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33 Cards in this Set
- Front
- Back
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factors that affect fertility |
40% of time is female, 20% is male, the rest is both 25% of time is failure to ovulate- aging is most important factor in failing, can be irregular or anovulatory, age, PCOS, excess exercise, endometriosis, breast feeding tubal patency- from scarring, PID, gonorrhea, chlamydia, congenital defects, prior surgery causing adhesions, ectopic pregnancy passage between ovary and tubes; between tubes and cervix- abnormal shape, fibroids, stenosis of cervix, adhesions reproductive hormones that affect endometrial preparation and cervical mucous- thyroid, adrenal, stress, antisperm immunologic response |
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percent of infertile couples |
10-15%, delay in childbearing is increasing infertility diagnosis does not occur unless unable to conceive after 1 year of attempting |
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when would you make a referral for infertility evaluation |
after 1 year of attempting, couple has positivie history of infertility women over 35 years of age only need 6 months of attempting before referral can be given |
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investigation of infertility |
educate about timing folic acid intake, teratogens, drugs, medications, appropriate nutrition, impact of stress ovulation- basal body temp increases by half a degree to degree day after ovulation may look at hormone levels look at structural factors tubal patency can diagnose adhesions, endometriosis, and structural abnormalities through visualization tests |
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methods of managing infertility |
IVF (ovum is fertilized outside of body and then embryo placed in uterus) (can use gestational carrier, carries embryo for another person)(surrogate is gamete donor and gestational carrier), CAM (complementary and alternative medicine), therapeutic insemmination (only sperm handled) hormonal treatment- clomid hyperinsulinemia from PCOS- metformin progesterone- facilitates thickening of uterine lining accupuncture, herbal, ginseng |
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indications for preconceptual genetic testing
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if mother is over 35 (risk factor is 1 in 200 of chromosomal abnormality, over 45 is 1 in 20), if there is a family history of birth defects or intellectual disabilities if there was a previous pregnancy with chromosomal abnormalities, metabolic disorders or two first term spontaneous abortions parental genetics- carriers for metabolic disorder women with teratogenic risk exposed to chemicals, radiation, diabetes |
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birth defects/ genetic counseling |
1 out of 28 cleft lip, heart defects, down's syndrome, spinal bifida 70% are from unknown causes no screening if there isn't follow up counseling |
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how many pregnancies terminated |
4 in 10 |
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benefits of family planning |
important component of women health- lower incidence of STIs, fewer unintended pregnancies, lower rates of induced abortions, fewer unwanted pregnancies, improved socioeconomic status |
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leading method of contraception |
birth control pill for under 35 sterilization for over 35 increase in condom use |
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natural family planning method |
highest risk of fertility, 5-6 days before ovulation and 3 days after ovum is viable for up to 3 days, sperm up to 7 days calendar, basal body temperature, and cervical mucus methods are combined. Avoid having sex between days 8-19 (least reliable) cervical mucus becomes stretchy, clear and slippery when ovulating symptothermal method- combines symptoms and basal body temperature, cervical mucus changes, abdominal bloating, changes in basal body temperature, cramping must take her temp every morning and record it (progesterone creates the increase) |
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who cannot use fertility awareness cycle |
need regular menstrual cycles between 26 and 32 days long need to be able to use condoms as well wait to start if recently given birth wait if using long acting injectible such as depoprovera |
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diaphragm |
needs to be measured for fit and refit should be used with spermicidal gel needs to be left in place 6 hours after intercourse- no more than 24 hours HPV prevention |
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cervical cap |
similar to diaphragm but is smaller and fits over cervix needs spermicide spermicide doesn't need to be reapplied to cap after intercourse (unlike diaphragm) left in place for 6 hours and can be left in for 48 hours difficult to fit, insert, and remove |
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today sponge |
spermicide, barrier method, obsorbs sperm, moistened with water before insertion, can be put in 24 hours before, and stay in place 6 hours after |
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hormonal methods |
use estrogen or progesterone or both estrogen suppresses FSH and LH progesterone inhibits LH surge |
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who can not use pill |
smokes and is over 35, high blood pressure, gave birth within 3 weeks, breastfeeding, may be pregnant, other serious health conditions presence or history of blood clots, history of stroke or heart disease migraine headaches breast cancer |
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combined oral contraceptives |
taken daily for 21 days minipill is progestin only pill- sometimes suppresses ovulation, but also diminishes cervical lining |
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other benefits of the pill |
relieving menstrual cycle flow, pain, reduces incidence of ectopic pregnancy, PID, ovarian/ endometrial/ colorectal cancer, iron deficiency anemia, benign breast disease |
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possible side effects of the pill |
rare, but can include nausea, spotting, mild headaches, tender breasts, dizziness, slight weight gain |
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ACHS |
abdominal pain, chest pain, headaches, eye problems, severe leg pain signs and symptoms of strokes or blood clots with the pill |
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the patch |
three weeks on, one week off for menses, less than 198 pounds safe and effective of pill DVT risk |
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vaginal contraceptive ring (nuvaring) |
3 weeks on 1 week out, refrigerated estrogen and progesterone |
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librel |
low dose pill taken for 1 yfear with no breaks suppress all bleeding |
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seasonal and seasoniqu |
take pill for 3 month and off for 1 week |
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depoprovera |
every 3 months only use progestin IM injection- can be given subcutaneous and can be self administered |
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implenon |
subdermal which is replaced every 3 years thickens cervical layer |
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IUD |
increased bleeding during menses mirena- effective for 5 years, hormonal- thicken cervical mucus, slow growth of uterine lining paragard- effective up to 10 years- immobilize sperm, not hormonal, copper changes lining of uterus leading to inflammation may lower cervical cancer risk previous pregnancy makes it helpful to insert device increases risk of PID so need condoms side effcts: bleeding and cramping, infection within the first 3 weeks, accidental pregnancy, expulsion of device |
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coitus interruptus |
withdrawal method great self control on man's part can remain in urethra afterwards to make female pregnant |
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douching |
completely ineffective, not recommended, may induce pregnancy |
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emergency contraception |
within 72 hours after intercourse sexual assault, , contraceptive failure two regimes: high dose of birth control pill, progestin only approach (plan b) do not need prescription if 17 or older almost 90% decrease in pregnancy Ella- perscription only- 5 days after unprotected sex |
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sterilization |
nonoperative (essure- 99% effective, permanent, inserts placed between fallopian tube and uterus and leads to completeblockage, afterwards do a confirmation) and operative (tubal ligation (fallopian tubes cut and removed), vaectomy (vas deferns is severed, takes 4-6 weeks after procedure, must have negative sperm count to be considered sterile, 6-36 ejaculations needed) |
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abortions |
mifepristone- blocks progesterone and alters endometriom 63 days after last menstrual period 1-3 days after, oral or vaginal dose of misoprostol is administered which induces contractions to dispel fetus third visit is to confirm success in the first trimester or second trimester. first is more safe, suction curettage used in first. second may need dilatation and evacuation |
