reproductive assigment

04/11/2023 contraception

Addis Ababa UniversityCollege Of Health Science

Department Of Medical Physiology

Presentation on contraception

By Girmay F.1


Presentation out line• Objectives• Introduction• Classification• Barrier method• IUCD• Hormonal contraceptives• Emergency contraceptives• Natural family planning • Coituis interrupts• Permanent contraceptives• Summery• References

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Objectives

• At the end of these presentation students expected:-

List the broad classification of contaceptive.Mention the types of barrier methods.explain The mechanism of hormonal

contraceptives.Know the permanent type of contraception

and their advantages.

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INTRODUCTION

Contraception deliberate prevention of pregnancy using any ofSeveral methods.

• Birth control prevents a female sex cell (egg) from being fertilized by a male sex cell (sperm) and implanting in the uterus.

• variety of birth control methods to choose from, although most options are for women.

• Selecting a method is a personal decision that involves consideration of many factors including convenience ,reliability, side effects, and reversibility.

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Cont’d

EFFECTIVENESS• No birth control method, is 100 percent effective in preventing

pregnancy. • two types of pregnancy rates when describing effectiveness.a. Method effectiveness ( perfect use) The percentage of pregnancies that occur when a particular

method is used correctly and consistently with each act of sexual intercourse.

b. User effectiveness( typical use) The percentage of pregnancies that result from average use of

the method, which accounts for improper or inconsistent use.

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classification

Broadly can be classified:-• Temporary• Permanent • Temporary: Reversible, includes the natural family

planning,coitus interrupts, barrier methods,IUCD and hormonal contraceptives.

• Permanent: vasectomy and tubal ligation.• Most contraceptive methods are reversible—they do not

affect a person’s ability to reproduce once the method is halted.

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TYPES OF BIRTH CONTROL

Birth control methods work in different ways to prevent pregnancy.

Some methods prevent sperm from meeting eggs.

Others affect a woman’s hormones, altering her reproductive cycle.

Other birth control methods involve behaviors that alter sexual activity in ways that lessen the chance for pregnancy.

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1.Temporary methods

A. Barrier methodso Barrier methods physically block sperm from entering the

uterus to unite with an egg.o Barrier methods must be used with each act of sexual

intercourse. While they are easy to use, some people feel barrier methods are inconvenient because they interfere with sexual spontaneity.

o Barrier methods include male and female condoms, the diaphragm, the cervical cap, and spermicides.

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A1.Male Condom

MOA:- During ejaculation (when semen ejects from the penis), the condom catches and holds sperm before it can travel into a woman’s uterus.

• Male condoms made of latex or polyurethane also protect users against many STIs, including HIV ,

• 86 % effective in preventing pregnancy. • Condom + spermicide / with coituis interaptius

greatly improves condom effectiveness.

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A2.Female Condom

o It is an elongated polyurethane .o A woman inserts the closed end of

the sac into the vagina to cover the cervix and prevent sperm from entering the uterus.

o The open end of the sac remains outside the vagina for the penis to enter.

o 79 % effective in preventing pregnancy.

o S/E :- genital irritation • It also reduces the risk of many

STIs.

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A3.Diaphragm

A shallow, molded cup of thin rubber with a flexible rim.

Before intercourse, spermicide must be placed inside the cup and around the inside of the rim of the diaphragm.

MOA :- Inserts the diaphragm into the vagina so that it covers the cervix, preventing the passage of sperm from the vagina to the uterus.

The spermicide kills any sperm that are able to pass by the diaphragm.

Various sizes to fit the cervix. 80 % effective in preventing

pregnancy.11

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A2.FC cont’d

C.The diaphragm is removed by hooking a finger under the forward rim (the edge behind the pubic bone).

B. The diaphragm is in proper position, fitting snugly between the posterior aspect of the pubic bone and the posterior vaginal fornix, completely covering the cervix. 04/11/2023

12contraception


A4 .Cervical Cap

• The cervical cap is a small silicone cup that blocks the cervix and held in place by suction.

• It should be used with a spermicide.

• It must be left in place at least 8 h after coitus and must be removed within 48 hr.

• 80 % effective in preventing pregnancy in women who have not given birth.

• 60 % effective in those who have given birth.

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A5.Spermicides

o Spermicides sperm-killing chemical that block the entrance to the cervix .o can be used alone or with a condom, diaphragm, or

cervical cap. o Spermicides used alone must be inserted deep into the

vagina before each act of intercourse and a woman should not douche for six to eight hours after intercourse.

o Spermicides used alone are 74 % effective in preventing pregnancy.

o S/E:- An allergic reaction such as irritation of the vagina or penis.

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B .Intrauterine Device(IUD)

• IUD is a small plastic device consists of a T-shaped piece of flexible placed through the cervical canal into the uterine cavity.

• Some IUDs have a wrapping of copper wire around the plastic or contain a progestogen.

• A plastic string attached to the IUD hangs down through the cervix, enabling a woman to check regularly that the IUD is properly positioned.

MOA:-1.They interfere with the movement of sperm and egg.2. They decrease the ability of sperm to fertilize an egg.3.Rarely, they prevent a fertilized egg from implanting in the lining of the

uterus.• Depending on the device, it must be replaced every one to ten years.• 96 % effective in preventing pregnancy.

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Copper IntraUterine Device (IUD)

• Copper bearing IUD• MOA• Does not contain

hormones prevent fertilizationmaking the mov’t of

sperm difficult.Prevent

implantation

Inflammatory r xn :- create hostile environment for sperm motility/transport + spermicidal and for implantation of blastocyst.

04/11/2023 16contraception

contraception

Progesterone releasing IUDs

• Contains a hormone called progestin

• 99% effective in presenting pregnancy.

• Long acting contraceptive.• Hormone acts on the lining of

the uterus and thickens.• the cervical mucus making it difficult for sperm to reach the

egg. • May prevent ovulation• Decrease in menstrual blood

loss by 74-97%.Thicken cervical mucus & prevent sperm transportation

Cause atrophic change to the endometrial lining

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Affects tubal motility & interferes with ovum transport


Side effects

• increase menstrual bleeding , irregular bleeding or cramping.

• It has an increased risk for PID .

• perforation of the uterus and embedding of the IUD in the uterus.

• In rare cases an ectopic pregnancy occurs.

Copper sleeve (33mm×2=66mm2

Copper wire (314mm2

Arms (Rt./Lt.)

Stem

String/Thread

Parts of IUCDs

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C .Hormonal Contraceptives

Exogenous administration female sex hormones that alter a woman’s reproductive cycle in one or more ways.

These hormones may interfere :-1. With ovulation to prevent the maturation and release of an egg from the

ovaries.2. Thicken the cervical mucus, which interferes with sperm movement.3. Alter the rate at which the egg moves through the fallopian tubes to

prevent sperm from meeting the egg.4. Change the condition of the uterine lining to prevent fertilized eggs from

implanting in it. • Hormonal contraceptives are extremely effective in preventing pregnancy

when used properly.• Many people prefer them because their use does not interfere with sexual

spontaneity.

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Hormonal contraceptivescont’d

• Two types:-1.the combination pill 2.the progestin only pill The combination pill MOA:- prevents conception by inhibiting ovulation.• The combination of estrogen and progestogen inhibits ovarian follicle

growth and prevents the FSH and surge LH secretion . • In essence, this pill mimics the negative feedback effects of estrogen

and progestogen present during the luteal phase of the menstrual cycle and in pregnancy.

• Renders the cervical mucus hostile to sperm transport.• Even if some sperm reach the egg and fertilization occurs, the pill

causes the uterine endometrium to be unreceptive to the embryo because the estrogen: progestogen ratio.

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Hormonal contraceptivesCont’d

• Draw backs1. Reduced effectiveness when used in

conjunction with some medications .2. Lack of protection against STIs. Hormonal contraceptives may be administered

by pill form, implant, injection, or through vaginal rings or skin patches.

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1 . oral contraceptive

MOA:-

• To prevent pregnancy a woman takes one birth control pill each day for 21 days, after which she takes no pill or a placebo (a pill containing no active ingredients) for 7 days.

• 95 % effective in preventing pregnancy.

• Relieve menstrual pain and reduce menstrual bleeding. It may also offer some protection against PID, endometrial and ovarian cancer, endometriosis and uterine fibroid tumors .

• S/E - breakthrough bleeding (bleeding between periods), headache, hypertension, weight gain, mood change, decreased sexual desire, blood clotting disorders, cardiac complications, breast tenderness, and galactorrhea .

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2 . Hormonal Implants

These is progestin only,thin,flexible implant a matchstick-sized tube .

Inserted under the skin of the woman’s arm by the bicep muscle.

Implanted in the arm for 3 years. The most highly effective form of

birth control. S/E - irregular intervals between

menstrual periods, breakthrough bleeding, headache, acne, weight gain or loss, depression, breast tenderness, and infection or skin discoloration at the implant insertion point.

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3. Contraceptive Injection

There are two types of contraceptive injections: Depo-Provera and Lunelle. Depo-Provera contains the synthetic hormone progestin

and protects against pregnancy for 12 weeks. Lunelle contains a combination of estrogen and progestin

and must be injected once a month. S/E :- irregular bleeding is the most common. Other

includes breakthrough bleeding, weight gain, headache, sore breasts, depression, nausea, vaginal dryness, and acne.

99 % effective in preventing pregnancy.

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4 .Contraceptive Ring

• it is a small flexible ring containing a combination of estrogen and progestin.

• Each month a woman inserts a new ring deep into the vagina, leaving it in place for three out of four weeks.

• Does not require fitting by a health-care professional or the addition of spermicide.

• 95 to 99 % effective in preventing pregnancy. • Adverse effects include :-

increased vaginal discharge vaginal irritation or infection.

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5 .Contraceptive Patch

• It is a thin, plastic patch containing a combination of estrogen and progestin.

• MOA:- applies to the skin of the buttocks, stomach, upper arm, or upper torso once a week for three out of four weeks.

• The skin absorbs the hormones, which alter the woman’s reproductive cycle to prevent pregnancy.

• S/E:- skin reaction at the application site.• 95 to 99 % effective in prevent pregnancy. • Women who smoke should not use the patch because of

increased risk of stroke and heart attack.

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D .Emergency Contraception

• It refers to methods that a woman can use after unprotected intercourse to prevent fertilization or implantation of the fertilized egg.

• Two methods are available:- 1.emergency contraceptive pills 2. emergency insertion of an IUD.• Emergency contraceptive pills(morning-after pills) are similar

to birth control pills but they contain a higher dose of hormones.

• The pills are usually taken in two doses, 12 hours apart. • 79 to 85 % effective when a woman takes the pills within 72

hours of unprotected intercourse.

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Emergency contraceptives cont’d

• MOA:-• Depending on where a woman is in her menstrual cycle at the

time she takes these contraceptives:- 1. the pills will either inhibit or delay ovulation. 2.It alter the uterine lining, preventing implantation of a

fertilized egg.• The insertion of an IUD within seven days of unprotected

intercourse is 99 % effective.• The IUD interferes the ability of a fertilized egg to implant in

the uterine lining.

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E. Coitus Interrupts

-Deliberate removal of the penis from the vagina before ejaculation so that sperm is not deposited in or near the vagina.

- It is not recommended, because drops of fluid secreted by the penis when it first becomes erect can contain enough sperm to cause pregnancy. In addition, a man may not withdraw in time.

Drawbacks includes:- The fact that it requires high motivation and is highly

frustrating to some couples. Any sperm deposited before withdrawal or left on the vulva

wall during withdrawal could reach the cervix.

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F. Natural Family Planning

• These methods are based on restriction of coitus to a “safe period” of the menstrual cycle.

• The “fertile” period of the cycle, when coitus is avoided, is determined – by the number of days sperm remain capable of fertilization

(6–7 days). – And the time that the ovum remains capable of being

fertilized (1 day). Therefore, a woman is fertile for about 5 days before ovulation, the day of ovulation, and possibly 1 day after ovulation.

• it requires instruction, daily monitoring, and a strong commitment from both sexual partners.

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NFPcont’d• most reliable for women with regular menstrual cycles. • As a woman becomes more familiar with the signs of

ovulation and the pattern of her menstrual cycle, the method become more effective.

• Methods that can help predict ovulation include 1.monitoring the lengths of menstrual cycles

2.measuring basal body temperature 3. observing changes in cervical mucus. • Recommend using more than one method to more accurately

determine a woman’s fertile period. • 80 % effective in preventing pregnancy.

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NFP cont’d

1.Calendar Method• Based on the predicted time of ovulation . • The women should record of the dates of her

first day of menstruation over the period of 8 to 12 months.

• From this record she can calculate the average number of days in her menstrual cycle, and estimate the day in her cycle when she is most likely ovulating.

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How to calculate

• 18 days are subtracted from the shortest cycle recorded and 11 days from the longest cycle recorded. Thus, the fertile period is defined.

• For example, suppose a woman, after recording her cycle lengths for a year, had a longest cycle of 35 days and a shortest cycle of 25 days.

• Her possible fertile period then would be 35-11=24 and 25-18=7 Her possible fertile period

then would be from days 7 to 24 of her cycle.

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NFP cont’d

2 .Basal Body Temperature Measurement• The woman takes her temperature at the same time

each morning before getting out of bed. In most women, body temperature rises about one degree on the day of ovulation and stays raised for several days.

• A woman can keep a record of her basal body temperature over a period of 8 to 12 consecutive months to determine the time in her cycle when she ovulates.

• Drawback :- many factors can raise body temperature .

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NFPcont’d

3. Cervical Mucus Monitoring Monitor the consistency of cervical mucus. Cervical mucus

changes consistency during the menstrual cycle and plays a vital role in fertilization of the egg.

Mucus that is clear, wet, and sticky or elastic appears in the days preceding ovulation.

Cervical mucus that is dry, cloudy, or yellowish indicates that ovulation is not occurring.

Drawback The consistency of cervical mucus can be altered by the use

of douches or spermicides, making it difficult for a woman to identify changes.

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2.Permanent methods

• Surgical methods

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2A.Vasectomy

• Methods of male surgical sterilization-vasectomy• permanent forms of birth control.• A vasectomy is performed using local anesthesia. • minor surgical procedure, each of the two vas

deferens (ducts that carry sperm from the testes to the penis) is cut and the ends are tied off to prevent sperm from reaching the penis.

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Vasectomy cont’d

Fig Following a longitudinal incision of the scrotal skin along the vas deferens the vas is lifted by a small clamp

Fig Distal ligation of the vas deferens and cauterization ofthe proximal lumen

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Vasectomycont’d

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Vasectomycont’d

The failure rate lies below 1% .• Failure is due to recanalization of the divided

duct in up to 1.5% of cases (even possible in the form of late recanalization) , or to the extremely rare occurrence of a double vas or incomplete division of the duct.

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2B.Tubal Ligation

• the fallopian tubes are cut and tied, blocked, or sealed to prevent eggs from descending from the ovaries to encounter sperm.

• Tubal ligation is performed under general or spinal anesthesia .

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Tubal ligation cont’d

• There are mainly four occlusion methods for tubal ligation, typically carried out on the isthmic portion of the fallopian tube, that is, the thin portion of the tube closest to the uterus.

• Partial salpingectomy• Clips• Silicone rings:• Electro coagulation

(cauterization)

AmpullaIsthmus

Infundibulum

Fimbria

Anatomy42


summary

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summary

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contraception


References

1.human reproductive biology,3rd edition,richard E.jones,elsevier press imprint

2.Lecture note.3.Internet websites

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04/11/2023

Thank you!!!

contraception 46

reproductive assigment

Health & Medicine