224 Unit 2 Lecture 1 (Contraception & Infertility)

What is contraception?

Any method that reduces the risk of fertilization or implantation to prevent pregnancy.

When should contraceptive discussions occur postpartum?

Before discharge, so couples can choose a safe and appropriate method.

What factors affect contraceptive choice?

Health status, religion, side effects, effectiveness, cost, and access.

What is the most effective natural method of contraception?

Abstinence — 100% effective, no medical risks, prevents STIs.

What is coitus interruptus and why is it unreliable?

Withdrawal before ejaculation; pre-ejaculate may contain sperm → high failure rate.

PULLOUT METHOD

How does the rhythm method work?

Track menstrual cycles and avoid sex during fertile days (LMP-11 to LMP-18 rule).

What are key disadvantages of the rhythm method?

Unreliable with irregular cycles, requires strict tracking, and no STI protection.

What is basal body temperature tracking used for?

Detects ovulation by daily temperature changes — a slight rise signals ovulation.

When does fertility end using the Basal Body Temperature (BBT) method?

3 days after the temperature rise remains sustained.

What can affect accuracy of the Basal Body Temperature (BBT) method?

Stress, illness, alcohol, interrupted sleep, or inconsistent timing.

What is the cervical mucus (Billings) method?

Tracking changes in vaginal mucus; clear, stretchy mucus indicates ovulation.

When does fertility start and end in the mucus method?

Begins with mucus change; lasts about 3–4 days after ovulation signs appear.

Advantages of fertility awareness methods?

Inexpensive, hormone-free, acceptable by many religions, promotes body awareness.

Disadvantages of fertility awareness methods?

Requires regular cycles, record keeping, cooperation, and no STI protection.

Which natural methods prevent STIs?

Only abstinence. All other natural methods lack STI protection.

What do barrier methods do?

Physically or chemically block sperm from reaching the egg; some provide STI protection.

What material provides STI protection in condoms?

Latex and polyurethane — natural membrane (lambskin) does not protect from STIs.

What lubricant is safe with latex condoms?

Water-based lubricants only — oil-based products can cause breakage.

When is a male condom most effective?

When used correctly, with space at the tip and spermicide for extra protection.

Can you use a male and female condom together?

No. Friction between them can cause tearing or slippage.

How long is spermicide effective?

About 1 hour after insertion; must reapply each time.

What are disadvantages of spermicides?

Messy, irritates tissue, increases STI risk if mucosa is damaged, no STI protection.

What is the contraceptive sponge?

Foam device containing spermicide; protects up to 24 hours but must be removed to avoid TSS.

How long should a diaphragm remain after sex?

6 hours minimum, no longer than 24 hours total.

When should a diaphragm be refitted?

Every 2 years or after weight change, childbirth, or pelvic surgery.

Does a diaphragm protect against STIs?

No. It only prevents sperm from reaching the cervix.

How long can the cervical cap remain in place?

Up to 48 hours, minimum 6 hours after sex.

What is a major risk if the contraceptive sponge is left too long?

Toxic Shock Syndrome (TSS). rare but life threatening response due to bacteria going into bloodstream

Which barrier methods require a prescription?

Diaphragm and Cervical Cap.

Which barrier methods are available over-the-counter (OTC)?

Condoms and spermicides.

What is the main action of hormonal contraceptives?

Suppress ovulation, thicken cervical mucus, thin uterine lining.

What hormones are in combined oral contraceptives?

Estrogen + progestin.

Who should avoid combined oral contraceptives?

Smokers >35, or those with clotting disorders, hypertension, or migraines with aura.

What to do if a pill is missed?

Take ASAP and use backup method for 7 days.

What makes COCs less effective?

Anticonvulsants, antifungals, and some antibiotics.

What is the main difference between COC and POP?

POP has no estrogen and must be taken same time daily.

What makes the progestin-only pill safer for breastfeeding mothers?

It does not interfere with milk production.

When should emergency contraception be taken?

Within 72 hours of unprotected sex; delays ovulation.

Does Plan B terminate a pregnancy?

No — it only prevents ovulation and fertilization.

How often is the patch changed?

Weekly for 3 weeks, then 1 patch-free week.

Can patients swim with the contraceptive patch?

Yes, swimming and showers are safe.

How long is the vaginal ring left in place?

3 weeks in, 1 week out.

How often is Depo-Provera (INJECTIBLE PROGESTINS) given?

Every 11–13 weeks (4 times per year).

What are key side effects of Depo-Provera (INEJECTIBLE PROGESTINS)?

Bone loss, weight gain, mood changes, amenorrhea.

How can patients reduce osteoporosis risk on Depo-Provera (INJECTIBLE PROGESTINS)?

Weight-bearing exercise, calcium, vitamin D intake.

How long does the contraceptive implant last?

3 years.

What hormone is used in the contraceptive implant?

Progestin.

Does the implant affect milk production?

No, safe for breastfeeding.

Main disadvantages of the implant?

Irregular menses, weight gain, mood changes, no STI protection.

How long does an IUD provide contraception?

3–10 years depending on the type.

What are two types of IUDs?

Hormonal (levonorgestrel) and copper.

What are contraindications for IUD use?

Uterine infection, abnormal bleeding, structural abnormalities.

What should patients check monthly after IUD insertion?

IUD strings for presence/position.

What are possible complications of IUDs?

PID, uterine perforation, expulsion, infection.

What is the main advantage of tubal ligation?

Permanent, immediate contraception, no effect on hormones.

What is a key disadvantage of tubal ligation?

Irreversible, risk for ectopic pregnancy, surgical risk.

What is a vasectomy?

Surgical cutting/sealing of vas deferens for permanent contraception.

How long does it take for a vasectomy to become effective?

After about 20 ejaculations and two negative semen tests.

Does vasectomy affect sexual function?

No, erections and orgasm remain the same.

Do any LARC or surgical methods protect from STIs?

No — only barrier methods (condoms) protect against STIs.

What is infertility?

nability to conceive or maintain a pregnancy after 12 months of unprotected intercourse.

What percentage of infertility is caused by male factors?

About 40%.

List 3 male causes of infertility.

Low sperm count, poor motility, or structural blockage.

List 3 female causes of infertility.

Ovulation disorder, endometriosis, blocked fallopian tubes.

What are common emotional issues in infertility?

Stress, expense, guilt, lack of support.

What is the purpose of a semen analysis?

Checks sperm count, motility, and shape.

What test evaluates if fallopian tubes are open?

Hysterosalpingography (HSG).

What does a hysteroscopy evaluate?

The inside of the uterus for polyps, fibroids, or scarring.

What procedure directly visualizes the pelvis and checks for endometriosis?

Laparoscopy.

What is the purpose of hormone testing in infertility?

To check ovulation and reproductive hormone balance.

What test examines how sperm interact with cervical mucus?

Postcoital test.

What is ART?

Assisted Reproductive Technologies (e.g., IVF, IUI).

What role does genetic counseling play in infertility?

Helps identify inherited causes or risks for birth defects.

What are 2 examples of ART?

In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI).

When should infertility evaluation begin for women over 35?

After 6 months of trying.

What does CAM stand for in infertility care?

Complementary and Alternative Medicine.

What lifestyle changes can improve fertility?

Better nutrition, regular exercise, and stress reduction.

Why should men avoid high scrotal temperatures?

Heat decreases sperm count and motility.

What do ovarian stimulation medications do?

Stimulate ovulation (release of eggs).

What is IUI?

Intrauterine insemination — sperm placed directly in uterus.

What is IVF?

In vitro fertilization — sperm and egg fertilized in a lab, embryo placed in uterus.

What is GIFT?

Gamete intrafallopian transfer — sperm and egg placed together into fallopian tube.

What is a donor oocyte?

An egg from a donor used for fertilization.

What is a gestational carrier?

Another woman carries the embryo made from the couple’s sperm and egg.

What’s the difference between a surrogate and gestational carrier?

A surrogate uses her own egg; a gestational carrier does not.

What should the nurse acknowledge about infertility?

It is a significant emotional stressor that can cause grief, guilt, and frustration.

What is the nurse’s role in education for infertility treatment?

Explain procedures, medication side effects, and realistic expectations.

What does a genetic counselor do for infertility care?

Reviews hereditary conditions and risks before conception.

What should patients report while taking fertility medications?

Pain, swelling, dizziness, or signs of ovarian overstimulation.

What support options should the nurse recommend?

Counseling, support groups, and adoption services.

What’s the difference between a reproductive specialist and a geneticist?

The reproductive specialist manages fertility treatments; the geneticist evaluates genetic causes of infertility.