Contraception

Potpourri

Sterilization

Sterilization: Vasectomy

• Vasectomy blocks sperm from traveling through the vas deferens, preventing sperm from mixing into semen

• No glands or organs are removed

• Effectiveness: 99%+• Considered irreversible

Sterilization: Vasectomy

• Vas deferens must be isolated

• Similar to tubal ligation, the vas deferens can be cut and tied, clamped, cauterized, no scalpel technique

• Another form of contraception must be used for a few months

Sterilization: Vasectomy• Cost: $350-1000 (plannedparenthood.org)

• Side effects– Bruising– Sensitivity/pain for up to a few weeks past the

procedure– Sperm leaking from tubes may lead to small lump

(usually clears up on its own)– Antibodies to sperm may develop, reducing chances of

fertility in a reversal

Vasectomy Complications

• Rare• Usually associated with infection (fever,

pus/blood from incision site, swelling, pain)• Ends of tubes may grow back together (very

rare)• Decreased sexual desire (4 out of 1000 cases

per Planned Parenthood) - no apparent physical cause

Sterilization: Vasectomy

• Animation (BUPA Health via YouTube, 2:36)

• Open-ended (no scalpel) vasectomy (medicalvideos.us)

• Video (vasectomymedical.com)

Sterilization: Tubal Ligation

• Surgical technique• Close fallopian tubes,

preventing egg from traveling to uterus, preventing sperm from reaching egg

• Neither organs nor glands are removed

• Effectiveness: 99%+• Considered irreversible

Sterilization: Tubal Ligation

• Tubal sterilization:– Tubes can be tied and cut

(Pomeroy technique)– Tubes can be cauterized– Tubes can be clipped, clam

ped– These incision methods

often performed after childbirth/abortion

– Animation (SMART imagebase)

Sterilization: Tubal Ligation

• Cost: $1000-3000• Side effects: thought by many to be rare;

hormonal imbalance may lead to increased menstrual bleeding, cramping; adhesions

• Complications: infection, internal bleeding, ectopic pregnancy

• Before/after photos (private Flickr account)

Sterilization: Implants

• Non-incision method– No general anesthesia– Under an hour

• Coils inserted into fallopian tubes

• In following months, coils and tissue grow together, forming barrier to prevent sperm from reaching egg

Sterilization: Implants

• Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting

• Demo (YouTube, 1:04)

Long-Term Contraception & Sterilization: Project Prevention

• Societal aid or eugenics?– FOX News program (1:30 minutes)– ABC News program (2:19 minutes)

Contraception in the Future: Nestorone

• Estrogen and progestin• Gel• Spray• Acrux Announcement,

February 2009• Figure 2: Estrogen content in

Nestorone, OrthoEvra, NuvaRing, combination pills

• 2012: Combination of nestorone and testosterone reduced sperm count in UCLA study

Contraception: The Future• Male hormonal contraceptive:

monthly testosterone injection• 5/ 2009: China clinical trials

– 1 in 100 fathered a child– Reversible six months after

stopping injections– 1/3 of 1000 participants did

not complete; no reason provided

– Few side effects reported (acne, weight gain), but more research needed

– Contraceptive methods may work better in Asian men vs European men

– Photo from BBC

Contraception: The Future

• RISUG– Reversible Inhibition of Sperm Under Guidance– Contraceptive method for men– Clinical trials in India– Injection into vas deferens of male (video, wired.com, :34)– RISUG disrupts membranes of sperm so they cannot fertilize– One injection to last 10 years– Reversibility not well tested, though reports on primates appear

positive (requires another injection)– Marketing challenges

Contraception: The Future

• Male contraceptive pill research at UW (KOMO report, 2009, 2:10, YouTube)

• Non-hormonal manipulation of sperm production has been successful in mice (2012)

• Vitamin A blocking can reduce fertility (but Vitamin A needed for other bodily functions)

Contraception: The Past

• Male Contraceptive: Heat– Prolonged heat exposure

can impair sperm production in testes

– Ancient method– Effectiveness?

• 116 degree bath• 45 minutes• Every day• Three weeks

Contraception: Impact of Heat on Sperm

Contraception: Impact of Heat on Sperm

Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India.Vol. 50, No. 2 (2001-07-2001-12)

Contraception: Impact of Heat on Sperm

• Upper left: coiled tail• Upper right: bent tail• Lower left: double

head• Lower right: triple

head

Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

Temperature Method• Track temperature every

morning• Look for slight drop in

temperature occurring immediately before ovulation

• At ovulation, temperature increases

• Temperature changes are small

• Look for trends, expect daily fluctuations

• Image source: Public domain, Wikimedia Commons

Temperature Method

• Use basal thermometer– Smaller scale (1/10 degree)

• Chart temperature for at least three months before relying on method

• Safe sex time begins 72 hours after temperature has risen, remains until temperature begins to drop

• Source: Dr. Sacha Elliott, ND

Temperature Method

• Day 10: 98.5 Day 17: 98.8• Day 11: 98.4 Day 18: 99.0• Day 12: 98.4 Day 19: 98.7• Day 13: 98.1 Day 20: 98.7• Day 14: 97.9 Day 21: 98.8• Day 15: 98.0 Day 22: 98.6• Day 16: 97.5 Day 23: 98.5

Cervical Mucus Method

• Tracking the variation in mucus consistency throughout cycle

• Cervical mucus begins a few days after menstruation• As mucus production increases, it’s yellow or white

in color & cloudy, sticky• Will become wet, clear• Clear, slippery mucus = most fertile• Mucus production decreases, cloudy & sticky

Cervical Mucus Method

• Tracking Your Cervical Mucus, Babycenter.com

• “Safe days” = begin after slippery mucus decreases, continue into cloudy & tacky, and especially dry days

• Short cycles = mucus may be hidden in menstrual flow

Calendar Method

• Predicting “safe” and “unsafe” days based on length of monthly cycles

• Can use traditional calendar, software, phone app, web tools

Calendar Method

• Count length of menstrual cycle – Day #1 = first day of menses– Last day = day before menses returns– Eight cycles are recommended before relying on

this method (Planned Parenthood)– First fertile day = shortest cycle minus 18– Last fertile day = longest cycle minus 11

Calendar Method

• Cycle 1: 24 Cycle 2: 27• Cycle 3: 25 Cycle 4: 28• Cycle 5: 25 Cycle 6: 27• Cycle 7: 29 Cycle 8: 25• Shortest day: 24• Longest day: 29• Unsafe days: #6-18

Calendar Method

• Online calendar method tool - virtualmedicalcentre.com

• Irregular period cycles = reduced effectiveness• Calendar method = requires another method

for most to experience adequate effectiveness

United Nations: Contraceptive Prevalence Across the World, 2005