Contraception and Termination of Pregnancy
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Transcript of Contraception and Termination of Pregnancy
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Contraception andTermination of Pregnancy
By Dr. Qaisar Shahzad
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Contraception?
Contraception is the prevention of the fusionof gametes during or after sexual activity.
The term contraception is a contraction ofcontra, which means against, and the wordconception, meaning fertilization.Contraception can occur both naturally and
via artificial means in humans and inanimals
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Contraception
Surgical Medical
Ovariohysterectomy Androgens
Progestogens
Immunization
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Surgical Methods for
Estrus SuppressionOvariohysterectomy and
Ovariectomy
Advantages:Permanent
Reduces mammary tumor
Disadvantages:
Produces less resting metabolic rate in cats
Obesity in dogs
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Tubal LigationAdvantages:
Can be performed laproscopically,
which requires less surgical time andpost operative care
Disadvantages:
It does not offer health advantages
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Pharmacological Methods for
Estrus Suppression
Progestogens
May act locally to prevent follicular growth
Estrogen production
OvulationDont alter LH levels
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Advantages of Progestogens:
Effective at suppressing estrus
Manufacturer of megesterol acetate reports noadverse effect on fertility when administered asdirected
Disadvantages:
Pyometra
Endometrial hypoplasia
Incidence of mammary carcinoma increases
In pregnancy causes fetal death,mummification ormaceration
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Progestogens Megesterol acetate (Ovaban; Schering-Plough)
Medroxyprogesterone acetate(Depo-Provera;Pharmacia & Upjohn)
Norethindrone (Primolut N;Schering-Plough)
Proligestone (Covinan; Intervet, Millsboro, Del.)
Levonorgestrel(50 j1g)/ethinylestradiol (30 j1g)(Nordette; Wyeth-Ayerst Philadelphia)
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AndrogensNegative feed to the pituitary gland decreases synthesis and
release of FSH and LH
Advantages:
Effective at suppressing estrus
1. Lack of estrogenic or progestational effects decreasesincidence of cystic endometrial hyperplasia/pyometra andmammary neoplasia as side effect
Disadvantages:
Mucoid vaginal discharges
Clitoral hypertrophy
Increased serum live enzymes
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Androgens
Mibolerone
Testosterone combinations (Durateston,Intervet)
Testosterone cypionate(Depo- Testosterone, Pharmacia & Upjohn)
Testosterone enanthate (Delatestryl; BTGPharmaceuticals, Iselin, NJ)
Boldenone undecanoate (Vebonol Novartis)
Methyltestosterone (Android; ICNPharmaceuticals,Costa Mesa, Calif.)
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GnRH Agonists
GnRH agonist bind to GnRH receptors on pituitary cells resultingin down regulation and decreases production of FSH and LH
Advantages:
Can suppress estrus upto 27mo in dogs and 14mo in cats
No long term effect on fertility has been reported
Disadvantages:
Initially there is induction of estrus
Minimal oedema at the site of injection
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GnRH antagonistGnRH antagonists bind to GnRH receptors on pituitary cellsand decrease the secretion of LH and FSH by preventinggene transcription
Advantages:
Reversible effect
Produces atrophy of organs and inhibits ovulation
Disadvantage:
Expensive drug
Localized skin erythema and pruritus may develop at thesite of injection site
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GONADOTROPIN-RELEASINGHORMONE AGONISTS
DesloreJin acetate(Peptech Animal Health, New South Wales)
GnRH ANTAGONISTS
Detirelix acetate
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Immunization against Zona
PellucidaAntibodies directed against zona Pellucida prevents bindingof spermatozoa and fertilization and impair oocytedevelopment and ovulation
Advantages:
Immunocontraception lasts for several months aftervaccination
It is reversible in some species
Disadvantages:
Ovarian atrophy
Polycystic ovarian disease
Autoimmune oophoritis
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Immunocontraception
Injection of a reproductive protein to produce ahumoral immune response that leads to fertility for a
defined period
Disadvantages: Skin irritation and localized pain at the
immunization site
Glomerulonephritis if antigen-antibody complex iscontinuously circulating
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Pregnancy Termination
Pregnancy termination is defines as expulsion of theproduct from uterus before the fetus is viable
It is also termed as induced abortion
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Estrogenic Compounds
Delay transport of embryo through uterine tube
Induces endometrial congestion and oedema therebypreventing normal embryo migration and implantation
Changes composition of uterine milk
Only safe if given after ovulation
Disadvantages:
Pyometra
Endometrial hyperplasia
Ineffective before ovulation
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ESTROGENIC COMPOUNDSDiethylstilboestrol
Estradiol cypionate (Depo-Estradiol,
Pharmacia & Upjohn)Estradiol benzoate
Tamoxifen citrate (Novadex; Astrazeneca,
Wilmington, Del.)
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Prosglandins
It induces vasoconstriction that reduces blood flow to corpusluteum with subsequent cellular degeneration. Prostaglandinalso induces myometrial contractility and contribute to cervicaldilation
Advantages: Few side effects
80-100% efficacy
Can be used as early as one week
Disadvantages: Duration of treatment averages 4 days
Tachypnea, hypersalivation, vomiting, ataxia, urination
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LUTEOLYTIC AGENTS(Prostaglandins)
Dinoprost tromethamine (Lutalyse,
Pharmacia & Upjohn) Cloprostenol (Estrumate, Schering-
Plough)
Fenprostalene (Bovilene, Fort Dodge)
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Dopamine agonist and Serotoninantagonist
Inhibition of prolactin secretion results in lutolysis
Advantages:
100% efficacy past the LH surge
Disadvantages:
Efficacy is 66% before 40 days
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DOPAMINEAGONISTS ANDSEROTONIN ANTAGONISTS Bromocriptine mesylate (Par/odel,
Novartis) Cabergoline(Dostinex, Pharmacia &
Upjohn
Metergoline
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Combination of Dopamine agonistand prostaglandin
Advantages
Its efficacy is 100% when initiated after 25days pastLH Surge
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Inhibitors of Progesterone Action
Progesterone receptors antagonists bind toprogesterone receptors with higher affinity than withendogenous progesterone
Advantages: Pregnancy is terminated within 4-7days of
instituting therapy
Disadvantages:
Mammary gland development occurs
It is less effective in feline pregnancy termination
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COMBINATIONSOFDOPAMINEAGONISTSANDPGF-2a Bromocriptine and cloprosteno
Cabergoline and cloprostenol
INHIBITORS OFPROGESTERONEACTION Mifepristone(RU486) (Mifeprex; Danco Laboratories, NewYork,
NY)
Aglepristone(RU534) (Alizine; Verbac Laboratories, Csttos,France)
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Dexamethasone
Corticosteroids mediate a luteolytic effect that is notwell understood
Advantages:
Very good efficacy after 30days past LH surge
Disadvantages:
Anorexia, polydipsia, polyuria
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Inhibitors of ProgesteroneSecretion
Epostame inhibits progesterone synthesis bycompetitive inhibition of enzymes involved in
the conversion of pregnanolone toprogesterone
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DEXAMETHASONE
NHIBITORS
OFPROGESTERONESECRETION Epostane (Hoescht-Roussel, KansasCity,
Mo.)
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