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Gynaecology > Fertility and Contraception > Flashcards

Fertility and Contraception Flashcards

1
Q

Define Subfertile? How many couples are affected?

A

If conception hasn’t occurred after a year of regular unprotected intercourse

15 %

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2
Q

What is primary and secondary infertility?

A

Primary - female partner has never conceived

Secondary - previously conceived, even if ended in miscarriage or termination

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3
Q

What 4 conditions must be met for fertilisation?

A

Egg must be produced - anovulation (30%)

Adequate sperm must be released - male factor (25%)

Sperm must reach egg - fallopian tube damage (25%), sexual and cervical problems (5% each)

Fertilized embryo must implant (30%)

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4
Q

Counselling needs for couples that are dealing with subfertility?

A

responsible

guilty about past terminations or STIs

Feel disempowered and less ‘male’

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5
Q

What some symptoms that women experience around ovulation?

A

vaginal spotting

increase in vaginal discharge

pelvic pain (mittelschmertz)

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6
Q

What are some indications on examination that a women is ovulating?

A

cervical mucus is normally acellular and will fern and form spinbarkeit (elastic-like strings) of up to 15cm

temp normally drops preovulation and rises in luteal phase

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7
Q

What are the forms of ovulation detection?

A

21 day mid-luteal phase serum progesterone

Ultrasound follicular tracking (time-consuming)

Temperature charts (not recommended)

Luteinizing hormone -based urine predictor kit

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8
Q

What are some causes of anovulation?

A

PCOS

hypothalamic hypogonadism

hyperprolactinaemia

Thyroid disease

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9
Q

What lifestyle changes could treat anovulation?

A

restoration of normal weight

stop smoking

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10
Q

If lifestyle measures don’t work, what else can be done to fix anovulation caused by PCOS?

A

clomifene

metformin

gonadotrophins (FSH + LH)

ovarian diathermy

IVF

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11
Q

If lifestyle measures don’t work, what else can be done to fix anovulation caused by hypothalamic hypogonadism?

A

gonadotrophins if weight normal

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12
Q

If lifestyle measures don’t work, what else can be done to fix anovulation caused by hyperprolactinaemia?

A

bromocriptine

cabergoline

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13
Q

What are side effects of ovulation induction?

A

multiple pregnancy

ovarian hyperstimulation syndrome

ovarian and breast carcinoma

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14
Q

Where is sperm produced? And which hormones regulate this?

A

Sertoli cells

FSH and testosterone

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15
Q

Where is testosterone produced? what hormone regulates this?

A

Leydig cells

LH

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16
Q

What are conditions for a male sperm sample?

A

masturbation

last ejaculation 2-7 days ago

sample analysed 1-2 hrs after production

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17
Q

What is next step after an abnormal sperm count?

A

repeated after 12 weeks

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18
Q

What is normal sperm volume? sperm count? progressive motility?

A

> 1.5ml

> 15 million/mL

> 32%

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19
Q

What is azoospermia,oligospermia, severe oligospermia, athenospermia?

A

Azoospermia : no sperm present

Oligospermia : <15 million/mL

Severe Oligospermia : <5 million/mL

Asthenospermia : absent/low motility

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20
Q

What causes common abnormal/absent sperm release?

A

unknown

smoking

alcohol

anabolic steroids

solvents

varicocoele

antisperm antibodies

infections

Klinefelter’s

absence of vas

Kallmann’s

retrograde ejaculation

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21
Q

What lifestyle changes can improve male fertility?

A

smoking

drug exposure

testicles below body temp : loose clothing an testicular cooling

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22
Q

What investigations can be done to detect tubal damage?

A

laparoscopy and dye test

hysterosalpingogram (HSG)

HyCoSY - transvaginal USS and ultrasound opaque liquid

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23
Q

What are indications for assisted conception?

A

when any/all methods have failed

unexplained subfertility

male factor subfertility

tubal blockage

endometriosis

genetic disorders

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24
Q

What are the methods of assisted conception?

A

Intrauterine insemination

In vitro fertilization

25
Q

Success rate for IVF?

A

35% per cycle <36

10% per cycle <40

26
Q

How is ovarian reserve assessed?

A

FSH

antimullerian hormone

USS

27
Q

What are the stages of IVF?

A

multiple follicular development

ovulation and egg collection

fertilization and culture

embryo transfer

28
Q

What is the mandatory amount of cleavage embryos allowed to be transferred in IVF?

A

no more than two in women <40 years old

29
Q

What staged eggs are transferred in IVFs?

A

cleavage (day 2-3)

blastocyst (5- 6)

blastocyst have higher implantation rates

30
Q

When is intracytoplasmic sperm injection useful?

A

male factor infertility when motility is the issue

31
Q

What is PGD? What is its use?

A

preimplantation genetic diagnosis

couples who are carriers of single-gene defects (CF)

32
Q

Problems with assisted conception?

A

superovulation : multiple pregnancy, ovarian hyperstimulation

egg collection : haemorrhage and pelvic infection

pregnancy complications : ectopic, perinatal mortality,

33
Q

What are some forms of barrier contraception?

A

condoms, female condoms, diaphragms and caps

34
Q

What does the combined oral contraceptive pill work?

A

oestrogen and progesterone

negative feedback on gonadotrophin release that

i) inhibits ovulation
ii) thins endometrium
iii) thicken cervical mucus

35
Q

What are the instructions for taking the COCP?

A

Taken EVERY DAY for 3 weeks and then stopped for 1 week

Pill can be taken back-to-back

36
Q

What are the advantages and disadvantages to taking the COCP back to back?

A

reduces the frequency of withdrawal bleed

increases irregular spotting

37
Q

What are the indications for the COCP?

A

until age 50

menstrual cycle control

menorrhagia

PMS

dysmenorrhoea

acne/hirsutism

*stop 4 weeks before a major surgery (prothrombotic)

38
Q

What should be done if taking COCP and broad spec abx?

A

continue pills but use condoms for abx course

39
Q

What should be done if pill missed?

A

30-35micro grams - one or two missed no problem
20 mg - only one can be missed

missed pill taken ASAP (even if 2 pills one day)

if more pills missed use condoms for 7 days
if less than 7 pills taken and in 3rd week, avoid pill-free break and use new packet

must be taken 7 consecutive days to be effective

if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*

if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

40
Q

What are some complications associated with COCP?

A

nausea, headaches and breast tenderness

venous thrombosis

myocardial infarction

cerebrovascular accidents

focal migraine

hypertension

jaundice

liver, cervical and breast carcinoma

41
Q

What are advantages of the COCP?

A

less painful and lighter menstruation

protection against ovarian cysts, benign breast cyts, fibroids and endometriosis

ovarian, endometrial and bowel cancer

42
Q

Some absolute CI for COCP?

A

history of VTE

hx of CVA, IHD, increased HTN

migraine with aura

active breast and endo cancer

pregnancy

smokers above 35 y/o

BMI > 40

43
Q

names of COCP?

A

Microgynon, Logynon and Ovranette.

44
Q

names of progesterone only pill?

A

micronor

45
Q

How do you take the progesterone only pill?

A

if commenced up to and including day 5 of the cycle it provides immediate protection - if not, condom

if switching from a combined oral contraceptive (COC) gives immediate protection if continued directly from the end of a pill packet

msut be taken everyday without break and at the same time +/- 3 hrs

46
Q

How does the progesterone only pill work?

A

cervical mucus becomes hostile to sperm and in 50 % inhibits ovulation

47
Q

What are some side effects of the POP?

A

vaginal spotting

weight gain

nostalgia and PMS

functional ovarian cysts

48
Q

When is the POP indicated?

A

suitable for older women

or when COCP contra-indicated (no increased risk of thrombosis)

abx no effect

49
Q

What should be done if you miss taking the POP?

A

if < 3 hours* late: continue as normal
if > 3 hours*: take missed pill as soon as possible, continue with rest of pack, extra precautions (e.g. Condoms) should be used until pill taking has been re-established for 48 hours

Cerazette allows a longer period = 12 hrs

50
Q

What are the types of intrauterine contraceptive devices?

How long do they last?

A

Copper

Progestogen-bearing

5-10 years

51
Q

How do the IUD and IUS work?

A

IUD: primary mode of action is prevention of fertilisation by causing decreased sperm motility and survival (possibly an effect of copper ions)

IUS: levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening

52
Q

What are the disadvantages to using IUD or IUS?

A

pain or cervical shock

perforation

heavier or more painful menstruation (IUD)

infection

the proportion of pregnancies that are ectopic is increased but the absolute number of ectopic pregnancies is reduced, compared to a woman not using contraception

expulsion

53
Q

When are intrauterine devices deemed to effective?

A

IUD is effective immediately following insertion

IUS can be relied upon after 7 days

54
Q

What are some long-acting reversible contraception? How often do they have to be administered?

A

Depot-Provera injection - 12 weeks

Noristerat -injection - every 8 weeks

Nexplanon implant - 3 years

55
Q

Disadvantages to long-acting reversible contraception?

A

Depo-Provera - prolonged amenorrhoea may follow cessation

Nexplanon - irregular bleeding in first year

56
Q

What are some forms of emergency contraception?

A

Levonelle (levonogestrel) - with 24-72 h (95% efficacy if within 24 hrs)

ellaOne (Ulipristal) - 120h

IUD - up to 5 days after

57
Q

Disadvantages with emergency contraception?

A

Levonelle - vomiting, menstrual disturbance

Ulipristal - reduce the effectiveness of hormonal contraception

58
Q

What are the methods of female sterilization?

A

Clips - applied to the tubes laparoscopically

Hysterscopic placement of microinserts - confirmed 3 months later with hysterosalpingogram

Gynaecology (3 decks)

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