WH Fertility

Question 1

Track menstrual cycle pattern and calculate ovulation date (14 days before menses), anticipate some variability and consider the fertile window to be 11-18 days before the next expected menses

Answer 1

Calendar rhythm

Question 2

another rhythm method using a ring of beads to track the days, must have regular cycles no more than 32 days in length, fertile days are marked with white beads

Answer 2

Standard days “cycle beads”

Question 3

using a special thermometer, women monitor their resting (waking) temperature everyday on a chart, there should be a small drop and then rise in temperature with ovulation, this method can be greatly affected by external factors and takes many months to interpret charts.

Answer 3

Basal body temperature (BBT)

Question 4

hormone changes during the menstrual cycle greatly affect cervical mucous in the vagina, making it remarkably slippery and stretchy following ovulation (this may help in the transport of sperm), this change is called “spinnbarkeit”, women evaluate the mucous at the introitus (opening) of the vagina daily and record the changes

Answer 4

Cervical mucous

Question 5

vaginal secretions almost disappear following the fertile window, so the absence of secretions for 2 days should indicate that the fertile phase has passed

Answer 5

2- day method

Question 6

Mumps (as an adult)
Endocrine disorders
Genetic disorders
Reproductive disorders
Substance abuse
Environmental exposure to hazardous substances or excessive heat to scrotum

Answer 6

Male Risk Factors for Infertility

Question 7

Age: reduced fertility after age 35
Endocrine disorder: symptom may include irregular or absent menses, atypical body hair distribution and body fat distribution.
Prior pelvic, uterine or tubal surgery with resultant scarring or occlusion
Prior miscarriages (3 or more)
Prior uterine or tubal infections
Uterine malformations
Prior STI (sexually transmitted infections) particularly chlamydia and gonorrhea
Environmental exposure to hazardous materials
Morbid obesity or underweight status
Substance abuse

Answer 7

Female Risk Factors for Infertility

Question 8

Men: semen analysis, ultrasound, genetics
Women: pelvic exam, ultrasound, hormone analysis, post-coital mucous test, hysterosalpingogram (HSG), hysteroscopy, laparoscopy, genetics
Couples are usually referred to fertility centers for complex workups and treatment
Genetic testing is often done after referral to a genetic counselor.

Answer 8

Fertility testing and treatment

Question 9

Refraining from sexual intercourse (intercourse or coitus involves insertion of the penis into the vagina)

Answer 9

Abstinence

Question 10

removing the penis prior to ejaculation

Answer 10

Withdrawal “coitus interruptus”

Question 11

scheduled intercourse using guidance from calendar, cycle beads, basal body temp, cervical mucous

Answer 11

Natural Family Planning/ Fertility Awareness

Question 12

male & female condom, contraceptive diaphragm, cervical cap, contraceptive sponge

Answer 12

Barrier methods

Question 13

kills sperm, placed into vagina prior to coitus, also used with barriers

Answer 13

Spermicide

Question 14

estrogen & progesterone combination as a pill, ring, or patch; progesterone only as a pill, injection, subdermal implant, or embedded in an IUD

Answer 14

Hormonal Birth Control Methods

Question 15

tubal ligation, vasectomy, trans cervical (hysteroscopic) sterilization (tubal occlusion)

Answer 15

Sterilization

Question 16

apply on the erect penis, leave space at the tip for ejaculate, remove penis from vagina with it still on to prevent spillage, helps reduce STI exposure

Answer 16

Male condoms

Question 17

insert closed end into vagina prior to intercourse, let the open end cover the labia, helps reduce STI exposure

Answer 17

Female condoms

Question 18

silicone cup that fits over the cervix, used with spermicide, place up to 6 hours before coitus, important to LEAVE IN PLACE for 6 hours after coitus (up to 24 h), now available OTC (no fitting required – tell ATI), wash with soap & water between uses, does not protect against STIs, does not fit everyone, may increase frequency of UTIs & toxic shock syndrome

Answer 18

Diaphragm

Question 19

same use as diaphragm, smaller and fits more snugly against the cervix, not for use with cervical / pap smear abnormalities

Answer 19

Cervical Cap

Question 20

fits against cervix, wet with water and squeeze to fully moisten, insert before coitus and leave in place for 6 hours after, leave in place with repeat coitus, does not protect against STIs

Answer 20

Contraceptive sponge

Question 21

apply 15 min before coitus, only effective for 1 hour, reapply with each act, available OTC. comes as film, foam, cream, gel, suppository
does not protect against STIs

Answer 21

Spermicide Considerations

Question 22

also called transcervical sterilization. Small flexible coils are placed via the vagina, cervix and uterus into the fallopian tubes. The body responds by creating permanent scar tissue over these coils which then blocks (occludes) the tube. The scarring process takes several months.
The woman must return for testing 3 months after the procedure to be sure that the tube is completely blocked. Very effective with proven blockage. Failures in preventing pregnancy have high risk of ectopic pregnancy. Tubal perforation and chronic pain are known risks.

Answer 22

Tubal Occlusion

Question 23

“tying the tubes” is a permanent surgical procedure to tie, cut and cauterize (burn) the ends of the fallopian tubes so that ova cannot become fertilized. Surgery can be done postpartum through the umbilicus, at the time of cesarean section, or laparoscopically through the abdomen. Reduces risk of ovarian cancer by 50% and some recommend removal of the entire tube. The ovaries and uterus remain unaffected so menstrual cycles are unchanged. Risks are related to surgery and possible regret. Failure leading to pregnancies following BTL have increased risk of being ectopic.

Answer 23

Bilateral tubal ligation

Question 24

a surgical outpatient procedure to tie and cut the vas deferens to block the passage of sperm into ejaculate. Men should be tested after 20 ejaculates to prove no more sperm can be detected. Reversal can be attempted but is complicated and expensive. Sperm can be banked for potential future use. Sexual function is not impaired. Risks are surgical.

Answer 24

Vasectomy

Question 25

Oral “Morning after pill” prevents fertilization by inhibiting ovulation and the transport of sperm
Must be taken within 72 hours of coitus (and don’t have unprotected sex again)
Can be nauseating / may need anti emetic medication
Contraindicated if already pregnant!
Copper IUD can also be used as this if placed within 5 days of coitus

Answer 25

Emergency contraception

Question 26

Both provide continuous release of estrogen and progesterone, inhibit ovulation and thicken cervical mucous and have the same risks and benefits as COCs

Answer 26

Ring and Patch

Question 27

insert vaginally and leave in place for 3 weeks, then remove for 1 week (menstrual week)

Answer 27

Contraceptive Ring

Question 28

apply to arm, back, abdomen or torso (not on breast), replace weekly x 3, then take one week off (menstrual week)

Answer 28

Contraceptive Patch

Question 29

The ability to achieve pregnancy. It requires the effective female systems of HPO axis (hypothalamic-pituitary-ovarian axis) for hormonal regulation, ovaries, fallopian tubes, uterus and vagina and the male systems coordinating ejaculation and adequate sperm morphology & motility.

Answer 29

Fertility

Question 30

The onset of menstrual cycles. Average age is 13.8 years but ranges widely.

Answer 30

Menarche

Question 31

Cessation of menstrual cycle

Answer 31

Menopause

Question 32

Failure to achieve pregnancy after 12 months of trying may be normal but is termed this because it is an appropriate time to begin analysis of potential fertility problems.
Can arise from hormonal, structural or unexp;ained causes. 40% is male factor related to abnormal semen analysis

Answer 32

Infertility

Question 33

Increase risk of multiples. Considered high risk even if singleton. Includes ovarian stimulation meds, intrauterine insemination, IVR, surrogate mother, donor insemination

Answer 33

Fertility treatments

Question 34

Meds that trigger follicle production

Answer 34

Ovarian stimulation

Question 35

Sperm are collected and transferred into the uterus at ovulation. Gamete intrafallopian transfer. Retrieval of ova and sperm which are then replaced together into fallopian tube.

Answer 35

Intrauterine insemination

Question 36

a strategy or device used to reduce the risk of fertilization or implantation in an attempt to prevent pregnancy. No method will disrupt an established pregnancy. Choices should involve the desires of the sexual partners, their priorities and ethical concerns, their health, and tolerance for the use, effectiveness and risks of each method

Answer 36

Contraception

Question 37

contain estrogen and progestin which act to suppress ovulation, thicken the cervical mucous, and alter the uterine decidua to prevent implantation; traditional use results in controlled vaginal bleeding monthly (usually very light) during the placebo week, frequently now women will take a placebo week every 3 or 6 months;
benefits are improved menses and dysmenorrhea, protection against endometrial and ovarian cancer, cyclic acne and mood disorders
Risks include increased risk of thromboembolism, stroke, HTN, gallbladder disease, liver tumor
use with extreme caution with breast cancer (or history of), bariatric surgery, lupus, liver tumors, severe cirrhosis
Effectiveness may be reduced with anticonvulsant or antibiotic medications

Answer 37

Combined Oral Contraceptives (COCs)

Question 38

“minipill” are similar to COCs but without estrogen they are less effective at suppressing ovulation, and they do not regulate vaginal bleeding (often there is irregular light bleeding instead of cyclic bleeding), safer to use while breastfeeding and with estrogen related risks (thrombosis)
use with extreme caution with breast cancer (or history of), bariatric surgery, lupus, liver tumors, severe cirrhosis
Effectiveness may be reduced with anticonvulsant or antibiotic medications

Answer 38

Progestin only pills (POPs)

Question 39

Take pills everyday, minipills must be taken at the same time of day everyday
If a pill is missed, take it as soon as you realize (OK to double up) and use backup method for 1 week Irregular bleeding is common – do not change the pill pattern because of the bleeding
Nausea is common, especially when first starting Breast tenderness is also common when first starting
Danger signs include sx of PE or DVT (leg edema, calf pain, SOB, chest pain, headache, visual changes)
Estrogen containing pills can contribute to HTN. Typically women return to have their BP assessed after 2-3 months on OCPs

Answer 39

Teaching for Birth Control Pills

Question 40

“The shot” IM injection given every 12 weeks, no breaks or menstrual weeks, very effective, multiple adverse side effects: irregular bleeding or spotting is common, can inhibit calcium absorption into bone, can cause weight gain and worsen depression

Answer 40

Medroxyprogesterone injection

Question 41

a small rod containing progestin which is implanted under the skin on the inner upper arm, lasts for 3 years and can be replaced at that time, adverse effects include irregular bleeding and spotting, mood changes, weight gain, usually results in small scarring at insertion site, infection can occur following insertion (rare)

Answer 41

Nexplanon

Question 42

flexible T shaped device which is inserted through the cervix during an examination and placed into the uterus, procedure is quick but crampy, often clients are given premedication to soften the cervix and relieve discomfort, testing for STIs and a pap smear are performed prior to or with insertion, pregnancy must be ruled out before placement
Depending on the choice, lasts from 3 – 10 years and can be removed at any time Immediately effective, immediate return to fertility once removed

Answer 42

Intrauterine device

Question 43

no hormones, lasts 10 years, menses continue on spontaneous cycle but may get heavier and crampier, women should check the strings monthly, increases risk of PID and ectopic pregnancy

Answer 43

Copper T IUD

Question 44

last 3-7 years, usually causes lightning of menses or amenorrhea (yay!), protects against PID (tell ATI)

Answer 44

Progesterone containing IUDs