managing your fertility

© 2009 McGraw-Hill Higher Education. All rights reserved.

Chapter Thirteen: Managing Your Fertility


Birth Control vs. Contraception

Birth control refers to all procedures and methods that can prevent the birth of a child

Contraception refers to procedures used to prevent fertilization


Theoretical Effectiveness vs. Use Effectiveness

Theoretical effectiveness: Measure of a contraceptive method’s ability to prevent a pregnancy when the method is used precisely as directed during every act of intercourse

Use effectiveness: Measure of a contraceptive method’s ability to prevent a pregnancy when used by the general public


Selecting Your Contraceptive Method

SafetyEffectivenessReliabilityReversibility

Affordability Ease of use Interference with

sexual expression

Considerations when choosing contraception


Behavioral Contraceptive Methods

Abstinence No sexual activity 100% effective

Chance No method used 15% use effectiveness

Withdrawal (“coitus interruptus”)

Removal of penis from vagina before ejaculation

73% use effectiveness


Behavioral Contraceptive Methods (cont.)

Periodic abstinence (rhythm method)

• Calendar (calculating the unsafe days of a women’s menstrual cycle)

• Basal body temperature (rise in body temperature correlates with timing of ovulation)

• Billings cervical mucus method (evaluate consistency of vaginal discharge to predict ovulation)

• Symptothermal (combines basal temperature and mucus methods)



Periodic Abstinence


Over-the-Counter Contraceptive MethodsSpermicides

Foams Creams Jellies Films Suppositories

Condoms Male Female

Contraceptive sponge


Over-the-Counter Contraceptive Methods

Vaginal spermicides

OTC agents that are capable of killing sperm



Over-the-Counter Contraceptive Methods (cont.)

Male condom OTC latex shield designed to cover erect penis and retain semen upon ejaculation


Male condom with spermicide

Latex condom in combination with spermicide


Female condom Polyurethane sheath inserted into the vagina


Contraceptive sponge

Small, pillow-shaped contraceptive that contains spermicide; placed in the vagina to cover the cervical opening



Use of a Male Condom

Keep a supply on hand Handle condoms with

care Put condom on before

genital contact Lubricate the condom Take care the condom is

not dislodged from penis Inspect condom for tears

before discarding


Prescription Contraceptive Methods

Diaphragm Lea’s Shield FemCap Intrauterine device

(IUD) Oral contraceptives

Combined pills Minipills

Injectable contraceptive

Contraceptive implant Contraceptive ring Contraceptive patch


Prescription Birth Control Methods

Diaphragm • Soft rubber cup that covers the cervix• Fitted by health care professional• Used with spermicide


Lea’s Shield or FemCap

• Lea’s shield: Reusable oval silicone device that covers the cervix

• FemCap: Reusable hat-shaped silicone cap that covers the cervix

• Use similar to diaphragm


Intrauterine device (IUD)

• T-shaped device inserted into the uterus• Medicated or unmedicated• Somehow interferes with implantation of

the ovum• World’s most popular reversible

contraceptive method

99%+ use effectiveness


Use of a Diaphragm


Prescription Birth Control Methods(cont.)

Oral contraceptive pills

• Daily pills• Estrogen works by reducing ovum development• Progesterone reduces ovulation and thickens cervical

mucus• 92% use effectiveness

Side effects •Tenderness in breasts•Nausea•Headaches•Spotting•Weight gain•Sex drive fluctuation•Frequent vaginal infections•Mild depression

Potential risks Blood clots, stroke, hypertension, heart attack



Minipills • Daily pill• Low-dose progesterone• 92% use effectiveness

Injectable contraceptive

• Each shot effective for a 3-month period • Prevents ovulation and thickens the cervical mucus• 97% use effectiveness

Contraceptive ring (NuvaRing)

• Polymer device containing estrogen and progestin• Placed deep in the vagina for a 3-week period • 92%+ use effectiveness

Contraceptive patch

• Skin patch containing estrogen and progestin• Worn for 3 weeks, then 1 week off, then new patch• 92%+ use effectiveness



Contraceptive implant

• Protection is good for 3 years• Can be used while breastfeeding • Physician must insert and remove• May cause temporary irregular bleeding• Possibility of cardiovascular problems• Use effectiveness not yet known


Emergency Contraception Contraceptive measured used to prevent pregnancy

within a few days of unprotected intercourse Hormonal or IUD insertion “Morning after” pill; not RU-486 (“abortion pill”) Plan B available behind the pharmacy counter

Those under age 18 must have a prescription Will not cause abortion or affect established pregnancy


Sterilization

Sterilization = Generally permanent birth control techniques that surgically disrupt the normal passage of ova or sperm

Vasectomy: Removal of a section of the vas deferens

Tubal ligation: Fallopian tubes are cut and the ends tied back


Male Sterilization: Vasectomy


Female Sterilization: Tubal Ligation


Abortion: Termination of a Pregnancy

First Trimester Procedures Manual vacuum aspiration

Procedure performed by dilating the cervix and removing uterine contents

Dilation and suction curettage (D&C) Procedure in which the cervical canal is dilated to

allow the uterine wall to be scraped Medication abortion

RU-486 (mifepristone) blocks the action of progesterone and causes the lining of the uterus to break down


Abortion: Termination of a Pregnancy (cont.)

Second Trimester Procedures Dilation and Evacuation (D&E)

Performed between 13 and 16 weeks of pregnancy Cervix is dilated and contents are removed by suction

Rarely used procedures Hypertonic saline procedure Prostaglandin procedure


Dilation and Evacuation


Abortion: Termination of a Pregnancy (cont.)

Partial-birth abortion Federal ban

Third-trimester abortion procedures Hysterotomy Hysterectomy


Pregnancy

Obstacles to FertilizationAcid level in the vaginaCervical mucus thicknessLocation of cervical entrance for spermLocation of the correct fallopian tube for

spermDistance sperm travelsMotility of sperm


Aids to Fertilization

200-500 million sperm cells are deposited into the vagina during ejaculation

Sperm are deposited near the cervical opening Male accessory glands help make the semen

nonacidic Uterine contractions aid sperm movement in the

proper direction Sperm cells move fairly quickly Sperm can live for days Cervical mucus is thin and watery at the time of

ovulation


Fertilization and Implantation


Signs of Pregnancy (Presumptive)

Missed menstrual period after sexual intercourse the previous month

Morning sicknessIncrease in size and tenderness of breastsDarkening of the areolar tissue around the

nipples


Signs of Pregnancy (Probable)

Increased frequency of urinationIncreased in the size of the abdomenCervix becomes softer by the sixth weekPositive pregnancy test


Signs of Pregnancy (Positive)

Determination of a fetal heart beatFeeling of the fetus moving (“quickening”)Observations of the fetus by ultrasound or

optical viewers


Agents that Can Damage a Fetus

Rubella/herpes viruses

Tobacco smoke Alcohol

Certain OTC drugs Radiation Accutane (acne drug)


Intrauterine Development

Three trimesters (13 weeks each) First trimester

Zygote Blastocyst Embryo Fetus (after 8 weeks)

Second trimester: Organs develop, fetal heartbeat and bone structure evident, prominent weight gain in the mother

Third trimester: Fetus increases weight from 2-3 pounds; absorption of major nutrients allowing increased growth and weight


Three Stages of Labor

Effacement/dilation of the cervix: Uterine contractions thin the cervix and enlarge

the cervical opening Cervix opens to 10 cm during this stage

Delivery of the fetus: Uterine contractions are aided by mother’s

voluntary contractions of abdominal muscles Fetus moves through the birth canal

Delivery of the placenta: Placenta detaches from uterine wall


Stages of Labor and Childbirth


Cesarean Deliveries (C-section) Fetus is removed from the uterus through the

abdominal wall Possibly due to one or more of the following

factors: Fetus is improperly positioned Mother’s pelvis is too small Fetus is especially large Fetus shows signs of distress Umbilical cord is compressed Placenta is being delivered before the fetus Mother’s health is at risk


Causes of Infertility

Low sperm count Poor sperm motility Sperm abnormalities Lack of ovulation Obstruction of fallopian tubes


Enhancing Fertility

Cold packs on the scrotum (men) Boxer shorts vs. briefs (men) Increase intercourse frequency


Treatments for Infertility

Artificial insemination Surgical procedures Fertility drugs Assisted reproductive technology

In vitro fertilization Gamete intrafallopian transfer Zygote intrafallopian transfer Intracytoplasmic sperm injection


Options for Infertile Couples

Surrogate parenting

Adoption

Foster parenting


Cloning Techniques

Procedures involve the following: Surgical removal of an egg from female donor Nucleus of the egg is removed Cell is taken from a cloning subject

(male/female) Through an electrical jolt, the cell is fused with

the enucleated egg, creating a clonal zygote Embryo is implanted in the womb of a surrogate

mother After nine months, a genetically matched

reproduction is born


Cloning

Reproductive cloning Not yet accomplished Banned in selected countries and states

Therapeutic cloning Can be used to create stem cells


Chapter Thirteen: Managing Your Fertility

managing your fertility

Health & Medicine