FERTILITY & INFERTILITY

• Fertility is the ability of a man or woman to cause conception of a child.

• Infertility is the inability of a man or woman to cause conception of a child.

– Primary infertility

– Secondary infertility

CONTRACEPTION

• To prevent the occurrence of conception

• Measures which are responsible for preventing of conception are called contraceptive methods or contraceptives.

EMERGENCY CONTRACEPTION

• Methods of protecting against pregnancy after unprotected sexual intercourse.

• Also called post coital or morning after contraception.

• Prevents at least three fourth of pregnancies that would have occurred, sooner EOCs are used, better they prevent pregnancy.

FAMILY PLANNING

• Planning of the family

• Planning about the no. of children

• Planning of the family size within your economic resources

• Limit the size of the family

• All couples and individuals has a basic right to decide freely and responsibly for no. of children.

FAMILY PLANNING

A way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country.

OBJECTIVES OF FP

• A. To avoid unwanted births• b. To bring about wanted births• c. To regulate the intervals between

pregnancies• d. To control the time at which births

occur in relation to the ages of the parent• e. To determine the number of children in

the family.

Scope of FP Services

• The proper spacing and limitation of births• Advice on sterility/ infertility• Education for parenthood• Sex education• Screening for pathological conditions related to the

reproductive system• Genetic counseling• Premarital consultation and examination• Carrying out pregnancy tests,• Marriage counseling• The preparation of couples for the arrival of their first

child• Providing services for unmarried mothers• Teaching home economics and nutrition • Providing adoption services

Health aspects of FP

• Women’s Health:• Unwanted pregnancy• Limiting the no. of births & proper spacing• Timing of births

• Foetal health:• Congenital abnormalities with advanced maternal age• Quality of population

• Child health:• Family size and birth spacing• Child mortality• Child growth, development and nutrition• Infectious diseases• intelligence

FP & Birth control

• FP includes contraception, management of infertility, habitual abortion, genetic counselling & evaluation of termination of pregnancy.

• BIRTH CONTROL; – Control birth rate– Limit population

Population explosion

• Food deficit• Housing problems• Un-employment• Increase in mortality & morbidity• Low industrial / other development• Risk of communicable diseases• Lack of educational & health facilities• Low standard of living

Success of FP in Pakistan

• Wrong planning

• Non co-operation of public/ low literacy

• Lack of budget

• Lethargy, laziness & corruption of staff

• Failure of methods used

• Not proper health education

• High infant mortality rate

Spacing Methods

1. Barrier Methods:a. Physical methodsb. Chemical methodsc. Combined Methods

2. Intra-Uterine Devices3. Hormonal Methods4. Post-Conceptional Methods5. Miscellaneous/ conventional methods

Terminal Methods

1. Male sterilization

2. Female sterilization

Contraceptives

• Conventional: -coitus interruptus, -condom

-Rhythm method -diaphragms

• Chemical : -Hormonal-OCP, Inj,Norplant

• Clinical: Lippes loop, Copper-T, Multil.

• Surgical : vasectomy, tubal ligation.

Contraindications of FP

• Acute or chronic PID

• Large fibroid

• Cancer

• Pregnancy or suspected pregnancy

CondomThe Advantages:a. They are easily available

b. Safe and inexpensive

c. Easy to use; do not require medical supervision

d. No side effects

e. Light, compact and disposable, and

f. Provides protection not only against pregnancy but also against

The Disadvantages:a. It may slip off or tear during coitus due to incorrect use,

and

b. Interferes with sex sensation locally about which some complain while others get used to it.

Advantages of copper devices• Low expulsion rate

• Lower incidence of side-effect, e.g., pain and bleeding

• Easier to fit even in nulliparous women

• Better tolerated by nullipara

• Increased contraceptive effectiveness

• Effective as post-coital contraceptives. If inserted within 3-5 days of unprotected-intercourse

• Advantages:a. simplicity, i.e., no complex procedures are involved in insertion no hospitalization is required

b. insertion takes only a few minutes

c. once inserted IUD stays in place as long as required

d. inexpensive

e. contraceptive effect is reversible by removal of IUD

f. virtually free of systemic metabolic side-effects associated with hormonal pills

g. highest continuation rate

h. there is no need for the continual motivation required to take a pill daily or to use a barrier method consistently.

Contraindications• ABSOLUTE:

a. suspected pregnancy

b. pelvic inflammatory diseasec. vaginal bleeding of undiagnosed aetiologyd. cancer of the cervix, uterus or adnexia and other pelvic humours e. previous Ectopic pregnancy

• RELATIVE:a. anaemiab. menorrhagia c. history of PID since last pregnancyd. purulent cervical discharge malformations, fibroidsf. unmotivated person.

The ideal IUD candidate

The planned Parenthood Federation of America (PPFA) has described the ideal IUD candidate as a woman:

who has borne at least one child Has no history of pelvic disease Has normal menstrual periods Is willing to check the IUD tail Has access to follow-up and treatment of potential

problems, and Is in a monogamous relationship

Side effects• 1. Bleeding• 2. Pain• 3. Pelvic infection• 4. Uterine perforation• 5. Pregnancy • 6. Ectopic pregnancy• 7. Expulsion• 8. Fertility after removal• 9. Cancer and teratogenesis• 10. Mortality

Classifications

A. Oral Pills1. Combined pill2. Progestogen only pill (POP)3. Post-coital pill4. Once-a-month (long-acting) pill5. Male pill

B. Depot (slow release) formulations1. Injectables2. Subcutaneous implants3. Vaginal rings

Checklist for prescription of oral contraceptives

• above 40 years of age

• above 35 years of age

• heavy smoker

• H / o Seizures

• Severe pain in the calves or thighs

• Symptomatic varicose veins in the legs

• Severe chest pains

• Unusual shortness of breath

• Severe headache

• Lactating (yes=for less than 6 months)• Inter menstrual bleeding and/or bleeding

after sexual intercourse• Amenorrhoea• Abnormally yellow skin, eyes• Blood pressure (yes=above 140mm

Hg systolic and /or90 mm Hg diastolic

• Mass in the breast• Swollen legs (Oedema)