15) Contraception and Infertility

Question 1

What are some examples of natural contraceptive methods?

Answer 1

Fertility awareness method, lactational amenorrhoea

Question 2

How does the fertility awareness method work?

Answer 2

Use of fertility indicators to identify fertile points in the cycle e.g. body temp

Question 3

What are the advantages of natural contraceptive methods?

Answer 3

No hormones or contraindications

Question 4

What are the disadvantages of natural contraceptive methods?

Answer 4

Not as effective, unreliable

Question 5

How does breastfeeding affect ovulation?

Answer 5

Delays return of ovulation after childbirth (6 months)

Question 6

What are some examples of barrier contraception?

Answer 6

Male/female condoms, female diaphragm

Question 7

What are the advantages of barrier contraception?

Answer 7

Prevent STIs, inserted anytime before intercourse

Question 8

What are the disadvantages of barrier contraception?

Answer 8

Sensitivity to latex
Female condoms not widely available
Spermicide can cause local reaction

Question 9

What contraceptive methods work by preventing ovulation?

Answer 9

COCP, progesterone depot, progesterone implant

Question 10

What are the advantages of the COCP?

Answer 10

Relieves menstrual disorders and reduces risk of ovarian cysts and cancer

Question 11

What are the disadvantages of the COCP?

Answer 11

User dependent
Side effects (mood and breast tenderness)
Increased of thromboembolism and MI

Question 12

How is the COCP administered?

Answer 12

Taken for 21 days and then a 7 day break

Question 13

How is the progesterone depot administered?

Answer 13

Subcutaneous/IM injection, lasts 8-13 weeks

Question 14

What are the advantages of the progesterone depot?

Answer 14

Convenient, relieves menstrual disorders

Question 15

What are the disadvantages of the progesterone depot?

Answer 15

Altered and irregular bleeding
Delayed return to fertility
Small loss of bone mineral density

Question 16

How is the progesterone implant administered?

Answer 16

Flexible rod below skin in upper arm, 3 years of protection

Question 17

What are the advantages of the progesterone implant?

Answer 17

Long duration, relieves menstrual disorders

Question 18

What are the disadvantages of the progesterone implant?

Answer 18

Small procedure
Local adverse effects
Changes in bleeding pattern

Question 19

What is an example of contraceptive that inhibits sperm transport? What is its action?

Answer 19

Progesterone only pill

Thickens cervical mucus

Question 20

How does the intrauterine system work?

Answer 20

Using progestogen, reduces endometrial proliferation and prevents implantation, also thickens cervical mucus

Question 21

What are the advantages of the intrauterine system and device?

Answer 21

Convenient, long duration and relieve menstrual disorders

Device can be emergency contracpetion

Question 22

What are the disadvantages of the intrauterine system?

Answer 22

Insertion unpleasant
IUS displacement
Menstrual irregularity in first 6 months
Risk of uterine perforation

Question 23

How does the intrauterine device work?

Answer 23

Copper toxic to sperm and ovum so no fertilisation. Also copper causes endometrial inflammation to prevent implantation

Question 24

What are the disadvantages of the intrauterine device?

Answer 24

Insertion unpleasant
IUD displacement
Heavy peirods
Risk of uterine perforation

Question 25

What is a vasectomy?

Answer 25

Vas deferens interrupted to prevent sperm entering ejaculate

Question 26

What is tubal ligation?

Answer 26

Fallopian tubes cut or blocked to stop ovum travelling from ovary to uterus

Question 27

Define infertility:

Answer 27

Failure of conception in a couple having regular, unprotected coitus (2+ per week) for one year

Question 28

What examinations may be performed to investigate infertility?

Answer 28

``` BMI Secondary sexual characteristics Galactorrhoea Pelvic examinations Testicular size and descent ```

Question 29

What are some of the causes of infertility? (general)

Answer 29

``` Male factors Ovulatory disorders Tubal damage Uterine or peritoneal disease Other factors (unexplained) ```

Question 30

What are some male factors causing infertility?

Answer 30

Idiopathic oligospermia Varicocele Abnormal sperm production Hypothalamic-pituitary dysfunction

Question 31

What are some ovulatory disorders causing infertility?

Answer 31

``` Hypothalamic-pituitary failure Polycystic ovary syndrome Congenital adrenal hyperplasia Adrenal tumours Turner's ```

Question 32

What are the 3 core signs of polycystic ovary syndrome?

Answer 32

Polycystic ovaries Anovulation Hyperandrogenism - hirsutism (facial hair)

Question 33

What can cause tubal damage leading to infertility?

Answer 33

Past pelvic infection e.g. chlamydia Previous pregnancy or pelvic surgery Developmental anomaly Endometriosis

Question 34

What uterine and peritoneal disease can cause infertility?

Answer 34

Endometriosis Uterine fibroids Cervical stenosis or hostility (acidic)

Question 35

What is endometriosis?

Answer 35

Presence of endometrial tissue in sites other than uterine cavity

Question 36

What are some signs of endometriosis?

Answer 36

Dysmenorrhoea, dyspareunia, chronic pelvic pain, infertility

Question 37

How is endometriosis diagnosed?

Answer 37

Laparoscopy

Question 38

What is the management of endometriosis?

Answer 38

Anti-inflamms and pill to regulate periods

Question 39

What investigations can be performed in female infertility?

Answer 39

LH and FSH (day 2) Progesterone (day 21) Pelvic USS Tubal patency by hysterosalpography

Question 40

What investigations can be performed in male infertility?

Answer 40

Sperm analysis Antisperm antibodies USS FSH, LH and testosterone

Question 41

What treatment is there for inducing ovulation?

Answer 41

Clomefine citrate - increases GnRH GnRH agonists Changes to weight e.g. if anorexic

Question 42

What treatment is there for tubal occlusion?

Answer 42

Surgery | Assisted conception

Question 43

What are some treatments for male infertility?

Answer 43

Artificial insemination Intracytoplasmic sperm injection GnRH agonists or dopamine agonists