Session 7 : Reproduction

Question 1

What are the main mechanisms of contraception ?

Answer 1

Natural 
Barrier 
Preventing ovulation 
Liming the mobility of sperm transport 
Inhibitors of implantation 
Sterilisation

Question 2

What are the differing effects of progesterone under high and low levels?

Answer 2

In high levels it will :
Facilitate the negative feedback action of oestrogen to
-> decrease ovulation as it prevents the LH surge
-> mid-follicular phase it will prevent the secretion of FSH & LH

In low levels it will :
Act to Alter the cervical mucus making it more sticky and less conducive to sperm transport.

Question 3

What is lactational amennohrea?

Answer 3

This last for 6mnths post giving birth (if baby only breastfed) the suckling will limit the pulsatile GnRH secretions and also LH surge to prevent ovulation as well as the maturation of the ova.

Question 4

In natural contraception what markers are used to determine when a female is infertile?

Answer 4

Nature of cervical secretions
Basal body temperature (this will increase with progesterone)
Length of menstrual cycle

Question 5

What problems are associated with barrier contraception?

Answer 5

There can be reactions to spermicide (present in the female diaphragm) or to the latex.

Question 6

What is the COCP and how is it administered?

Answer 6

This is a combined pill of oestrogen and progesterone
It is a pill for 21 days with a 7 day break (sometimes a dummy pill is given instead)
Ideally taken at same time of day

Question 7

What are the principal actions of the contraceptive mechanism which prevent ovulation ?

Answer 7

Prevention of the LH surge
(ALSO effect the cervical mucus making it more sticky & also limit the proliferation of the endometrium and limits implantation)

Question 8

Which contraceptive mechanisms are preventing ovulation?

Answer 8

COCP
Progesterone depot
Progesterone implant

Question 9

What are the side effects & contraindications of the COCP?

Answer 9

Venous thromboebolism. Risk of TIA, Stroke, MI etc.
It can also cause problems with the liver and increase the likelihood of some cancers (breast)
(This is as the COCP is a pro-thrombotic- should not be given to ppl who have blood disorders, smokers & who are predisposed to clots)

Question 10

What are the benefits of COCP?

Answer 10

Benefits include : reduction of the risk of endometrial, ovarian cancer and cysts
Helps to relieve certain menstrual disorders including : pms, endometriosis, heavy bleeding (menorhagia)

Question 11

What is the progesterone depot?

Answer 11

This is a synthetic from of progesterone called progestogen which is injected SC/IM which releases progesterone for up to 8-13 weeks.

Question 12

What is the progesterone implant ?

Answer 12

This is a 4cm rod inserted subdermally in the upper arm surgically which lasts for up to 3 years.

Question 13

What are the main side effects of the progesterone depot?

Answer 13

Effect on bone density and fracture risk
It can cause altered bleeding
It can limit fertility for up to a year after it has been first used.

Question 14

How does progesterone help regulate menstural problems? ??

Answer 14

It can limit endometrial proliferation.

It can act to reset the cycle (hormonally) so that these conditions can be managed better.

Question 15

What are the side effects of the prgesterone implant ?

Answer 15

Thy can be sometimes displace to other areas, there can be local adverse reactions (redness, itching).
It can alter bleeding patterns
Sometimes can trigger severe allergic reactions.

Question 16

What are the general side effects of progesterone & oestrogen?

Answer 16

Nausea 
Bloating 
Breast tenderness 
Anxiety 
Depression 
Breakthrough bleeding 
Clots 
Mood disturbance

Question 17

What is the POP and how does it work?

Answer 17

This is the progesterone only pill, it will work to have an effect on the cervical mucus, thickening it to prevent the mobility of sperm.

Question 18

When is POP commonly given?

Answer 18

It is often given when there is a contraindication to COCP.

Question 19

What are the main side effects of the POP?

Answer 19

The pill must be taken daily at the same time (+/-) 3 hours to be effective.
Note :This pill does not inhibit ovulation

Question 20

What is an IUD?

Answer 20

This is a copper containing intreruterine device
This lasts for 5-10 years
Copper is toxic to the sperm and ovum
(It also effects the cervical mucus as well as causing endometrial inflammation which is not hospitable to implantation)

Question 21

What is the IUS?

Answer 21

This is an interuterine device which has progesterone.
This acts for 3-5years
It’s main action is to limit endometrial proliferation& prevent implantation
(Effects cervical mucus but has little to/ no effect on limiting ovulation)

Question 22

What are the side effects associated with the IUD?

Answer 22

There is an increased risk of PID,
heavier, more painful and longer lasting periods
Cramps and back pain

Question 23

What are the side effects associated with the IUS?

Answer 23

Menstural irregularities

Coil can become displaced.

Question 24

What are the advantages of interuterine devices?

Answer 24

Convenient & have a long duration of action.

Also the IUD can be used as an emergency form of contraception up to 5 days post coitus.

Question 25

How is sterilisation performed in men and what are the failure rates?

Answer 25

Failure rate : 1/1000
Vas deferens is ligated to prevent sperm entering into the ejaculate this is done under local anaesthetic
16-18 weeks later ejactulate must be checked to ensure there is no sperm.

Question 26

How is sterilisation performed in women and what are the failure rates?

Answer 26

Failure rate: 2-5/1000
Fallopian tubes clipped or blocked under local or general anaesthetic (generally more invasive) to prevent ova reaching the uterus.
Hysterectomy can also be performed (mennorhagia/ cancer)