contraception, birth control

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HUMAN INTERVENTION IN
REPRODUCTION
CONTRACEPTION
AND
BIRTH CONTROL???

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 Planned pregnancies are healthier
 Unplanned pregnancy can have an impact on many
areas of a woman’s life
-Academics
-finance
-future plans
-relationships
-mental and physical health
 Tremendous impact on her partner’s life as well…..

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How pregnancy can be prevented?
 Birth Control:-Method or device that prevent birth
(prevent fertilization)
CONTRACEPTION
2 types:- Natural and Artificial
Contraceptive
choice
Efficacy
Safety
Non
contraceptive
benefits
Cost
Personal
consideration

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I. Natural Methods
1. Abstinence (Not having sex)
2. Rhythm system(Periodic Abstinence)
3. Withdrawal Method (Coitus Interruptus)

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1. ABSTINENCE
 Only 100% method of birth control
 Abstinence is when partners do not engage in sexual
intercourse
 Healthiest choice for young teens
 Avoid risk of STDs + pregnancy
 Effective use of abstinence means:
-making a Decision
-making a Plan
-Being Prepared

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2. RHYTHM METHOD (periodic abstinence)
 Your fertility pattern is the number of days in the month when
you are fertile(able to get pregnant), days when you are
infertile and days when fertility is unlikely, but possible.
 If you have a regular menstrual cycle, you have about nine or
more fertile days each month.
 No sex during fertile period/use contraceptive: No pregnancy
 Fertility awareness based methods-75-96% effective

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 Calendar ‘rhythm”
 Ovulation (cervical mucus) method
 Basal Body Temperature( 1 to11/2oC)
 Combination
 Standard days method (cycle beads)
 Ova remains viable-12 to 24hrs
 Sperm Viability-3 days
Abstinence 4 days before
and 4 days after probable
ovulation date

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3. COITUS INTERRUPTUS
 Male withdrawal method
 Male withdraw penis from vagina prior to ejaculation
 Extremely erratic and unreliable sperms may be present in
the fluid secreted before ejaculation (sufficient for
conception).
Effectiveness rate is 80% (very unpredictable in teens,
wide variation)

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II. ARTIFICIAL METHODS
1. Barrier Methods
a) Condoms
b) Diaphragm
c) Cervical Caps
d) Sponge
e) Spermicide
2. Hormonal Methods
a) Oral contraceptives
b) The SHOT: Depo-provera
c) Implants
d) Combined Vaginal Ring :NuvaRing
e) Combined Patch
3. Intrauterine Devices
4. Sterilization

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1. BARRIER METHODS
 Prevents pregnancy blocks the egg and sperm from
meeting
 Barrier methods have higher failure rates than hormonal
methods due to design and human error

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1) CONDOMS
a) Male Condoms
Condoms are latex sheaths that cover the penis and prevent
sperm from entering the vagina
 Perfect effectiveness rate = 97%
 Typical effectiveness rate = 88%
 Latex and polyurethane condoms are available
 Combining condoms with spermicides raises effectiveness
levels to 99%
 How to use?
 A condom is unrolled over the length of an erect penis
before vaginal or anal sex.
 Always check expiry date and be careful when opening
package
 Use water based lubricants only

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b) Female condoms
-it is a polyurethane pouch with rings at both ends
-prevents sperm from being deposited into the vagina
 Perfect rate = 95%
 Typical rate = 79%
 Woman can use female condom if partner refuses
 How to use?
 Placed inside the vagina so that the inner ring (closed end)
reaches the cervix. Outer ring (open end) hangs slightly
outside the vagina.
 Can be used with both water based and oil based lubricants.

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Reality  : The Female Condom
The female condom is a lubricated polyurethane sheath, similar in appearance to a male condom. It
is inserted into the vagina. The closed end covers the cervix. Like the male condom, it is intended
for one-time use and then discarded.
The sponge is inserted by the woman into the vagina and covers the cervix blocking sperm from

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2.DIAPHRAGM
-It is a flat ring with a latex cap that covers the cervix and
prevents sperm from moving up the female genital tract to
unite with the egg.
How to use?
 The women inserts diaphragm in vagina before intercourse
and place it so that it covers the cervix.
 Must be used with a spermicide gel or cream since diaphragm
can move slightly during the intercourse.
 Must be kept in place for 8 hours after sex but no longer than
24 hours.
 Must be fitted by a physician.
 Perfect Effectiveness Rate = 94%
 Typical Effectiveness Rate = 80%

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DIAPHRAGM
The diaphragm is a flexible rubber cup that is filled
with spermicide and self-inserted over the cervix
prior to intercourse. The device is left in place
several hours after intercourse. The diaphragm is a
prescribed device fitted by a health care
professional and is more expensive than other

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3. CERVICAL CAPS
A cervical cap is a small latex cap (shaped some what like a
thimble, but larger) that covers the cervix and prevents sperm
from travelling up the female genital tract to unite with an
egg.
 “Caps” around cervix with suction
 Fill with spermicidal jelly prior to use
 Can be left in body for up to a total of 48 hours
 Must be left in place six hours after sexual intercourse
 Perfect effectiveness rate = 91%
 Typical effectiveness rate = 80%
How to use?
 Similar to diaphragm but left in place for up to 48 hours.

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Cervical Cap
The cervical cap is a flexible rubber cup-like device that is filled
with spermicide and self-inserted over the cervix prior to
intercourse. The device is left in place several hours after
intercourse. The cap is a prescribed device fitted by a health care
professional and can be more expensive than other barrier

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4. SPONGE
 The contraceptive sponge is a round disposable barrier made
of a polyurethane foam that contains spermicide. It is placed
deep in the vagina and absorbs and traps sperm so that they
don’t travel up the female genital tract to unit with an egg.
How to use?
 Similar to diaphragm but left in place for 6 hours and no more
than 24 hours

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Sponge
The sponge is inserted by the woman into the vagina and covers
the cervix blocking sperm from entering the cervix. The sponge
also contains a spermicide that kills sperm. It is available without
a prescription

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5)SPERMICIDES
 Chemicals kill sperm in the vagina
 Different forms:
-Jelly -Film
-Foam -Suppository
 Some work instantly, others require pre-insertion
 Only 76% effective (used alone), should be used in combination
with another method i.e., condoms/diaphragm
How to use??
 Inserted into vagina before intercourse

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2. HORMONAL METHOD
Reproductive Hormones are manipulated –to prevent
pregnancy
a) Oral contraceptives
b) The SHOT: Depo-provera
c) Implants
d) Combined Vaginal Ring :NuvaRing
e) Combined Patch

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1)ORAL CONTRACEPTIVES
(BIRTH Control Pills)
 These are synthetic compounds that mimic the effects of
hormones(Estrogen and Progestrone). These hormones
prevent the release of an egg from the ovaries.
 Must be prescribed by a physician.
 Pills are safe and effective when taken properly
 Pills are over 99% effective
 Pills DO NOT prevent STD’s

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 3 types of pills :-
1. Combination Pills-Oestrogen + Progestron
-Taken daily for 21 days (5th to 25th of menstrual cycle)
2. Sequential Pills- Only oestrogen for 1st 14 days
-Oestrogen + Progestrone-next 7 days
3. Mini Pills- Only Progestrone
-taken through out the year.

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How does the pill work?
 Stops ovulation(These hormones inhibits the release of LH and FSH by acting
on the pituitary and hypothalamus. Lack of LH and FSH in turn inhibits follicle
development and ovulation)
 Thins uterine lining
 Thickens cervical mucus

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Positive Benefits of Birth Control Pills
 Prevents pregnancy
 Eases menstrual
cramps
 Shortens period
 Regulates period
 Decreases
incidence of
ovarian cysts
 Prevents ovarian
and uterine cancer
 Decreases acne
• Breast tenderness
• Nausea
• Increase in
headaches
• Moodiness
• Weight change
• Spotting
Side-effects

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Taking the Pill
 Once a day at the same time everyday
 Use condoms for first month
 Use condoms when on antibiotics
 Use condoms for 1 week if you miss a pill or
take one late
 The pill offers no protection from STD’s

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2) The SHOT: Depo-Provera
 It is a single synthetic hormone(Progestin) that is injected into the muscle
of the upper arm.
 Long acting Progestin
 Hormone prevents the release of an egg from the overies
 It also thickens cervical mucous, which inhibits sperm from moving up the
female genital tract.
 No estrogen-less risk than pills.
How to use?
Depo-provera is prescribed by a physician and a woman using this method
receives an injection every 10-13 weeks.

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How does the shot work?
 The same way as the Pill!
 Stops ovulation
 Stops menstrual cycles!!
 Thickens cervical mucus

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3) IMPLANTS
 Set of plastic rods that slowly release a synthetic
hormone (Progestin)
 The rods are inserted under the skin or the
upper arm.
 The hormone prevents the release of an egg
from the ovaries.
How to use?
 Physically inserted in simple 15 minute
outpatient procedure by physician
 Protection lasts for 3-5 yrs.
 99.95% effectiveness rate

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Norplant Implant

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4)Vaginal Ring (NuvaRing)
 Flexible, Transparent
 Placed inside the vagina
 Releases daily- Estrogen and progestrone
 95-99% Effective
 In for 3 weeks and out for 1(during periods)
 A new ring is inserted into the vagina each month
 Does not require a "fitting" by a health care provider, does not
require spermicide,
NuvaRing is a
flexible plastic
(ethylene-vinyl
acetate
copolymer) ring
that releases a low
dose of a
progestin and an
estrogen over 3
weeks.

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5) Combined PATCH
Estrogen and Progestrone: prevents ovulation
Cycle: 3 weeks-1 patch each
-4th week-no patch
91-99% effective
Less effective in women who weigh more
Side effects-
•Break through bleeding
•Breast tenderness
•Itching and rashes
•Fall off: check once a day

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3.INTRAUTERINE DEVICES (IUD)
 T-shaped object placed in the
uterus to prevent pregnancy
 Works by killing the sperm and
altering the environment of the
uterus to make it more difficult
for a fertilized egg to implant.
 Extremely effective without
using hormones > 97 %
 Consult with aphysician
The intrauterine device (IUD) shown uses copper as the active contraceptive,
others use progesterone in a plastic device. IUDs are very effective at
preventing pregnancy (less than 2% chance per year for the progesterone
IUD, less than 1% chance per year for the copper IUD). IUDs come with
increased risk of ectopic pregnancy and perforation of the uterus and do not
protect against sexually transmitted disease. IUDs are prescribed and placed

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4. STERILIZATION
 Procedure performed on a man or a woman
permanently sterilizes
 Female = Tubal Ligation
 Male = Vasectomy

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i) SURGICAL STERLIZATION
a)TUBAL LIGATION
 Surgical procedure performed on a woman
 Fallopian tubes are cut, tied, cauterized, prevents eggs from
reaching sperm
 Failure rates vary by procedure, from 0.8%-3.7%
 May experience heavier periods
Surgical sterilization which
permanently prevents the
transport of the egg to the
uterus by means of sealing the
fallopian tubes is called tubal
ligation, commonly called
"having one's tubes tied." This
operation can be performed
laparoscopically or in
conjunction with a Cesarean
section, after the baby is
delivered. Tubal ligation is
considered permanent, but
surgical reversal can be

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b) VASECTOMY
 Male sterilization procedure
 Ligation of Vas Deferens tube
 Faster and easier recovery than a tubal
ligation
 Failure rate = 0.1%, more effective than
female sterilization

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During a vasectomy (“cutting the vas”) a urologist
cuts and ligates (ties off) the ductus deferens.
Sperm are still produced but cannot exit the body.
Sperm eventually deteriorate and are phagocytized.
A man is sterile, but because testosterone is still
produced he retains his sex drive and secondary sex
characteristics.

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ii) REMOVAL OF SEX ORGANS
 Surgical removal of sex organs –absolute contraceptive
method
 Castration- Removal of Testes
 Oophorectomy-Removal of ovaries
 Hysterectomy- Removal of uterus
 Non reversible
 Cause hormonal imbalance

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THANKYOU

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TERMINATION OF PREGNANCY
 When contraception fails : Terminating a pregnancy
 Abortion is the termination of pregnancy-Death of the embryo/
foetus
 2 types: Natural (Spontaneous)
-Artificial (Induced/Medical termination of pregnancy)
#before 20th week, sometime before 28th week
Choosing a method of pregnancy termination
 Two methods used for terminating a pregnancy
-Surgical abortion
-Medical abortion
 The earlier the procedure performed-fewer the risk and problem
 After20 weeks of pregnancy an abortion is performed only under
exceptional circumstances.

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SURGICAL ABORTION
 Involves the gentle opening of the cervix and extracting the
contents of the uterus-most common method
 To have a surgical abortion a women must beat least 6 weeks
pregnant.
 Surgical abortion are best done between 6 and 12 weeks;after
which the complication increases.
 Risk include : Infection, hemorrhage, laceration of the cervix,
perforation of the uterus and incomplete abortion.
 Complication rate: less than 0.5%-6 to 12 week
1%- 12 to 20 week

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1. VACUUM ASPIRATION( Vacuum suction)
-cervix dilated first using a dilator
-then, a suction aspirator is inserted into the uterus-with its help EMBRYO
and the connected structures are evacuated.
-1st 3 months (12 weeks)
2. DILATION AND CURETTAGE (D&C)
-Cervix is dilated first using a dilator
Then, endometrium is scraped out –implanted embryo is removed with the
help of spoon like instrument-CURETTE
-1st 3 month
3. LAPROSCOPIC TECHNIQUE
-some amniotic fluid is removed 1st using needle or syringe
-then, a solution (Salt + prostaglandins) is injected to replace the amniotic
fluid taken out.
 Salt sol.- Kills the foetus in 1-2 hr.
 Prostaglandins- contraction of uterine wall-expel the foetus
 Late pregnancy (6 months)

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MEDICAL ABORTIONS
 Available only before 49 days (7 weeks ) of pregnancy. With this type of
abortion, medication, rather than surgery, is used to end the pregnancy.
 Require regular visit (3-5) to the clinic to ensure that the abortion has
occurred and that there are no complications.—3-5% chance of needing a
surgical abortion because the pregnancy has not been terminated or
because of excessive bleeding.
 Less invasive compared to surgical abortion. However, it takes longer to
complete and a women may experience more significant bleeding and
more acute pain than with a surgical abortion.

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