ch 31- management of fertility and infertility

which women should not take oral contraceptives

those with thrombophlebitis or stroke, hormones increase risk

effectiveness rates reflect what two types of contraceptive failure

method itself, related to user

what can lead to amenhorrea in women

hormone implants or infections and IUDS

what are some benefits from OCs

acne improvement, decreased bleeding, prolonged amenorrhea

how is a vasectomy performed

in physicians office with local anesthesia

what could be disadvantages of sterilization

no protection of STDs, reversal difficult, expensive

how long are intrauterine devices or intrauterine systems effective for

5-10 years

how often are depo-provera progestin injections have to be repeated

12 weeks

what is a noticeable adverse side effect of progestin injections

temporary decrease in bone density

how long is progestin implant protect for

3 years

what is a noticeable advantage of progestin implant

safe during lactation

how soon must emergency oral contraceptive be taken

within 120 hours

how often should transdermal contraceptive patch be applicated

weekly

what is a disadvantage for transdermal contraceptive patch

less effective for women over 90 kg (198 lb)

how often much vaginal contraceptive ring be placed

every 3 weeks

spermicides effective time

varies from less than 1 - 8 hrs

sponge time constraints (contraception)

remain in place for 6 hrs after last intercourse, no more than 30 hrs

when does fertility begin to decline in women

35-40 years

in perimenopausal women, how long should contraception be used to avoid pregnancy

until 1 year after a woman’s last menses

what is the most common method used by women over 30 years

sterilization

women older than 35 who smoke or have cardiac risk factors should not use

combined hormonal contraceptives, should use progestin only

what are some good contraceptive choices for older women

progestin IUD, depo-provera, progestin-only OCs

description of tubal sterilization (ligation)

cutting or occluding fallopian tubes to prevent sterilization

when is a good time for tubal sterilization, and why

48 hrs after vaginal birth, fundus near u, fallopian tubes directly below abdominal wall

what is a vasectomy

male sterilization, remove section from vas deferens, sperm does not pass into semen

what is an IUD

inserted into uterus to provide continuous pregnancy prevention

there is a slight risk of what with an IUD

infection 20 days after insertion

how do IUDS work

cause a sterile inflammatory response that results in spermicidal intrauterine environment

how does progestin work for IUDs

decreased sperm and ova viability, thickening of cervical mucus, inhibit sperm motility, prevent ovulation, endometrium hostile to implantation

women with what history should avoid IUDs

recurrent pelvic infections, history of ectopic pregnancy, bleeding disorders, or uterus abnormalities

what are ways hormones can be delivered

implant, injection, patch, vaginal ring, orally

progestin-only contraceptives work to do what

inhibit ovulation, thicken cervical mucus, makes endometrium unfavorable for implantation

example of hormone injection

depo-provera

how are hormone injections given, and how often

IM and SQ, every 12 weeks

how long does depo-provera stop ovulation for

14 weeks

what should you not do after giving hormone injections

massage, accelerates absorption and decreases period of effectiveness

max time that depo-provera should be used, and why

2 years due to loss of bone density

what other vitamins or minerals should a person taken while on depo-provera

calcium and vitamin D

progestin only pills are less effective at what

inhibiting ovulation

combined oral contraceptives work how

suppress estrogen and LH, inhibit maturation of follicles and ovulation

how long may breakthrough bleeding occur with oral contraceptives

3 months

how long are women advised to wait to start combined oral contraceptives and why

3-4 weeks, reduce milk production in women

which type of oral contraceptive is advised to women after pregnancy

progestin only, can increase milk production, and can start immediately after delivery

which drugs can interact with OCs by altering effectiveness

drugs that stimulate metabolism in liver, anticonvulsants

how do emergency contraceptives work

delays or inhibits ovulation and interfere with corpus luteum function with progestin

emergency contraception is most effective when

within 72 hours of intercourse

what are the warning signs of oral contraceptive complications (pneumonic)

ACHES: abdominal pain, chest pain, severe headache, eye problems, severe pain or swelling

how does transdermal contraceptive patch work

release small amounts of estrogen and progestin that are absorbed through skin to suppress ovulation and make cervical mucus

where should transdermal contraceptive patches be placed

skin of abdomen, buttock, upper torso, upper outer arm

how do contraceptive vaginal ring work

release small amounts of progestin and estrogen continuously to prevent ovulation

barrier methods of contraception involve what

chemicals or devices that prevent sperm from entering cervix

forms of spermicides

creams and gels with mechanical barriers, like diaphragm or cervical cap

how long are spermicides effective for

less than an hour or up to 8 hrs

types of mechanical barriers

condom, sponge, diaphragm, cervical cap

what are female condoms called

vaginal pouch

should male and female condoms be used together

no

how do sponges work

traps and absorbs semen

what is a diaphragm

latex dome surrounded by spring or coil, place cream in dome, insert into cervix

which contrceptive sheath has a central valve to allow drainage and cervical secretions

lea’s shield

what is the cervical mucus technique based on

changes in cervical mucus assessed by wiping from vagina

symptoms that occur near ovulation

weight gain, abdominal bloating, mittelschmerz (pain on ovulation), increased libido

least reliable methods of contraception

breast feeding and pullout method

infertility definition

inability to conceive after 1 year of unprotected regular sexual intercourse

retrograde ejaculation

discharge of semen into bladder

factors that impair number and function of sperm

abnormal hormonal stimulation, chronic illnesses, infections, obstruction of ducts, exposure to toxins, therapeutic treatments, excessive alcohol intake, drugs, elevated temp

what is hypospadias

urethral opening on underside of penis

erectile dysfunction

consistent inability to achieve or maintain erection that is sufficiently rigid and sustained for vaginal intercourse

purpose of seminal fluid

nourishes, protects, carries sperm into vagina until enter cervix

woman’s fertility depends on

regular production of normal ova, open path from cervix to fallopian tube to permit fertilization and movement of embryo into uterus, uterine endometrium that is supportive

what is responsible for many cases of infertility from tubal obstruction

STDs such as chlamydia and gonorrhea

endometriosis

growth of uterine lining tissue outside uterine cavity

inadequate progesterone secretion by corpus luteum prevents what

normal thickening of endometrium for implantation and establishment of placenta

tests that are common for early infertility evaluation

BBT, cervical mucus eval, hormone evaluations, ultrasound, imaging, semen analysis, testicular biopsy

what are often used to stimulate follicle development

progesterone vaginal suppositories and clomiphene citrate

how does IVF work

bypasses blocked or absent fallopian tubes, put into uterus

what is secondary infertility

when a couple can concieve before, but not able to have another