Unit 2 - Preconception & Conception

What does women's health cover?

Diagnosis and treatment of conditions affecting a woman's physical and emotional well-being, from adolescence through older age, far beyond reproduction

Main areas in the scope of women's health

Gynecology and reproductive health, breast care, sexual health, pregnancy and childbirth, infertility services, bladder and pelvic floor care

Life stages of women's health and key issues

Adolescence (menarche, HPV vaccine); reproductive years (menstrual health, contraception, pregnancy, fertility); midlife (menopause at avg age 51, bone loss, cardiovascular risk)

Key women's health care team roles

OB/Gyn (pregnancy and reproductive care), perinatologist (high-risk pregnancy), nurse midwife (labor, delivery, postpartum), urogynecologist (pelvic floor and bladder)

Main preventive care and screening in women's health

Pelvic and breast exams, Pap and HPV testing, STI screening, immunizations, mammography, bone density testing

Mental health and women main points

Mood is affected by hormonal transitions; 1 in 8 report postpartum depression symptoms; perinatal mood disorders are underdiagnosed; women diagnosed with depression and anxiety about twice as often as men

Violence and safety main points

1 in 4 women experience IPV in their lifetime; IPV screening is standard care; IPV is linked to preterm birth and low birthweight; reproductive coercion is a form of abuse

Autoimmune disease and women

Immune system attacks the body's own tissue; 80% of those diagnosed are women (lupus about 9 times, MS about 2-3 times more common in women)

Research and social disparities in women's health

Only 5% of global R&D goes to women's health; women spend 25% more of life in poor health; access barriers delay care; women were routinely excluded from drug trials until a 1993 U.S. law

What is endometriosis?

Endometrium-like tissue grows outside the uterus (usually the pelvis), causing chronic inflammation and scar tissue

Endometriosis main facts

Affects about 10% of reproductive-age women; average 4-12 years to diagnosis; no cure; 25-50% of women with infertility have it

Main symptoms of endometriosis

Severe menstrual pain, heavy bleeding, chronic pelvic pain, infertility, bloating and nausea

Main treatments for endometriosis

NSAIDs, hormonal therapy, surgery, physiotherapy and CBT

What is PCOS/PMOS?

A chronic hormonal and metabolic disorder where excess androgens disrupt ovulation, causing irregular periods and potential infertility

PCOS/PMOS main facts

Affects 10-13% of reproductive-age women; up to 70% undiagnosed; diagnosed with 2 of 3 criteria (irregular periods, excess androgen signs, enlarged ovaries or cysts)

Causes of PCOS/PMOS

High androgens, insulin resistance, low-grade inflammation

PCOS/PMOS treatment and long-term risks

Lifestyle changes, combined oral contraceptives, ovulation-inducing medicines, IVF; risks include type 2 diabetes, cardiovascular disease, endometrial cancer, and mental health issues

How do endometriosis and PCOS/PMOS differ?

Endometriosis is ectopic tissue and inflammation with pelvic pain; PCOS/PMOS is excess androgens and anovulation with irregular cycles

What do endometriosis and PCOS/PMOS share?

Infertility risk, stigma, mental health burden, global access gaps, structural inequities, and normalized pain

Four phases of the menstrual cycle

Menstrual, follicular, ovulation, luteal

Menstrual cycle main facts

Hormone-regulated, 21-35 days; Day 1 is bleeding, ovulation about Day 14; lining sheds if no pregnancy

Why does menstruation matter?

2.1 billion menstruate; menstrual health includes information, affordable materials, and freedom from stigma; heavy or painful bleeding may signal endometriosis or PMOS; irregular cycles may signal ovulation problems

Menstrual health education statistic

Only 39% of schools worldwide provide it

Female reproductive anatomy path

Eggs mature in the ovary, are released at ovulation, travel through the fallopian tube toward the uterus, where the lining has thickened

Male reproductive anatomy path

Sperm are made in the testes, mature in the epididymis, travel through the vas deferens, mix with prostate fluid, and exit through the urethra

Steps of conception

Ovulation, egg travels into fallopian tube, sperm meets egg, fertilization, implantation in the uterine lining

Conception timing

Egg is fertilizable about 12-24 hours after ovulation; sperm survive several days, so days leading up to and including ovulation matter most

Why does preconception health matter?

Health of both future parents before pregnancy shapes the health of the pregnancy and baby

Main preconception steps for women

See a provider, take 400 mcg folic acid daily, stop alcohol, smoking, and drugs, reach a healthy weight, avoid toxins, learn family history, prioritize mental health

Main preconception steps for men

Avoid smoking, alcohol, and drugs, maintain healthy weight, control chronic conditions, limit heat and toxin exposure, see a provider, support partner

Global family planning context

1.1 billion women need family planning; 874 million use a modern method; 164 million have unmet need

Barriers to contraception access

Limited availability, cost and restrictions, misinformation and fear of side effects, and variable counseling quality or provider bias

Five categories of family planning methods

Fertility awareness (FABM/NFP), barrier, hormonal, intrauterine devices, permanent

How do fertility awareness methods work?

Track cycle signs (calendar, temperature, cervical mucus, symptothermal) to identify fertile days, then avoid intercourse or use a barrier

FABM effectiveness and fertility effect

About 24% typical-use failure; depends on training and consistency; no effect on future fertility

How do barrier methods work?

Physically or chemically block sperm from reaching the egg

Barrier method main facts

Condoms are the only methods that reduce STI and HIV risk; male condom typical failure 13%; no effect on future fertility; withdrawal is behavioral, not a true barrier

Combined pill vs mini-pill

Combined has estrogen and progestin and prevents ovulation; mini-pill has progestin only, thickens cervical mucus, and is safe during breastfeeding

Patch and ring main facts

Estrogen and progestin like the combined pill; patch changed weekly for 3 weeks, ring worn 3 weeks; about 7% typical failure; fertility returns within 1-3 cycles

Implant main facts

Progestin rod in upper arm; lasts up to 3 years; about 0.1% failure; fertility returns within days to weeks

Depo-Provera main facts

Progestin injection every 3 months; about 4% typical failure; delayed return to fertility averaging 9-10 months

Copper vs hormonal IUD

Copper is hormone-free and lasts 10-12 years (also emergency contraception within 5 days); hormonal releases progestin, lasts 3-8 years, and reduces bleeding

IUD main facts

Failure below 1%; fertility returns within the first cycle after removal; pregnancy with an IUD has higher ectopic risk; no STI protection

Vasectomy main facts

Blocks the vas deferens; about 0.10-0.15% failure; backup needed until semen analysis confirms no sperm; reversal is possible but success declines over time

Tubal ligation main facts

Tubes cut, tied, sealed, or removed; about 0.5% failure; effective immediately; higher ectopic risk if pregnancy occurs; many choose IVF over reversal

How should permanent methods be counseled?

As irreversible, even though reversal procedures exist

Contraceptive effectiveness ranking (typical use)

Best are implant and hormonal IUD (0.1%), vasectomy (0.2%), female sterilization (0.5%), copper IUD (0.8%); then injection (4%), pill/patch/ring (7%), male condom (13%), FABMs (24%); no method 85%

Return to fertility by method

Immediate for FABMs and barriers; 1-3 cycles for pill, patch, ring; rapid for implant and IUD; delayed 9-10 months for injection; permanent methods not guaranteed reversible

Family planning takeaway

Effectiveness ranges from about 76% (typical FABM) to over 99% (LARCs and sterilization); most reversible methods allow rapid return to fertility except the injection

Family planning lecture approach

Presents clinical facts without endorsing any method, integrating personal, ethical, and religious values

WHO definition of infertility

A disease of the reproductive system diagnosed after 12 or more months of regular unprotected intercourse without pregnancy

Types of infertility

Primary (never pregnant), secondary (prior pregnancy but now unable to conceive), unexplained (no identifiable cause)

Infertility prevalence

About 1 in 6 people worldwide; male factor in about 50% of cases; 10-15% of U.S. men trying to conceive; at least 10% of women

Per-cycle conception chance

Only about 20-25% for a healthy young couple

Why does fertility care matter?

Human rights issue, affects diverse people, real social and mental health impact, gendered burden; infertility is a medical diagnosis, not a personal failing

What does conception require?

Healthy sperm and egg, sperm able to fertilize, an embryo able to implant, supportive hormones, open fallopian tubes

Main causes of male infertility

Sperm abnormalities, structural issues (varicocele, blockage), hormonal disorders, genetic conditions, medical treatments, infections

Main risk factors for male infertility

BMI over 25 or age 40+, heat, tobacco, marijuana, alcohol, toxins, medications, undescended testicles, radiation, trauma

Male infertility diagnosis

History and exam, semen analysis (primary test), lab testing, imaging and biopsy

Female infertility definition and when to seek care

Diagnosed after 12 months trying (6 if age 35+); seek care for irregular periods, pelvic pain, prior surgery, or diagnosed conditions

Main causes of female infertility

Ovulation disorders (leading cause), uterine problems, tubal factors, declining egg count and quality with age

Main risk factors for female infertility

Age (decline begins in 30s), weight extremes, over-exercise, endometriosis, fibroids, autoimmune disease, untreated STIs causing PID, smoking, alcohol, ectopic pregnancy history

Female infertility diagnosis

History, pelvic exam and ultrasound, hormone/thyroid/ovarian reserve labs, imaging (tube X-ray, hysteroscopy, laparoscopy)

Lifestyle approaches to infertility

Healthy weight and nutrition, moderate exercise and stress management, cut substances, fertility awareness

Medical and surgical infertility treatments

Ovulation induction, hormone therapy, antibiotics, medication changes; surgery for fibroids, polyps, endometriosis, tubal blockage, varicocele, vasectomy reversal, sperm retrieval

Assisted reproductive technologies

IUI places prepared sperm in the uterus; IVF fertilizes eggs in a lab then transfers the embryo; ICSI injects a single sperm into an egg

Complications of fertility treatment

Multiple gestation, ovarian hyperstimulation syndrome, physical demands, emotional strain

Emotional impact of infertility

Grief and anxiety for both partners, gendered stigma toward women, relationship strain; respond with nonjudgmental communication and counseling referral

Faith, values, and fertility care

Religious and ethical views on embryos, third-party reproduction, and fertility awareness vary; nonjudgmental, patient-centered counseling is a core professional obligation

Global access and equity in infertility care

Rarely covered by national health plans, poor and unmarried face the most disparities, many causes are preventable, WHO issued its first infertility guideline in late 2025