OB: Contraception, Abortion, and Infertility

How is infertility defined in women <35 years?

Trying to conceive for 1 year without success.

How is infertility defined in women >35 years?

Trying to conceive for 6 months without success.

What percentage of reproductive-age population is affected by infertility?

10-15%.

After what age does infertility increase exponentially?

After age 35.

What is subfertility?

Prolonged time to conceive.

What is primary infertility?

Never conceived.

What is secondary infertility?

Infertility after previously conceiving.

What is sterility?

Inability to conceive.

What are the three cause categories of infertility?

1/3 female, 1/3 male, 1/3 unexplained.

What must infertility diagnosis and treatment involve?

Physical, emotional, and financial investment.

What are ovarian factors of infertility usually related to?

Hormonal issues preventing ovulation or pregnancy maintenance.

How can anorexia contribute to infertility?

It disrupts hormones needed for ovulation.

How does PCOS contribute to infertility?

Hormonal imbalance prevents ovulation.

How can long-term contraceptives contribute to infertility?

Hormonal suppression of ovulation.

Where does fertilization occur?

Fallopian (uterine) tubes.

What causes tubal/peritoneal infertility?

Scarring or adhesions from endometriosis, STIs, congenital issues.

What is isoimmunization?

Development of antibodies against sperm with thick cervical mucus blocking sperm.

What nutritional states increase infertility risk?

Anorexia, obesity, nutritional deficiencies.

What endocrine disorder contributes to infertility?

Thyroid dysfunction.

What are uterine factors for infertility?

Structural issues or congenital malformations.

What structural uterine anomaly increases prematurity risk?

Heart-shaped uterus with one cervix.

How can fibroids affect fertility?

May inhibit implantation or cause prematurity.

What percentage of infertility is male-related?

1/3.

Most common hormonal cause of male infertility?

Low testosterone.

What glands can affect male hormonal infertility?

Pituitary gland and hypothalamus.

What structural disorders cause male infertility?

Undescended testes, hypospadias, varicocele.

What is varicocele?

Varicose vein of the scrotum.

How does substance abuse affect fertility?

Impairs sperm mobility, volume, and integrity.

What medications can cause impotence?

Antihypertensives.

What indicates ovulation hormonally?

LH surge.

What is true proof of ovulation?

Pregnancy or retrieval of ovum.

What hormone is checked to rule out endocrine causes?

Thyroid hormone.

What is the purpose of endometrial biopsy?

Assess uterine lining support for implantation.

What is HSG?

Injection of contrast into uterus to evaluate tubal patency and structure.

What pain can HSG dye cause?

Referred shoulder pain for 12-14 hours.

What gas is used during laparoscopy?

CO₂.

What pain does CO₂ cause post-procedure?

Shoulder pain up to 18 hours.

What does laparoscopy best evaluate?

Endometriosis and structural abnormalities.

How many days should male abstain before semen analysis?

2-5 days (or 3-5 days).

How many semen samples are collected?

Two samples weeks apart.

What pH should semen be?

Alkaline.

What sperm count is considered adequate?

>20-39 million.

What is assessed besides count?

Mobility and volume.

What is IUI?

Intrauterine insemination of sperm into uterus.

What is IVF?

Fertilization outside uterus, embryo implanted into uterus.

What is PGD?

Genetic testing of fertilized ovum prior to implantation.

What is GIFT?

Gamete intrafallopian transfer.

What is ZIFT?

Zygote intrafallopian transfer.

What is TDI?

Therapeutic donor insemination via sperm bank.

What is contraception?

Intentional prevention of pregnancy.

What is the ONLY 100% effective contraceptive method?

Abstinence.

What determines contraceptive safety?

Woman's medical history.

What must contraceptive methods be ideally?

Safe, available, economical, acceptable, simple.

What are the three FAM phases?

Infertile before ovulation, fertile mid-cycle, infertile after ovulation.

How long is the fertile window?

5-7 days mid-cycle.

How long can sperm live?

3-5 days.

How long is ovum viable?

16-24 hours after ovulation.

What happens to basal body temperature before ovulation?

Drops.

What happens after ovulation to temperature?

Rises and stays elevated.

Ovulation occurs how long after temp drop?

Within 2 days.

What hormone does ovulation predictor detect?

LH surge 12-24 hours before ovulation.

How often must breastfeeding occur for lactation amenorrhea?

Every 2-3 hours.

When must spermicides be inserted?

Within 1 hour before intercourse.

When must spermicides be reapplied?

Every act of intercourse.

What chemical is common spermicide?

Nonoxynol-9.

Why is Nonoxynol-9 concerning?

Irritates tissue and increases HIV/STI risk.

Which barrier methods protect against STIs?

Male condoms and vaginal sheath.

How effective are hormonal methods when used correctly?

About 91% effective.

What do COCs prevent?

Ovulation.

What are COC contraindications?

CV disease, thromboembolism, smoker, migraines, liver disease.

What medications decrease COC effectiveness?

Anticonvulsants and antibiotics.

How long for fertility return after stopping COCs?

3-12 months.

What does ACHES stand for?

Abdominal pain, Chest pain, Headache, Eye problems, Severe leg pain.

How often is contraceptive patch changed?

Weekly for 3 weeks, none 4th week.

Where should patch not be placed?

Breast tissue.

Why is patch ineffective in obese women?

Poor absorption.

How long is vaginal ring kept in?

3 weeks, remove week 4 for withdrawal bleed.

Who are progestin-only pills best for?

Breastfeeding women.

When must progestin pill be taken?

Same time daily.

How often is Depo given?

Every 11-13 weeks.

When is Depo first administered in cycle?

First 5 days of menstruation.

What must NOT be done at Depo injection site?

Do not rub.

Depo increases risk of what clotting condition?

DVT.

What bone issue is associated with Depo?

Decreased bone mineral density.

How long do implants last?

3-5 years.

Where are implants inserted?

Upper part of non-dominant arm.

When must emergency contraception be used?

Within 72 hours of unprotected intercourse.

Does Plan B work after ovulation?

No, only inhibits ovulation.

What are the three US EC methods?

High-dose estrogen/OCPs, Levonorgestrel, Copper IUD.

What is most common EC?

Plan B (Levonorgestrel).

How is Plan B dosed?

1 tablet ASAP, may repeat in 12 hours.

When should pregnancy test be taken after copper IUD EC?

21 days later.

Do IUDs protect against STIs?

No.

What does PAINS stand for?

Period late, Abdominal pain, Infection exposure, Not well, String missing.

What is tubal occlusion?

Blocking fallopian tubes to prevent fertilization.

What is tubal ligation?

Bilateral closure of tubes.

Is sterilization permanent?

Yes (should be considered permanent).

How long before procedure must consent be signed?

30 days prior.

What is vasectomy?

Cutting vas deferens.

Define abortion.

Purposeful interruption before 20 weeks gestation.