12 Contraception and Infertility

Question 1

What are the 6 categories which we can divide contraception into?

Answer 1

• Natural
• Hormonal
• Barrier
• Prevention of implantation
• Sterilisation
• Emergency contraception

Question 2

Explain how the lactational amenorrhea method works as contraception.

Answer 2

Breast feeding delays return of ovulation

Suckling stimulus- effect of prolactin

Only effective up to 6 months

Must be exclusively breast feeding

Must be amenorrhoeic

Question 3

How effective are barrier methods (if used correctly) of contraception?

Male/Female condoms/ Diaphragm/ Caps (+ spermicide)

Answer 3

98%

Also protect against STIs

Question 4

Differentiate between the effects of progesterone given at high and low doses.

Answer 4

• Moderate/High
  
  • Progesterone enhances negative feedback of natural oestrogen
  • No LH surge, no ovulation
• Lower
  
  • Thicken cervical mucus
  • Ovulation still likely

Question 5

How does the combined oral contraceptive pill work? (98% effective if used correctly)

Answer 5

1. Primary
   
   1. PREVENTS OVULATION
2. Secondary
   
   1. Reduce endometrial receptivity to inhibit implanatation
   2. Thicken cervial mucous

Question 6

What does the COCP increase your risk of? What does it decrease your risk of?

Answer 6

Increase risk: breast and cervical cancer, vein thromboembolism, MI/stroke

Decreased risk: ovarian/endometrial cancer

Question 7

How does the progesterone injection work? What are the advantages and distadvantages?

Answer 7

• Prevents ovulation
• Thickens cervical mucus
• Prevents endometrial proliferation

Question 8

Why does the progesterone implant not always stop ovulation?

Answer 8

Hormone level can fluctuate- esp towards end of 3 years

Question 9

Patients who have the progesterone implant will fall into 3 categories broadly on the effects the implant will have on them. What are these categories?

Answer 9

1. Amennorhoea
2. Bleed all the time
3. Irregular periods

Question 10

What are the advantages and disadvantages of low dose progesterone pill?

Answer 10

Question 11

Differentiate between 2 types of coils.

(Action, how long it lasts)

Answer 11

Question 12

What are the advantages and disadvantages of the coil.

Answer 12

Question 13

Outline the methods of sterilisation in males and females as well as their failure rates.

Answer 13

Question 14

What are the options for emergency contraception?

Answer 14

Question 15

Define subfertility.

Answer 15

Failure of conception in a couple having regular, unprotected sex for one year (2-3 times per week)

Question 16

What is the difference between primary an secondary infertility?

Answer 16

Question 17

What are the main causes of subfertility? (general)

Answer 17

Question 18

Male causes of infertility can be categorised as pre-testicular, testicular or post testicular. Give examples of causes in each of these categories:

Answer 18

Question 19

What investigations would a GP carry out into infertility for a male?

Answer 19

Question 20

What management and investigations would a GP carry out into infertility for a female?

Answer 20

Question 21

What is a hysterosalpinogram?

Answer 21

Question 22

What are the 3 main types of fertility treatment offered?

(Everybody entitled to investigations into infertility on the NHS BUT not necessarily treatment)

Answer 22

Question 23

Which hormone provides eveidence that ovulation has occured? When should it be measured?

Answer 23

Progesterone: 7 days before 1st period

Question 24

During which phase of the ovarian cycle does body temperature rise?

Answer 24

Luteal