Contraception + fertility

What are the different types of contraceptives?

Natural: fertility awareness

Barrier method: condoms 

Hormonal Control: pills, implant

Prevention of implantation

Sterilisation

Emergency contraception

How can breast feeding be used as a contraceptive?

Lactational amenorrhoea method:

Breastfeeding delays the return of ovulation after childbirth

Suckling disrupts release of GnRH

must haves:

• Relies on exclusive breast feeding

• Only effective up to 6 months after giving birth

• must be amenorrhoeic

primary vs secondary infertility

Primary infertility: When a woman who's never conceived in the past has difficulty conceiving

Secondary infertility: When a woman who has had one or more pregnancies in the past, is having difficulty conceiving again (Includes abortion and ectopic pregnancy)

What are some infertility causes in men?

Endocrine:

• Hypothalamus/ pituitary dysfunction

• Hypogonadotropic hypogonadism

• Hypothyroidism

Genetic: Klinefelter’s,

STIs

Obstructive

erectile dysfunction

Ovulatory disorders

Group 1-hypothalamic-pituitary failure– 10%
◦ Hypothalamic amenorrhea
◦ Hypogonadotrophic hypogonadism

Group 2-hypothalamic-pituitary-ovarian dysfunction – 85%
◦ Polycystic ovary syndrome
◦ Hyperprolactinaemic amenorrhoea

Group 3-ovarian failure - 5%
o Congenital (Eg TurnersX0)
o Premature ovarian failure / Primary ovarian insufficiency

Uterine / Peritoneal disorders

Uterine Fibroids

Asherman syndrome

Endometriosis

Müllerian developmental anomaly:

• Agenesis - failure for the uterus or tubes to form

• Didelphys- Complete duplication of the uterus, cervix, and vagina

• Bicornuate 

• Septate - a single uterus with a fibrous band going down the centre of the uterus

  
  

What tests are done in men to test for fertility?

Semen analysis- sperm count, motility

Blood test:

• FSH/LH/ Testosterone

• Penile/urethral swabs

• USS testes

• Karyotype

• Cystic fibrosis

What tests are done in women to test for fertility?

Blood test
• Follicular phase LH, FSH(Day 2)
• Luteal phase progesterone (Day 21)
• Prolactin, androgens, TFTs
Cervical smear
Vaginal/cervical swabs (rule out STI)
Pelvic USS
Tests of tubal patency- Hysterosalpingogram

When can a woman be sent to a fertility clinic?

A women of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility

How can infertility be helped?

Medical treatment to restore fertility:

• use of drugs to stimulate follicular development and ovulation e.g. GNRH agonist/antagonist and gonadotropins

• Surgical treatment to restore fertility eg. removing fibroids, endometrial tissue

• Assisted reproduction techniques (ART) eg.IVF