Chapter Thirteen: Managing Your Fertility

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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

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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

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Selecting Your Contraceptive Method

SafetyEffectivenessReliabilityReversibility

Affordability Ease of use Interference with

sexual expression

Considerations when choosing contraception

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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

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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

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Periodic Abstinence

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Over-the-Counter Contraceptive Methods

Spermicides Foams Creams Jellies Films Suppositories

Condoms Male Female

Contraceptive sponge

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Over-the-Counter Contraceptive Methods

Vaginal spermicides

OTC agents that are capable of killing sperm

71% use effectiveness

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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

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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

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Prescription Contraceptive Methods Diaphragm Lea’s Shield FemCap Intrauterine

device (IUD) Oral

contraceptives Combined pills Minipills

Injectable contraceptive

Contraceptive implant

Contraceptive ring Contraceptive

patch

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Prescription Birth Control MethodsDiaphragm • 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

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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

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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

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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 (plan B)

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

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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

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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

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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

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Dilation and Evacuation

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Abortion: Termination of a Pregnancy (cont.) Partial-birth abortion

Federal ban Third-trimester abortion procedures

Hysterotomy Hysterectomy

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Pregnancy

Obstacles to Fertilization Acid level in the vagina Cervical mucus thickness Location of cervical entrance for sperm Location of the correct fallopian tube for

sperm Distance sperm travels Motility of sperm

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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

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Fertilization and Implantation

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Signs of Pregnancy (Presumptive) Missed menstrual period after sexual

intercourse the previous month Morning sickness Increase in size and tenderness of

breasts Darkening of the areolar tissue around

the nipples

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Signs of Pregnancy (Probable) Increased frequency of urination Increased in the size of the abdomen Cervix becomes softer by the sixth week Positive pregnancy test

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Signs of Pregnancy (Positive) Determination of a fetal heart beat Feeling 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

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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

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Causes of InfertilityLow sperm countPoor sperm motilitySperm abnormalitiesLack of ovulationObstruction of fallopian

tubes

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

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Treatments for InfertilityArtificial inseminationSurgical procedures Fertility drugsAssisted reproductive technology

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