Week 7.1 - Contraception and infertility

Question 1

How does barrier contraception work?

Answer 1

-Prevents sperm reaching cervix

Question 2

How does a diaphragm work?

Answer 2

-Inserted across the cervix to hold the sperm in the acidic environment to reduce survival

Question 3

Name 4 hormonal contraceptions which prevent ovulation

Answer 3

• Combined OCP
• Depot progesterone
• POP (may inhibit ovulation)
• Progesterone implant (may inhibit ovulation)

Question 4

How does the combined OCP inhibit ovulation?

Answer 4

• Negative feedback of oestrogen and progesterone inhibits follicular development
• loss of +ve feedback of oestrogen -> no LH surge

Question 5

How often are depot injections?

Answer 5

-Every 3 months

Question 6

How does depot progesterone inhibit ovuation?

Answer 6

-Negative feedback of progesterone inhibits ovulation by preventing follicular development and LH surge

Question 7

Which contraceptions have producing a thick cervical mucus as there main method of action?

Answer 7

• POP

- Progesterone implant

Question 8

How does producing thick cervical mucus act as a contraception?

Answer 8

-Prevents passage of sperm into cervix

Question 9

Which hormonal contraceptions act by altering receptivity of endometrium for implantation?

Answer 9

• Emergency contraceptive pill

- Intrauterine devices

Question 10

How long after coitus does the emergency contraception work?

Answer 10

-upto 72 hours

Question 11

How do intrauterine devices work?

Answer 11

-Make endometrium hostile by interfering with endometrial enzymes

Question 12

Name 3 methods of surgical contraception

Answer 12

• Ligation
• Clips
• Rings

Question 13

What is the emergency contraceptive pill?

Answer 13

-High dose of combined OCP

Question 14

Define infertility

Answer 14

-Failure to conceive within 1 year of trying

Question 15

How common is infertility?

Answer 15

-Affects ~ 15% of couples

Question 16

What % of infertility is due to male/female problems?

Answer 16

• 20-25% male
• 45-60% female
• 20-30% unexplained

Question 17

Give 5 causes of infertility

Answer 17

• Coital problems
• Anovulation
• PCOS
• Tubal occlusion
• Abnormal/Absent sperm

Question 18

When is anovulation normal?

Answer 18

-Occasional, especially at extremes of age

Question 19

List some causes of anovulation

Answer 19

• Ovarian failure
• Chemo/radiotherapy
• Pituitary tumour
• Weight loss
• Stress
• Exercise
• Hyperprolactinaemia

Question 20

What is PCOS?

Answer 20

-Elevated androgen secretion from theca cells of unknown pathogenesis producing the PCOS phenotype of excessive hair, amenorrhea/menorrhagia, anovulation, cystic ovaries and insulin resistance

Question 21

Give 3 causes of tubal occlusion

Answer 21

• Scarring from infection
• Endometriosis
• Sterilisation

Question 22

How is tubal occlusion diagnosed?

Answer 22

-Hysterosalpingogram

Question 23

Give 3 causes of absent/abnormal sperm

Answer 23

• Testicular disease
• Infection
• Obstruction of ductus deferens
• Hypothal/pituitary dysfunction

Question 24

How is anovulation diagnosed?

Answer 24

• Serum progesterone in middle of luteal phase (~day 21)

- Differentiate between causes by looking at hormone levels

Question 25

Give the hormone profile of a women in menopause

Answer 25

• High LH/FSH

- Low oestrogen

Question 26

Give the hormone profile of a women in ovarian failure

Answer 26

• High LH/FSH

- Low oestrogen

Question 27

Give the hormone profile of a women with hypothalamic failure

Answer 27

-Low FSH/LS/oestrogen

Question 28

Give 2 methods of inducing ovulation and state how they work

Answer 28

• Anti-oestrogen -> reduced -ve feedback to hypothal/pit -> increased GnRH/LH/FSH eg aromatase inhibitor
• Gonadotropins -> stimulates FSH/LH

Question 29

Name 3 methods of barrier contraception

Answer 29

• Condoms
• Diaphragm
• Cap