Infertility & Contraception - EHC & Terminations

Which hormone is responsible for stimulating the production of sperm?

Testosterone

Which hormone triggers ovulation?

Luteinising hormone

list 4 bacterial infections spread through sexual intercourse

chlamydia, gonorrhea, syphilis, and bacterial vaginosis (BV).

what hormone helps prepare the lining of the uterus for implantation?

progesterone

Which hormone stimulates the hypothalamus and pituitary gland to release more hormones to encourage egg development?

Gonadotropin-Releasing Hormone (GnRH)

Which hormone is released when the corpus luteum breaks down?

Progesterone - The corpus luteum will break down around 10 days after ovulation releasing progesterone.

Does the secretion of progesterone decreases during pregnancy?

No it increases

Located at the back of the testis, this is where sperm is stored.

Epididymis

male reproductive glands that produce the hormone testosterone and sperm.

Testes (singular = testis)

Which gland is regulated by testosterone, produce the fluid which combines with sperm to make semen, which is then ejaculated during sexual arousal. 

Prostate gland

Which Tube which transports urine and semen to outside the body?

Urethra

Which hormone feeds back to the hypothalamus and pituitary to switch off LH production in a negative feedback loop?

Testosterone

What are responsible for the production of ova and oestrogen and progesterone?

Ovaries

What does the vesicular follicle become?

corpus luteum

Which drugs treat PCOS?

*Clomifene - anti-oestrogen

*Metformin - effects on insulin

*Cyproterone, Finasteride & Dianette - anti-androgen treat hirsuitism

*Chorionic Gonadotrophins, follitropin alfa, menotrophinn- stimulate ovulation

Which drugs treat Endometriosis?

NSAIDs - ibuprofen, naproxen, mefanamic acid

Paracetamol

COC’s and POP contraceptives

Danazol - reduces FSH and LH leads to less oestrogen.

Treatments for male infertility

testosterone levels can be replaced with oral capsules, transdermal gel, intramuscular injection or implant.

Treatments for infertility

Goserelin, Buserelin (Gonadorelin analogues)

> mimic Gonadotrophin Releasing Hormone (GnRH)

:- pituitary gland releases LH and FSH

:- oestrogen levels go up

:- starts ovulation.

Which hormone decreases during pregnancy ?

Oestrogen

Which hormone increases during pregnancy ?

Progesterone

What is the most common synthetic oestrogen in COC’s?

ethinylestradiol

What are the common synthetic progestogens in COC’s?

Levonorgestrel, Desogestrel, Drospirenone , Gestodene

COCs maintain high amounts of oestrogen which does what to prevent pregnancy?

suppress ovulation preventing an egg being released from the ovaries.

Why do COCs thicken the mucus in the neck of the uterus?

So that it is harder for sperm to penetrate the uterus and reach an egg .

Why do COCs thin the lining of the uterus?

So there is less chance of a fertilised egg implanting into the uterus.

Who is the COC not suitable for?

Patients over 35 who smoke

Patients with high blood pressure

When is the COC pill considered to be 'missed' ?

If taken more than 24 hours after it was supposed to be taken.

What if you miss a COC pill?

Take the missed pill immediately and then take the next pill at the usual time (this may mean taking 2 pills together).

What if you miss 2 or more COC pills?

Take a pill immediately and then take remaining pills as normal - but abstain from sex or use extra precautions such as condoms for next 7 days.

The POP that suppresses ovulation is?

Desogestrel is a prodrug of the active progestogen. It is metabolised in the intestines and liver to etonogestrel. 

POP are better for who?

Suitable for patients over 35 who smoke

Suitable for breastfeeding mothers

No 7 day break, so less complicated

When to take the POP?

Take pill at same time each day and every day - no pill free intervals.

When is a POP pill considered missed?

If you take the pill late but within the 3-hour or 12-hour (desogestrel) window then the pill is not missed.

What do you do if pill or pills missed?

• Take 1 pill ASAP & next pill at normal time regardless how many pills missed.

• no contraception effect for 48hrs as it takes 2 days for the POP to thicken the mucus at mouth of cervix

Name the 2 Emergency Hormonal Contraceptives?

Levonorgestrel (Levonelle)

Ulipristal (EllaOne)

Are levonorgestrel and ulipristal POM drugs?

No - P medicines

When do you take Levonorgestrel and how much ?

Within 3 days of UPSI, 1.5mg or 3mg if BMI over 26.

What the Mode of Action of Levonorgestrel?

Delays ovulation (as opposed to complete suppression like COC).

Thickens cervical mucous, impeding sperm mobility.

When do you take Ulipristal and how much?

Within 5 days of UPSI, 30mg tablet.

Out of Levonorgestrel (Levonelle) &

Ulipristal (EllaOne) which is teratogenic?

Ulipristal (EllaOne) - possibility of pregnancy must be considered before administration

What the Mode of Action of Ulipristal (EllaOne) ?

It prevents ovulation by blocking the effects of progesterone.

What are the drugs used in Medical Abortions?

Mifepristone - steroid

Misoprostol or Gemeprost -prostaglandin analogues

What is the mode of action of Mifepristone?

Softens and dilates the cervix, making it more sensitive to prostaglandin analogues

What is the mode of action of prostaglandin analogues?

Cause contractions to terminate pregnancy.

When do you administer Misoprostol or Gemeprost - prostaglandin analogues?

36-48 hours after Mifepristone (steroid)