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
Identify 3 different fertility awareness methods
- Cervical secretions
- 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
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
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
- Endometriosis
- Ectopic pregnancy
- Pelvic surgery
- Past pelvic infection e.g. Chlamydia
