Fertility Control

Question 1

These are locally active devices preventing entry of sperm in through the cervix, thus preventing pregnancy.

Answer 1

BARRIER-SPERMICIDAL METHODS

Question 2

BARRIER-SPERMICIDAL METHODS Advanatges

Answer 2

Barrier methods become increasingly effective with advancing age and the associated natural decline in fertility.

They do protect against some STDs.

They do not have systemic
side effects.

Question 3

Failure rate of BARRIER-SPERMICIDAL METHODS

Answer 3

approaches 20%.

Question 4

They are the most common barrier contraceptive method used.

Answer 4

Condoms

Question 5

This is a dome-shaped device placed in the anterior and posterior vaginal fornices holding spermicidal jelly against the cervix. It can be placed an hour before intercourse.

Answer 5

Vaginal diaphragm

Question 6

Disadv of Vaginal diaphragm

Answer 6

Individual fitting is required. If too large a size is used, it can result in urinary retention.

Question 7

The active ingredient is nonoxynol-9, a surface-active agent that disrupts
cell membranes, thus the possible side effect of genital membrane irritation

Answer 7

Spermicides.

Question 8

These include inhibition of the midcycle luteinizing hormone (LH) surge, thus preventing ovulation;

alteration of cervical mucus making it thick and viscid, thus retarding sperm penetration; and alteration of endometrium inhibiting blastocyst implantation

Answer 8

STEROID CONTRACEPTION

Question 9

Mechanism of Action of Steroid Contraception

Pituitary _____
Ovary_______
Endometrium_____
Cervix ______

Answer 9

↓ LH surge

↓ ovulation

Atrophy

Hostile mucus

Question 10

Estrogen effect of steroid hormones

 1
2
3
4
5

Answer 10

fluid retention from decreased sodium
excretion;

accelerated development of cholelithiasis;

increase in hepatic protein production

healthy lipid profile changes

and increased venous and arterial thrombosis

Question 11

What hepatic proteins are increased with estrogenic effects of steroid hormones

Answer 11

(e.g., coagulation factors, carrier proteins, angiotensinogen);

Question 12

Lipid changes of estrogen

Answer 12

(increase in high-density lipoproteins [HDL]; decrease in low-density lipoproteins [LDL]);

Question 13

Progestin-Mediated Metabolic Effects of steroid hormones

Answer 13

These include mood changes and depression from decreased serotonin levels; androgenic effects (e.g., weight gain, acne); and unhealthy lipid profile changes (decreased HDL, increased LDL).

Question 14

Absolute Contraindications of steroid hormones

Answer 14

acute liver disease; history of vascular
disease cerebrovascular accident
[CVA], systemic lupus erythematosus [SLE]); hormonally dependent cancer (e.g., breast);
smoker ≥35; uncontrolled hypertension; migraines with aura; diabetes mellitus with vascular disease; and known thrombophilias

Question 15

Relative Contraindications of steroid hormones.

Answer 15

These include migraine headaches, depression, diabetes mellitus,
chronic hypertension, and hyperlipidemia

Question 16

Noncontraceptive Benefits of steroid hormones

Answer 16

These include decreased ovarian and endometrial cancer; decreased dysmenorrhea and dysfunctional uterine bleeding; and decreased PID and ectopic
pregnancy.

Question 17

Noncontraceptive Benefits of steroid hormones usually from what component

Answer 17

Mostly Progestin Component

Question 18

These contain both an estrogen and a progestin. They are administered
most commonly in one of two ways: daily with 21 days on and 7 days off or daily 24 days on
and 4 days off

Answer 18

Combination OCPs

Question 19

COCP

When “off” the hormones, _____will occur

Answer 19

withdrawal bleeding

Question 20

COCP failure rate

Answer 20

Failure rate is 2% with ideal use.

Question 21

A unique combination of OCP (YAZ) reduces severe PMDD symptoms by 50%. It contains______ and a new progestin, _____. The dosing is 24 days of active pills then 4 days of placebo, rather than the traditional 21 days

Answer 21

ethynyl estradiol

drospirenone

Question 22

Marketed under the trade name of NuvaRing, this device, inserted into the vagina, contains both an estrogen and a progestin. It is removed after 3 weeks for 1 week to allow for a withdrawal bleed.

Answer 22

Combination Vaginal Ring

Question 23

Combination Vaginal Ring failure rate

Answer 23

2%

Question 24

Marketed under the trade name of Ortho Evra, this patch contains both an estrogen and a progestin. A patch is replaced every week for 3 weeks then removed for 1
week to allow for a withdrawal bleed.

Answer 24

Transdermal Skin Patch

Question 25

They contain only progestins and are sometimes called the “minipill.” They need to be taken daily and continuously. A frequent side effect is break-through bleeding.

Answer 25

POP

Question 26

POP failure rate

Answer 26

Failure rate is 3% with ideal use.

Question 27

Marketed under the trade name of Depo-Provera, this is an IM injection of depo-medroxyprogesterone acetate (DMPA). The slow release allows administration only every 3 months.

Answer 27

Progestin-Only Injectable

Question 28

SE of DMPA

Answer 28

A frequent side effect is break-through bleeding. Other side effects are prolonged time for fertility return and decreased bone mineral density

Question 29

Failure rate of DMPA

Answer 29

Failure rate is <1%.

Question 30

Progestin-Only Subcutaneous Implant. Marketed under the trade name of Nexplanon, this uses _______ as the active ingredient

Answer 30

etonogestrel

Question 31

Progestin-Only Subcutaneous Implant contains small amount of _____ making it visible on x-ray.

Answer 31

barium,

Question 32

Progestin-Only Subcutaneous Implant The continuous release continues for ____

Answer 32

3 years

Question 33

Progestin-Only Subcutaneous Implant | failure rate

Answer 33

Failure rate is <1%.

Question 34

“Morning-After” Pill. Marketed under the trade name of “Plan B,” it uses ______

Answer 34

levonorgestrel tablets.

Question 35

“Morning-After” Pill failure rate

Answer 35

Failure rate is <1%.

Question 36

``` Mechanisms of Action of IUD 1 2 3 4 5 ```

Answer 36

inhibition of sperm transport; increased tubal motility causing failure of implantation of immature zygote; inhibition of implantation secondary to endometrial inflammation; phagocytic destruction of sperm and blastocyst; and alteration of cervical mucus

Question 37

alteration of cervical mucus only for

Answer 37

only progesterone IUSs).

Question 38

Absolute Contraindications for IUD include a 1 2 3

Answer 38

confirmed or suspected pregnancy; known or suspected pelvic malignancy; undiagnosed vaginal bleeding; and known or suspected salpingitis

Question 39

Relative Contraindications for IUD

Answer 39

abnormal uterine size or shape; medical condition (e.g., corticosteroid therapy, valvular heart disease, or any instance of immune suppression increasing the risk of infection); nulligravidity; abnormal Pap smears; and history of ectopic pregnancy

Question 40

IUD The LNG-containing IUS is effective for ______years, the copper T-380A is effective for ____ years, making it potentially the least expensive contraceptive available.

Answer 40

5 10

Question 41

This patient’s recent _______ is a significant risk factor for IUS use. Most of the increased risk of infection actually attributable to IUS use is within 20 days after infection

Answer 41

chlamydia infection

Question 42

_______ could also be a relative contraindication because they alter the shape of the endometrial cavity or cause heavy bleeding

Answer 42

Uterine fibroids

Question 43

Ectopic pregnancy in IUD

Answer 43

The IUS does not increase ectopic pregnancies. However, with pregnancy from failed IUS, the likelihood of it being ectopic is higher because primarily, intrauterine pregnancies are prevente

Question 44

A levonorgestrel-impregnated (LNG) IUS that releases the hormone gradually over 5 years. Bleeding and cramping may be decreased. Failure rate is <1%.

Answer 44

“Mirena.”

Question 45

______. A smaller (LNG) IUS similar to Mirena but effective for only 3 years. Failure rate is <1%.

Answer 45

Skyla

Question 46

________ Marketed under the trade name “Paraguard,” this copper-banded IUS releases copper gradually over 10 years. Bleeding and cramping may be increased

Answer 46

Copper T-380A IUS.

Question 47

Disadv of coitus interuptus

Answer 47

High failure rates. No protection against STDs. High degree of discipline required. Semen can enter vagina and cervical mucus prior to ejaculation.

Question 48

plain water, vinegar and other products are used immediately after orgasm to theoretically flush semen out of the vagina. It has a long history of use in the United States.

Answer 48

With vaginal douche,

Question 49

With lactation, elevated_____ with exclusive breastfeeding inhibit pulsatile secretion of GnRH from the hypothalamus

Answer 49

prolactin levels

Question 50

Effectiveness of LAM

Answer 50

Effectiveness is dependent on the frequency (at least every 4-6 hours day & night) and intensity (infant suckling rather than pumping) of milk removal.

Question 51

Disadvantages of LAM:

Answer 51

High failure rate if not exclusively breastfeeding. Reliable for only up to 6 months. No protection against STDs.

Question 52

Tubal Ligation Destruction or removal of a segment of the oviduct is performed in an operating room through a transabdominal approach usually using a

Answer 52

laparoscopy or minilaparotom

Question 53

Failure rate of Tubal Ligation

Answer 53

Failure rate is 1 in 200

Question 54

Destruction or removal of a segment of vas deferens is performed as an outpatient procedure using local anesthesia

Answer 54

Vasectomy.

Question 55

Vasectomy failure rate

Answer 55

Failure rate is 1 in 500

Question 56

A successful Vasectomy can be | confirmed by

Answer 56

absence of sperm on a semen specimen obtained 12 ejaculations after the surgery.

Question 57

Sperm antibodies can be found in _____ of vasectomized patients.

Answer 57

50%