Repro14 - Contraception & Infertility

Question 1

6 methods of contraception

Natural x4
Physical Barriers
Hormonal Control x6
Prevention of Implantation x2
Sterilisation x2
Emergency Contraception x2

Answer 1

1.) Natural - abstinence, withdrawal method, fertility awareness methods, lactational amenorrhoea

2. ) Physical Barriers - prevent sperm entering the cervix
   - condoms (male/female), diaphragm/caps
   - can also be used with spermicide
3. ) Hormonal Control - COCP, patch, vaginal ring, injection, implant, POP
4. ) Prevention of Implantation - IUS, IUD
5. ) Sterilisation - permanent
   - vasectomy: vas deferens is cut or tied to prevent sperm entering ejaculate
   - tubal ligation: fallopian tubes cut or blocked to stop the ovum reaching the uterus
   - tubal ligation has higher failure rate
6. ) Emergency Contraception - used up to 3/5 days after having unprotected sex
   - emergency IUD, emergency pill with ulipristal acetate or levonorgestrel

Question 2

3 ways to track fertility awareness as a method of contraception

Answer 2

1. ) Cervical Mucus - more mucus produced when fertile
   - CL secretes progesterone which thickens the mucus
2. ) Body Temperature - raised during ovulation
3. ) Menstrual Cycle Tracking - most fertile 14 days after the beginning of your period (menses)

Question 3

2 features of lactational amenorrhoea as a method of contraception

Mechanism
Effectiveness

Answer 3

1. ) Reduced GnRH Release - suckling stimulus during breast feeding produces high levels of prolactin
   - prolactin ‘switches off’ the hypothalamus
   - leads to less oestrogen production, delaying ovulation
2. ) Effectiveness - relies on exclusive breast feeding
   - only effective 6 months after giving birth
   - female must also be amenorrhoeic
   - overall, it is fairly unreliable

Question 4

6 features of using combined hormonal contraception (CHCs, oestrogen + progesterone) as a form of hormonal control

Forms x3
Primary Action
Secondary Actions x2
Effect on Menstrual Disorders x2
Contraindications x3
Side Effects

Answer 4

1. ) Forms - oral (COCP), patch, vaginal ring
   - COCP is taken for 21 days, then break for 7 days
2. ) Primary Action - inhibits the HPG axis
   - inhibiting the HPG axis –> ↓LH and ↓FSH
   - no LH surge or follicle stimulation –> no ovulation
3. ) Secondary Actions
   - progesterone (low dose) thickens cervical mucus
   - progesterone inhibits oestrogen, ↓endometrial hyperplasia, inhibiting implantation
4. ) Relieves Menstrual Disorders - due to no ovulation
   - reduces risk of ovarian cysts and ovarian cancer
   - reduces risk of endometrial cancer due to thinning of the endometrium
5. ) Contraindications
   - high BMI, migraines, breast cancer
6. ) Side Effects - breakthrough bleeding, breast tenderness, mood disturbance
   - increased risk of breast and cervical cancer, MI/stroke, venous thromboembolism

Question 5

5 features of using progesterone as a form of hormonal control

High Dose Progesterone
Low Dose Progesterone 
Progesterone Injections
Progesterone Implant
Progesterone Only Pill

Answer 5

1. ) High Dose Progesterone - inhibits oestrogen
   - primary: prevents ovulation (inhibits LH surge)
   - secondary: thickens cervical mucus and prevents endometrial proliferation
2. ) Low Dose Progesterone - thickens cervical mucus
   - doesn’t inhibit LH surge so ovulation still likely
3. ) Progesterone Injections - high dose
   - lasts for up to 12 weeks but may have side-effects which will continue for that period
   - there is a delay for fertility to return
4. ) Progesteron Implant - high dose
   - small tube inserted under the skin
   - lasts for 3 years and natural fertility returns quickly
   - also has side effects
5. ) Progesterone Only Pill (POP) - low dose
   - quickly reversible, used when COCP can’t be used
   - taken every day without a break
   - can cause menstrual problems, increase risk of ectopic pregnancy, interacts w/other medication

Question 6

4 differences between the 2 types of coil, intrauterine system (IUS) and the intrauterine device (IUD)

Contents
Principal Action
Length of Time
Disadvantages x3

Answer 6

1. ) Contents
   - IUS is a plastic device that releases progesterone
   - IUD is a plastic device with added copper
2. ) Principal Action - both somewhat physical barriers, prevent implantation, and thicken cervical mucus
   - IUD prevents implantation due to causing endometrial inflammatory reactions
   - IUD contains copper which is toxic to sperm and ovum
3. ) Length of Time
   - IUS lasts 3-5 years whilst IUD lasts 5-10 years
4. ) Disadvantages - both the same
   - risk of uterine perforation
   - menstrual irregularity
   - displacement/expulsion

Question 7

3 features of subfertility

Definition
Statistics
Main Causes

Answer 7

1. ) Definition - failure of conception in a couple having regular, unprotected coitus for one year
   - primary is someone who has never had a child
   - secondary is someone who cant have another child
2. ) Statistics
   - 1/7 couples have difficulty conceiving
   - 84% of couples will conceive naturally within one year of having regular (every 2/3 days), unprotected sex
   - if you’ve been trying to conceive for > 3 years, you have a <25% chance of conceiving within the next year

3.) Main Causes - male (30%), unexplained (25%), ovulatory disorders (25%), tubal damage (20%), uterine or peritoneal disorders (10%)

Question 8

3 groups of male causes of subfertility

Pre-Testicular
Testicular x4
Post-Testicular

Answer 8

1. ) Pre-Testicular - endocrine problems
   - HPG dysfunction, hyperprolactinaemia, hypothyroidism, diabetes, general health/systemic illness
2. ) Testicular - 4 groups
   - genetic/congenital: chromosomal defects
   - infective: STIs
   - antispermatogenic agents: heat, irradiation, drugs
   - vascular: testicular torsion or varicocele

3.) Post-Testicular - obstructive or coital problems (erectile dysfunction, ejaculatory failure)

Question 9

3 classes of ovulatory disorders

Answer 9

1. ) Group 1 (10%) - hypothalamic pituitary failure
   - hypothalamic amenorrhoea
   - hypogonadotropic hypogonadism
2. ) Group 2 (85%) - HPO dysfunction
   - hyperprolactinaemic amenorrhoea
   - polycystic ovarian syndrome
3. ) Group 3 (5%) - ovarian failure
   - congenital (e.g. Turner’s syndrome)
   - premature ovarian failure/ primary ovarian insufficiency