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Reproductive System > Session 7: Introduction to Contraception and Infertility > Flashcards

Session 7: Introduction to Contraception and Infertility Flashcards

1
Q

What is contraception?

A

Any method that is used to prevent a pregnancy.

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2
Q

Broadly give ways contraception work.

A

Blocking transport of sperm

Interuppting HPG axis

Prevent ovulation

Prevent implantation

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3
Q

Give examples of methods of natural contraception.

A

Abstinence

Withdrawal method

Fertility awareness method

Lactational amenorrhoea

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4
Q

Explain as well as discuss pros and cons of withdrawal method.

A

Withdrawal before ejaculation.

Advantages - no devices or hormones

Disadvantages - Not reliable, some sperm can be released in pre-ejaculate and no additional protection against STIs.

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5
Q

Explain as well as discuss pros and cons of fertility awareness method.

A

Monitoring basal body temp, avoiding intercourse around ovulation and monitoring cervical mucus.

Advantages - No devices or hormones

Disadvantages - Unreliable, requires a lot of education and time, no protection against STIs.

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6
Q

Explain as well as discuss pros and cons of lactational amenorrhoea.

A

Lactation delays onset of ovultation. This is because the hypothalamus is switched off due to the suckling response which lowers the release of GnRH due to the high levels of prolactin.

Advantages - No hormones or devices

Disadvantages - Only effective for about 6 months, unreliable, no STI protection.

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7
Q

Explain as well as discuss pros and cons of barrier contraceptions.

A

E.g. male condoms (most common). Can also be female condoms and diaphragm/caps. Acts as physical barriers preventing sperm to enter the cervix.

Advantages - Reliable if used correctly. Protects against STIs.

Disadvantages - Less sensation, often requires interupption of intercourse, can expire.

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8
Q

Different broad categories of hormonal contraception.

A

Short acting vs. long acting.

Both are reversible.

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9
Q

What is the common way hormonal contraception works?

A

Interrupt the HPG axis to prevent ovulation and may have additional effects on the endometrial lining.

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10
Q

What different short acting reversible contraceptions are there?

A

Progesterone only pill (POP)

Combined oral contraceptive pill (COCP)

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11
Q

Explain as well as discuss pros and cons of progesterone only pill.

A

Low dose of progesterone. This not enough to inhibit ovulation but affects the cervical mucus by thickening it. This inhibits penetration of sperm.

Advantages - Convenient and effective if used correctly.

Disadvantages - Has to be taken every day with no breaks so there is room for human error. Not effective in controlling periods. Does not inhibit ovulation. Can pose a higher risk of ectopic pregnancy due to effect on cilia.

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12
Q

Explain as well as discuss pros and cons of COCP.

A

Both oestrogen and progesterone. Prevents ovulation by tricking the hypothalamus to think it’s in the luteal phase. Reduces endometrial receptivity to prevent implantation. Also thickens the cervical mucus.

Advantages - Reliable. Alleviates menorrhagia, irregular periods and dysmenorrhea. Reduces risk of ovarian cancer due to fewer ovulations. Prevents proliferation of endometrium and endometrial cancer.

Disadvantages - Needs to be taken daily. Room for human error. Interaction with other medication via CYP450. Oestrogen is thromboembolic. Risk of breast cancer.

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13
Q

What to do if one pill is missed?

A

Take the pill you missed even if it means taking two in one day.

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14
Q

What to do if over 48 hours of pills have been missed?

A

Take the most recent forgotten pill as well as the day’s pill. Leave other forgotten pills.

Use extra protection like condoms.

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15
Q

Give examples of long acting reversible contraception.

A

Progesterone injection

Progesterone implant.

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16
Q

Explain as well as discuss pros and cons of progesterone injection.

A

Intramuscular. High dose of progesterone to prevent ovulation. Thicken cervical mucus and thin the lining of the endometrium. Taken every 12 weeks.

Advantages - Reliable and don’t need to worry about the daily work.

Disadvantages - Unpleasant due to injection. There can also be a delay in fertility upon ceasing treatment.

17
Q

Explain as well as discuss pros and cons of progesterone implant.

A

Small subcutaneous tube inserted in the arm. Releases high dose of progesterone. Prevent ovulation, thicken cervical mucus, thin the lining of the endometrium. Can last up to three years.

Advantages - Reliable, long lasting and no need to worry about daily work. Fertility returns much quicker.

Disadvantages - Can cause amenorrhoea, irregularity of bleeding/spotting or also cause heavy periods.

18
Q

Examples of prevention of implantation.

A

The coil - either intrauterine system (IUS) or intrauterine device (IUD).

19
Q

Explain as well as discuss pros and cons of the coil as the intrauterine system (IUS).

A

The coil contains progesterone. It’s released locally but not into systemic circulation. It provides a physical barrier as well as thinning the endometrial lining. Also useful in menorrhagia.

Advantages - Convenient and long duration. Useful in menorrhagia.

Disadvantages - Insertion may be unpleasant. Risk of uterine perforation. Menstrual irregularity. No protection against STIs.

20
Q

Explain as well as discuss pros and cons of the coil as the intrauterine device (IUD).

A

Coil made of copper. Physical barrier + copper is toxic to sperm and ova. No effect on endometrial lining. No effect on menorrhagia.

Advantages - Long lasting and convenient.

Distadvantages - Displacement, perforation, painful insertion. No protection vs. STIs.

21
Q

Give examples of sterilisation.

A

Vasectomy

Tubal ligation

22
Q

Explain as well as discuss pros and cons of vasectomy.

A

Clips the vas def to prevent entry of sperm into the ejaculate.

Advantages - long lasting, high success rate, reliable.

Disadvantages - Can fail. Samples must be provided to ensure it has been effective. Not reversible. No protection against STIs.

23
Q

Explain as well as discuss pros and cons of tubal ligation.

A

A bigger operation than vasectomy. Clip fallopian tubes to prevent ovum to enter the uterus.

Advantages - long lasting

Distadvantages - higher rate of failure than vasectomy. Not reversible. No protection against STIs.

24
Q

What are emergency contraceptions?

A

When a woman has believed she may have become pregnant unintentionally. Can be done with an IUD up to five days after the event or hormonal pills within 3-5 days.

25
Q

Define subfertility.

A

Couple who are having regular, unprotected sex every 2-3 days an unable to conceive for over a year.

26
Q

Define primary infertility.

A

Never been pregnant

27
Q

Define secondary infertility.

A

Have been pregnant in past (this includes ectopic and terminaton) but are now struggling to conceive again.

28
Q

How can subfertility in men be divided into categories?

A

Pre-testicular

Testicular

Post-testicular

29
Q

Explain pre-testicular causes of subfertility in men.

A

Issues that affect the HPG-axis.

30
Q

Give causes of testicular subfertility in men.

A

Problems with either sperm production or storage.

Causes include:

Chromosome or congenital abnormalities

STIs

Vascular causes like testicular torsion

Drugs like chemo

31
Q

Give causes of post-testicular subfertility in men.

A

Obstructive causes, e.g. vasectomy.

Ejaculatory problems

ED

32
Q

How can subfertility in women be divided into categories?

A

Ovulatory disorders

Uterine and peritoneal disorders

Tubal damage

33
Q

How can ovulatory disorders causing subfertility in women be further divided into categories?

A

HPG axis defects

1 - Failure of GnRH to act on pituitary

2 - Failure of the axis to respond appropriately to stimulation. E.g. PCOS and high prolactin levels.

3 - Failure of the ovary to respond appropriately. E.g. Turner’s or early menopause.

34
Q

Give causes of uterine and peritoneal disorders leading to subfertility in women.

A

Uterine fibroids

Scarring and adhesions like PID, Asherman’s syndrome, Endometriosis and Abdo surgery.

Mullerian duct developing incorrectly like septate or bicornate uterus.

35
Q

Give causes of tubal damage leading to subfertility in women.

A

Endometriosis

Pelvic surgery

Infection like chlamydia

Ectopic pregnancy.

36
Q

Investigations for subfertility in men.

A

Semen analysis (sperm count etc…)

LH, FSH, testosterone

Ultrasound

STI check

Karyotyping

37
Q

Investigations for subfertility in women.

A

LH and FSH (day 2)

Progesterone (day 21)

Androgens

Prolactin

Thyroid function

STI tests

Pelvic USS

Tubal patency

Reproductive System (31 decks)

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