S5) Contraception and Infertility Flashcards
1
Q
What is contraception?
A
Contraception is any method to prevent pregnancy
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
3
Q
Identify 6 broad methods of contraception
A
- Natural
- Barrier
- Hormonal Control
- Prevention of implantation
- Sterilisation
- Emergency contraception
4
Q
Identify 4 forms for natural contraception
A
- Abstinence
- Withdrawal method
- Fertility Awareness Methods
- Lactational amenorrhoea method
5
Q
What is abstinence?
A
Abstinence is the practice of refraining from sex
6
Q
What are the advantages and disadvantages of abstinence?
A
- Advantage: 100% reliable
- Disadvantage: no sex
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
8
Q
Identify 3 different fertility awareness methods
A
- Cervical secretions
- Basal body temperatures
- Length of menstrual cycle
9
Q
Identify the advantages and disadvantages of fertility awareness methods
A
- Advantages: no hormones/contraindications
- Disadvantages: unreliable, no protection from STI’s
10
Q
What does the withdrawal method involve?
A
The withdrawal method involves withdrawing the penis before ejaculation
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
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
13
Q
How long is the lactational amenorrhea method effective for?
A
Up to 6 months after giving birth
14
Q
What are the advantages and disadvantages of the lactational amenorrhoea method
A
- Advantages: no hormones/contraindications
- Disadvantages: unreliable, no STI prevention
15
Q
Identify 2 forms of barrier contraception
A
- Male/Female condoms
- Diaphragm/Caps
16
Q
What does barrier contraception involve?
A
- Physical barriers prevent sperm entering the cervix
- Can also used with spermicide (additional chemical barrier)
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
18
Q
Identify 4 forms of contraception involving hormonal control
A
- Combined Oestrogen and Progestogen
- Progesterone Depot
- Progesterone Implant
- Low dose progestogen
19
Q
Identify 2 long-acting reversible contraceptives (LARC)
A
- Progesterone Depot
- Progesterone Implant
20
Q
What is progestogen?
A
Progestogen is a synthetic form of progesterone
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
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
23
Q
What is the Combined Oral Contraceptive Pill?
A
COCP is a pill containing combination of synthetic oestrogen and progestogen
24
Q
What is the principal action of the COCP?
A
Principal action: prevents ovulation
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
- Endometriosis
- Ectopic pregnancy
- Pelvic surgery
- Past pelvic infection *e.g. Chlamydia*
