RNSG 2363 Reproduction and L&D Clinical Activity Worksheet Total 770 Points 2020

1. Describe the pathophysiology of infertility (10 pts) The inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception. Secondary infertility is the inabil ity to conceive after a previous pregnancy. Reproduction requires the interaction of the female and the male reproductive tracts, which involves (1) the release of a normal preovulatory oocyte, (2) the production of adequate spermatozoa, (3) the normal transport of the gametes to the ampullary portion of the fallopian tube (where fertilization takes place), and (4) the subsequent transport of the cleaving embryo into the endometrial cavity for implantation and development 2. Discuss the following contraception Methods and provide an example of each: 10pts each = (40 tot pts) A. Hormonal These methods of contraception work by altering the hormones within a woman’s body. They rely on estrogen and progestin or progestin alone to prevent ovulation. When used consistently, these methods are a reliable way to prevent pregnancy. Hormonal methods include OCs, injectables, implants, vaginal rings, and transdermal patches. OCs work primarily by suppressing ovulation by adding estrogen and progesterone to a woman’s body, thus mimicking pregnancy. This hormonal level stifles GnRH, which in turn suppresses FSH and LH and thus inhibits ovulation. Cervical mucus also thickens, which hinders sperm transport into the uterus. Implantation is inhibited by suppression of the maturation of the endometrium and alterations of uterine secretions. Progesterone only pills are appropriate for women who cannot take estrogen in combined OCs, for example, a woman older than 35 years who smokes cigarettes. They are prescribed for women who cannot take estrogen at all. These OCs work primarily by thickening the cervical mucus to prevent penetration of the sperm and make the endometrium unfavorable for implantation. B. Implantable Devices The implant is a subdermal time-release method that delivers synthetic progestin that inhibits ovulation. Once in place, it delivers 3 years of continuous, highly effective contraception. Like progestin-only pills, implants act by inhibiting ovulation and thickening cervical mucus so sperm cannot penetrate. A single-rod progestin implant (Nexplanon) is currently available in the United States. Intrauterine contraceptives are classified as either hormonal or nonhormonal. Both types prevent pregnancy via inhibition of sperm mobility and sperm viability and change the speed of transport of the ovum in the fallopian tube. An intrauterine contraceptive (IUC) is a small plastic T-shaped object that is placed inside the uterus to provide contraception by making the endometrium of the uterus hostile to implantation of a fertilized ovum by causing a nonspecific inflammatory reaction and inhibiting sperm and ovum from meeting. These include the Mirena, Skyla, and the Paragard.