Fertility, Conception, Contraception

What is Fertilization?

Process that occurs in the outer third portion of the fallopian tube where a fertilized egg travels to the uterus for implantation in 3-4 days

Ova is considered fertile for ___-___ hours after ovulation

12,24

Sperm can live in the reproductive tract for ___-___ hours (healthiest for first 24)

48,72

What does Folic Acid do?

Prevents neural tube defects

What period do Teratogens pose a greatest risk to an Embryo?

17-56 days from conception

What TRENDS do we look for when Tracking Periods?

Mittelschmerz pain, daily cervical mucus checks, daily temperature monitoring

Mittelschmerz Pain

One-sided pain that occurs during ovulation

Cervical Mucus Characteristics during Ovulation

Thin, clear, slippery, stretchy, alkaline

T or F: Body temperature drops prior to ovulation and rises during ovulation

T

What is Infertility?

Failure to achieve a successful pregnancy after a year or more of unprotected sex (under 35) or 6 months of unprotected sex (over 35)

What is Secondary Infertility?

Inability to conceive after a previous pregnancy

Assessments for Male Infertility

Assess appropriate sex characteristics, penis, scrotum, testicles, genital tract obstructions, prostate exams, and semen analysis

Semen Analysis Considerations

1st diagnostic done before any invasive female diagnostic, tests quality/quantity/motility of sperm, must abstain from sex 24-48 hours prior

Assessments for Female Infertility

Ovarian function, pelvic physical assessment, home ovulation predictor kits, serum hormone tests, Hysterosalpingography, Laparoscopy

What Hormones do we test for Female Fertility?

Progesterone, LH, TSH, FSH

What is a Hysterosalpingography?

A procedure that uses contrast dye to assess the patency of the fallopian tubes; can “flush out” debris, break up adhesions, and induce peristalsis

Non-Pharmacological Infertility Treatment

Diet changes, exercise, stress management, acupuncture

Ovarian Stimulation Medication for Infertility Treatment

Clomiphene Citrate and Letrozole

Other Medications for Infertility Treatment

Metformin and Progesterone

Other Treatment Options for Interfility

Assisted Reproductive Technology (ART), donor egg/sperm/embryo, gestational carriers, surrogate mothers

Gestational Carriers vs. Surrogate Mothers

Gestational Carriers: egg and sperm of intended parent

Surrogate Mothers: only the sperm of one intended parent

What is the ONLY 100% effective method of preventing pregnancy and STI’s?

Abstinence

3 Natural Fertility Awareness Methods

Calendar method, cervical mucus method, basal body temperature method

Male Barrier Methods

Condoms and Spermicide

Female Barrier Methods

Female condom, diaphragm/cervical cap

T or F: Cervical caps are more effective in nulliparous women

T

Two Types of Oral Contraceptives

Combination (estrogen and progestin) and Progestin only

Combination Oral Contraceptive Considerations

Prevents ovulation by mimicking hormones of pregnancy; thickens cervical mucus and thins endometrium; 21 days of active pills and 7 placebo pills

Progestin Only Oral Contraceptive Considerations

“Mini-pill”; for women unable to take estrogen; thickens cervical mucus and thins endometrium; MUST be taken at same time everyday; less cycle control

Combination Oral Contraceptive Contraindications

Hx of DVT/PE/clotting disorders, 35+ and a smoker, HTN, migraines, pregnancy, diabetes, Hx of breast or estrogen-related cancers

Benefits of Combination Oral Contraceptive

Highly effective, reduced ovarian/endometrial cancers, regulates cycle, improves acne/endometriosis/PCOS/dysmenorrhea/fibroids

Transdermal Contraceptive Patch Considerations

Delivers estrogen and progestin, one patch per week for 3 weeks then one week off, highly effective when used properly, weight guidelines, rotate placement but AVOID BREAST

Hormonal Contraceptive Ring Considerations

Low dose and sustained release, flexible and soft ring inserted vaginally, in place for 3 weeks and removed for 1 week

ACHES Symptoms of Birth Control Pills

Abdominal pain

Chest Pain

Headache

Eye Problems

Severe leg pain/Swelling of legs and feet

Morning-After Pill Considerations

Prevents fertilization, should take within 72 hours of unprotected sex, reduces pregnancy risk by 90%, can be given OTC, does not terminate established pregnancy

Hormone Injections (Depo Shot) Considerations

Effective for 12 weeks; 4 does per year; highly effective when compliant; can be used while breastfeeding; commonly causes weight gain; can cause calcium loss and bone mineral density when used long term; can delay fertility up to a year

Patients on the Depo Shot should take ______ mg of calcium daily

1200

Implantable Progestin (Nexplanon) Considerations

Thin and flexible rod inserted into upper arm; OK for breastfeeding moms; effective for 3 years; commonly causes irregular bleeding and mood changes

Long-Acting Reversible Contraception (IUD) Considerations

Hormonal and Non-hormonal (Copper); T-shaped device inserted into the cervix; minimal maintenance; in office placement and removal; immediate return to fertility after removal

Hormonal IUD Considerations

Contains progestin; lasts 3-5 years; decreased bleeding over time; less bleeding during menses

Non-Hormonal IUD Considerations

Made of copper; effective up to 10 years; toxic to sperm; can be used as emergency contraceptives up to 5 days after unprotected sex

What is a Vasectomy?

Male sterilization that is less expensive and has decreased morbidity; performed outpatient and requires 4-6 weeks to ensure effectiveness

What is a Tubal Litigation?

Female sterilization that is more invasive and has higher risk for morbidity; can be performed inpatient or outpatient

What is Abortion?

Medical or surgical termination of pregnancy