrawal method involves withdrawing the penis before ejaculation
Identify the advantages and disadvantages of the withdrawal method
- Advantages: no devices/hormones
- Disadvantages: unreliable, some sperm may be released in the pre-ejaculate, no protection from STI’s
What does the lactational amenorrhea method involve?
- Breastfeeding delays the return of ovulation after childbirth
- Suckling stimulus disrupts release of GnRH
- Affects feedback cycle of HPG axis
How long is the lactational amenorrhea method effective for?
Up to 6 months after giving birth
What are the advantages and disadvantages of the lactational amenorrhoea method
- Advantages: no hormones/contraindications
- Disadvantages: unreliable, no STI prevention
Identify 2 forms of barrier contraception
- Male/Female condoms
- Diaphragm/Caps (caps that cover the surface)
What does barrier contraception involve?
- Physical barriers prevent sperm entering the cervix
- Can also used with spermicide (additional chemical barrier)
What are the advantages and disadvantages of barrier contraception?
- Advantages: reliable, protection from STIs, widely available (male condom)
- Disadvantages: disrupt romantic nature, reduce sexual pleasure, can expire, allergy/sensitivity to latex/ spermicide
Identify 4 forms of contraception involving hormonal control
- Combined Oestrogen and Progestogen
- Progesterone Depot
- Progesterone Implant
- Low dose progestogen
Identify 2 long-acting reversible contraceptives (LARC)
- Progesterone Depot
- Progesterone Implant
What is progestogen?
Progestogen is a synthetic form of progesterone
What is the role of progesterone in moderate/high doses?
- Progesterone enhances the negative feedback of natural oestrogen – reducing LH and FSH secretion
- No LH surge means no ovulation
What is the role of progesterone in lower doses?
- Progesterone does not inhibit the LH surge
- Ovulation is still likely
- Cervical mucus thickens
What is the Combined Oral Contraceptive Pill?
COCP is a pill containing combination of synthetic oestrogen and progestogen
What is the principal action of the COCP?
Principal action: prevents ovulation
tricks body into thinking its In the luteal phase
What are the secondary actions of the COCP?
- Reduces endometrial receptivity to inhibit implantation
- Thickens cervical mucus to inhibit penetration of sperm
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
Identify 4 clinical conditions which are at increased risk when on the COCP
- Breast and cervical cancer
- Venous thromboembolism
- MI
- Stroke
What is the principal action of High Dose Progestogen contraception?
Principal action: prevents ovulation
What is the secondary action of High Dose Progestogen contraception?
- Thickens cervical mucus to inhibit penetration of sperm
- Prevents endometrial proliferation
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
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
What is the principal action of Low Dose Progestogen?
- Principal action: thickens cervical mucus
- Ovulation is usually not prevented
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
What is the intrauterine system (IUS)?
- IUS is a progestogen-releasing plastic device
- Works for 3–5 years
What are the principal and secondary actions of the IUS?
- Principal action: prevents implantation and reduces endometrial proliferation
- Secondary action: thickens cervical mucus
What is the intrauterine device (IUD)?
- IUD is a plastic device with added copper
- Works for 5-10 years
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
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
Identify 2 forms of sterilisation
- Vasectomy
- Tubual ligation/clipping
How is a vasectomy performed?
- Vas deferens cut/tied to prevent sperm entering ejaculate
- Performed under local anaesthetic
How is the success of a vasectomy confirmed?
- Post-operative semen analysis to confirm no sperm in ejaculate
- Approx. 12-16 weeks after surgery
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
Identify 3 forms of emergency contraception
- Emergency IUD
- Emergency pill with ulipristal acetate
- Emergency pill with levonorgestrel
What is subfertility?
Subfertility is the failure of conception in a couple having regular, unprotected coitus for one year
What is primary infertility?
Primary infertility is when someone who has never conceived a child in the past has difficulty conceiving
Identify the 5 main causes of subfertility
- Male factors (30%)
- Unexplained (25%)
- Ovulatory disorders (25%)
- Tubal damage (20%)
- Uterine or peritoneal disorders (10%)
Identify 5 causes of male subfertility which relate to general health/systemic illness
- Hypothalamus/ pituitary dysfunction
- Hypogonadism
- Hyperprolactinoemia
- Hypothyroidism
- Diabetes
Identify 2 genetic causes for male subfertility
- Klinefelter syndrome
- Y chromosome deletion
Identify 4 antispermatogenic agents
- Heat
- Irradiation
- Drugs
- Chemotherapy
Identify 2 vascular causes of male subfertility
- Testicular torsion
- Varicocele
Identify 2 coital problems which can lead to male subfertility
- Ejaculatory failure
- Erectile dysfunction
Identify the 3 groups of different ovulatory disorders
- Hypothalamic-pituitary failure (10%)
- Hypothalamic-pituitary-ovarian dysfunction (85%)
- Ovarian failure (5%)
Identify 2 clinical conditions which result from hypothalamic-pituitary failure
- Hypothalamic amenorrhea
- Hypogonadotrophic hypogonadism
Identify 2 clinical conditions which result from hypothalamic-pituitary-ovarian dysfunction
- Polycystic ovary syndrome
- Hyperprolactinaemic amenorrhoea
Identify 2 clinical conditions which result from ovarian failure
- Premature ovarian failure
- Primary ovarian insufficiency
Identify 3 uterine/peritoneal disorders
- Uterine Fibroids
- Endometriosis
- Pelvic Inflammatory Disease
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
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
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
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
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
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
