Contraception and Fertility Treatments

Contraception is the deliberate prevention of pregnancy. To understand how each method works, you need one fact from the menstrual cycle: FSH (follicle stimulating hormone) causes an egg to mature in the ovary, and LH (luteinising hormone) triggers its release at ovulation.

Methods of contraception split into two groups based on how they interfere with this process:

• Hormonal methods change the hormone signals so that no egg matures or is released.
• Non-hormonal methods leave the hormones alone and instead physically stop the sperm and egg from meeting, or stop a fertilised egg from implanting.

Hormonal vs non-hormonal is the key distinction examiners test. A hormonal method works by altering FSH/LH/progesterone levels; a non-hormonal method works by a physical or surgical barrier.

The spec requires you to describe how each method works and to evaluate them — weighing reliability, side effects, and protection against sexually transmitted infections (STIs).

Hormonal contraceptives all work the same way at heart: they keep hormone levels in a state that inhibits FSH, so no egg matures and ovulation does not happen.

• Oral contraceptives ("the pill") contain hormones that inhibit FSH production, so that no eggs mature. With no mature egg, there is nothing to release or fertilise.
• Injection, implant, or skin patch deliver slow-release progesterone to inhibit the maturation and release of eggs for a number of months or years.

Hormonal method	What it delivers	How it prevents pregnancy	How long it lasts
Oral contraceptive (pill)	Hormones taken daily	Inhibit FSH → no egg matures	Must be taken every day
Injection	Slow-release progesterone	Inhibits egg maturation and release	A few months
Implant	Slow-release progesterone (under the skin)	Inhibits egg maturation and release	Several years
Skin patch	Slow-release progesterone	Inhibits egg maturation and release	Changed regularly (weekly in practice — not a spec figure)

The pill must be remembered every day to stay reliable. Forgetting doses is the main reason it fails in real use, which is why the longer-lasting implant and injection are more reliable for many people.

A drawback shared by all hormonal methods: they can cause side effects (such as headaches, mood changes, or nausea) and they give no protection against STIs.

Non-hormonal methods do not touch the hormone system. Instead they stop fertilisation physically, chemically, or surgically.

• Barrier methods such as condoms and diaphragms prevent the sperm reaching an egg. A condom is worn over the penis; a diaphragm is a cap fitted over the cervix.
• Spermicides are chemical agents that kill or disable sperm. They are often used alongside a barrier method to improve reliability.
• Intrauterine devices (IUDs) are placed inside the uterus. They either prevent the implantation of an embryo or release a hormone (note: the hormone-releasing type is a borderline case — its main listed action is preventing implantation).
• Abstaining from intercourse when an egg may be in the oviduct — that is, around the time of ovulation — avoids the fertile window.
• Surgical sterilisation cuts or seals the tubes that carry the sex cells: the oviducts in females or the sperm ducts in males. This is permanent.

Condoms are the only common method that also reduces the spread of STIs, because they form a physical barrier to body fluids. No hormonal method offers this protection.

Non-hormonal method	How it works	Reversible?
Condom	Barrier — stops sperm reaching the egg; also reduces STI spread	Yes
Diaphragm	Barrier over the cervix	Yes
Spermicide	Kills or disables sperm	Yes
Intrauterine device (IUD)	Prevents implantation of an embryo (some release a hormone)	Yes (removed)
Abstaining around ovulation	Avoids intercourse when an egg may be in the oviduct	Yes
Surgical sterilisation	Sex-cell tubes cut or sealed	No — permanent

The exam rarely asks "which method is best" — there is no single best. It asks you to evaluate methods against a stated priority. The skill is matching the method's properties to what the person actually wants.

Scenario A — A couple wants reliable, long-term contraception and does not want to remember a daily routine.

• Rule out the pill: reliable only if taken every day, which is exactly what they want to avoid.
• The implant fits well: slow-release progesterone inhibits egg release for several years with nothing to remember daily.
• An IUD also fits: long-lasting and low-maintenance.
• Conclusion: implant or IUD suit the priority; the pill does not.

Scenario B — A person's top priority is protection from STIs as well as pregnancy.

• Hormonal methods (pill, implant, injection, patch) prevent pregnancy but give no STI protection — rule them out as a sole method.
• The condom is the standout: it is the one common method that both prevents sperm reaching the egg and reduces STI spread.
• Conclusion: a condom directly serves this priority where hormonal methods cannot.

Evaluation marks come from linking a method's mechanism to the stated need and saying why alternatives fall short — not from listing every method you know.

(Higher Tier only — sections 4.5.3.6 below, including fertility drugs and IVF, are assessed on the Higher Tier paper.)

Some people cannot conceive because too little FSH is produced, so eggs do not mature. The same hormones that the pill suppresses can instead be given to do the opposite.

A 'fertility drug' contains FSH and LH. Given to a woman, it stimulates ovulation — FSH matures an egg and LH triggers its release. She may then become pregnant in the normal way, through natural intercourse.

Contraception and fertility treatment are mirror images of each other. Oral contraceptives inhibit FSH so no egg matures; a fertility drug supplies FSH and LH so eggs mature and are released.

A drawback: stimulating the ovaries can mature several eggs at once, raising the chance of multiple births (twins or more), which carry higher risks for the mother and babies.

Use of hormone	FSH/LH effect	Outcome
Oral contraceptive	Inhibits FSH	No egg matures → pregnancy prevented
Fertility drug	Supplies FSH and LH	Egg matures and is released → ovulation stimulated

(Higher Tier only.)

If a fertility drug alone does not work, In Vitro Fertilisation (IVF) can be used. "In vitro" means "in glass" — fertilisation happens in the laboratory, not in the body.

The spec gives a precise sequence. Learn it in order:

The precise sequence, in order:

1. The mother is given FSH and LH, which stimulates the maturation of several eggs.
2. The eggs are collected from the mother.
3. The eggs are fertilised by sperm from the father — this happens in the laboratory.
4. The fertilised eggs develop into embryos.
5. At the tiny ball-of-cells stage, one or two embryos are inserted into the mother's uterus (womb).

Walk-through — put these jumbled steps in order:

"Embryos inserted into uterus / FSH and LH given / eggs fertilised in the lab / eggs collected / embryos develop."

• Start with the hormone stimulus: FSH and LH given to mature several eggs.
• You cannot fertilise eggs you have not got, so next: eggs collected.
• Then eggs fertilised in the lab by the father's sperm.
• The fertilised eggs then develop into embryos.
• Finally, at the ball-of-cells stage, one or two embryos inserted into the uterus.

Be precise on two marks examiners watch for: FSH and LH mature several eggs (not one), and only one or two embryos are transferred — to limit the risk of multiple births.

IVF must be evaluated, weighing the benefit against the costs. The spec lists the points to use.

For IVF	Against IVF
Gives a couple the chance to have a baby of their own	Very emotionally and physically stressful
Can help where natural conception has failed	Success rates are not high
Uses well-established microscopy and lab techniques	Can lead to multiple births, a risk to both babies and mother

A strong evaluation states the benefit and at least one drawback, then reaches a justified judgement — for example, that the emotional and physical stress, combined with low success rates, makes IVF a difficult choice despite the chance of a baby.

There are also social and ethical issues, and the question of what happens to unused embryos, which is why issues around fertility and contraception cannot be settled by science alone — science supplies the facts, but the decision involves personal and ethical values.

1. Saying the pill "kills eggs" or "kills sperm"

Oral contraceptives inhibit FSH so no egg matures in the first place. Killing sperm is what spermicides do — a different, non-hormonal method.

2. Mixing up which hormone does what

FSH matures the egg; LH releases it. A fertility drug and IVF both use FSH and LH together — do not name just one.

3. Calling a condom or IUD "hormonal"

Condoms and diaphragms are barrier (non-hormonal) methods. A standard IUD is non-hormonal; only some IUDs release a hormone. The pill, implant, injection, and patch are the hormonal methods.

4. Getting the IVF order wrong

The eggs are matured and collected first, fertilised in the lab, then grown into embryos before transfer. Inserting embryos comes last, and only one or two are used.

5. Forgetting STI protection in an evaluation

If a question stresses protection from infection, hormonal methods score poorly — only the condom among common methods reduces STI spread. Match the method to the stated priority.