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Managing Your Fertility
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Transcript of Managing Your Fertility
© 2009 McGraw-Hill Higher Education. All rights reserved.
Chapter Thirteen: Managing Your Fertility
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
Selecting Your Contraceptive Method
SafetyEffectivenessReliabilityReversibility
Affordability Ease of use Interference with
sexual expression
Considerations when choosing contraception
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
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)
75% use effectiveness
© 2009 McGraw-Hill Higher Education. All rights reserved.
Periodic Abstinence
© 2009 McGraw-Hill Higher Education. All rights reserved.
Over-the-Counter Contraceptive MethodsSpermicides
Foams Creams Jellies Films Suppositories
Condoms Male Female
Contraceptive sponge
© 2009 McGraw-Hill Higher Education. All rights reserved.
Over-the-Counter Contraceptive Methods
Vaginal spermicides
OTC agents that are capable of killing sperm
71% use effectiveness
© 2009 McGraw-Hill Higher Education. All rights reserved.
Over-the-Counter Contraceptive Methods (cont.)
Male condom OTC latex shield designed to cover erect penis and retain semen upon ejaculation
85% use effectiveness
Male condom with spermicide
Latex condom in combination with spermicide
95% use effectiveness
Female condom Polyurethane sheath inserted into the vagina
79% use effectiveness
Contraceptive sponge
Small, pillow-shaped contraceptive that contains spermicide; placed in the vagina to cover the cervical opening
84% use effectiveness
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
Prescription Contraceptive Methods
Diaphragm Lea’s Shield FemCap Intrauterine device
(IUD) Oral contraceptives
Combined pills Minipills
Injectable contraceptive
Contraceptive implant Contraceptive ring Contraceptive patch
© 2009 McGraw-Hill Higher Education. All rights reserved.
Prescription Birth Control Methods
Diaphragm • Soft rubber cup that covers the cervix• Fitted by health care professional• Used with spermicide
84% use effectiveness
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
86% use effectiveness
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
Use of a Diaphragm
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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
© 2009 McGraw-Hill Higher Education. All rights reserved.
© 2009 McGraw-Hill Higher Education. All rights reserved.
Prescription Birth Control Methods(cont.)
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
Prescription Birth Control Methods(cont.)
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
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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
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
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Male Sterilization: Vasectomy
© 2009 McGraw-Hill Higher Education. All rights reserved.
Female Sterilization: Tubal Ligation
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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
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
Dilation and Evacuation
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Abortion: Termination of a Pregnancy (cont.)
Partial-birth abortion Federal ban
Third-trimester abortion procedures Hysterotomy Hysterectomy
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
© 2009 McGraw-Hill Higher Education. All rights reserved.
Fertilization and Implantation
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
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Signs of Pregnancy (Probable)
Increased frequency of urinationIncreased in the size of the abdomenCervix becomes softer by the sixth weekPositive pregnancy test
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Signs of Pregnancy (Positive)
Determination of a fetal heart beatFeeling of the fetus moving (“quickening”)Observations of the fetus by ultrasound or
optical viewers
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Agents that Can Damage a Fetus
Rubella/herpes viruses
Tobacco smoke Alcohol
Certain OTC drugs Radiation Accutane (acne drug)
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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
© 2009 McGraw-Hill Higher Education. All rights reserved.
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
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Stages of Labor and Childbirth
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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
© 2009 McGraw-Hill Higher Education. All rights reserved.
Causes of Infertility
Low sperm count Poor sperm motility Sperm abnormalities Lack of ovulation Obstruction of fallopian tubes
© 2009 McGraw-Hill Higher Education. All rights reserved.
Enhancing Fertility
Cold packs on the scrotum (men) Boxer shorts vs. briefs (men) Increase intercourse frequency
© 2009 McGraw-Hill Higher Education. All rights reserved.
Treatments for Infertility
Artificial insemination Surgical procedures Fertility drugs Assisted reproductive technology
In vitro fertilization Gamete intrafallopian transfer Zygote intrafallopian transfer Intracytoplasmic sperm injection
© 2009 McGraw-Hill Higher Education. All rights reserved.
Options for Infertile Couples
Surrogate parenting
Adoption
Foster parenting
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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
© 2009 McGraw-Hill Higher Education. All rights reserved.
Cloning
Reproductive cloning Not yet accomplished Banned in selected countries and states
Therapeutic cloning Can be used to create stem cells
© 2009 McGraw-Hill Higher Education. All rights reserved.
Chapter Thirteen: Managing Your Fertility