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Managing Your Fertility

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  • The International Agency for Research on Cancer (IARC), the cancer research agency of WHO, in its press release of the 29th of July 2005, informed of the publication of Monograph 91 on the carcinogenicity of combined estrogen-progestogen oral contraceptives (COC) and combined estrogen-progestogen menopausal therapy (HRT), based on the conclusions of an international Working Group of 21 scientists from 8 countries. Please see
    http://www.who.int/reproductivehealth/publications/ageing/cocs_hrt_statement.pdf and
    http://www.iarc.fr/en/media-centre/pr/2005/pr167.html
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  • Image source: The McGraw-Hill Companies, Inc./Kirstan Price, photographer
  • Transcript

    • 1. Chapter Thirteen: Managing Your Fertility
    • 2. 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
    • 3. 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
    • 4. Selecting Your Contraceptive Method
      • Safety
      • Effectiveness
      • Reliability
      • Reversibility
      • Affordability
      • Ease of use
      • Interference with sexual expression
      Considerations when choosing contraception
    • 5. Behavioral Contraceptive Methods 73% use effectiveness Removal of penis from vagina before ejaculation Withdrawal (“coitus interruptus”) 15% use effectiveness No method used Chance 100% effective No sexual activity Abstinence
    • 6. Behavioral Contraceptive Methods (cont.) 75% use effectiveness
      • 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 (rhythm method)
    • 7. Periodic Abstinence
    • 8. Over-the-Counter Contraceptive Methods
      • Spermicides
        • Foams
        • Creams
        • Jellies
        • Films
        • Suppositories
      • Condoms
        • Male
        • Female
      • Contraceptive sponge
    • 9. Over-the-Counter Contraceptive Methods 71% use effectiveness OTC agents that are capable of killing sperm Vaginal spermicides
    • 10. Over-the-Counter Contraceptive Methods (cont.) 84% use effectiveness Small, pillow-shaped contraceptive that contains spermicide; placed in the vagina to cover the cervical opening Contraceptive sponge 79% use effectiveness Polyurethane sheath inserted into the vagina Female condom 95% use effectiveness Latex condom in combination with spermicide Male condom with spermicide 85% use effectiveness OTC latex shield designed to cover erect penis and retain semen upon ejaculation Male condom
    • 11. 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
    • 12. Prescription Contraceptive Methods
      • Diaphragm
      • Lea’s Shield
      • FemCap
      • Intrauterine device (IUD)
      • Oral contraceptives
        • Combined pills
        • Minipills
      • Injectable contraceptive
      • Contraceptive implant
      • Contraceptive ring
      • Contraceptive patch
    • 13. Prescription Birth Control Methods 99%+ use effectiveness
      • T-shaped device inserted into the uterus
      • Medicated or unmedicated
      • Somehow interferes with implantation of the ovum
      • World’s most popular reversible contraceptive method
      Intrauterine device (IUD) 86% use effectiveness
      • 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
      Lea’s Shield or FemCap 84% use effectiveness
      • Soft rubber cup that covers the cervix
      • Fitted by health care professional
      • Used with spermicide
      Diaphragm
    • 14. Use of a Diaphragm
    • 15. Prescription Birth Control Methods (cont.) Blood clots, stroke, hypertension, heart attack Potential risks
      • Tenderness in breasts
      • Nausea
      • Headaches
      • Spotting
      • Weight gain
      • Sex drive fluctuation
      • Frequent vaginal infections
      • Mild depression
      Side effects
      • Daily pills
      • Estrogen works by reducing ovum development
      • Progesterone reduces ovulation and thickens cervical mucus
      • 92% use effectiveness
      Oral contraceptive pills
    • 16.  
    • 17. Prescription Birth Control Methods (cont.)
      • Skin patch containing estrogen and progestin
      • Worn for 3 weeks, then 1 week off, then new patch
      • 92%+ use effectiveness
      Contraceptive patch
      • Polymer device containing estrogen and progestin
      • Placed deep in the vagina for a 3-week period
      • 92%+ use effectiveness
      Contraceptive ring (NuvaRing)
      • Each shot effective for a 3-month period
      • Prevents ovulation and thickens the cervical mucus
      • 97% use effectiveness
      Injectable contraceptive
      • Daily pill
      • Low-dose progesterone
      • 92% use effectiveness
      Minipills
    • 18. Prescription Birth Control Methods (cont.)
      • 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
      Contraceptive implant
    • 19. 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
    • 20. 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
    • 21. Male Sterilization: Vasectomy
    • 22. Female Sterilization: Tubal Ligation
    • 23. 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
    • 24. 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
    • 25. Dilation and Evacuation
    • 26. Abortion: Termination of a Pregnancy (cont.)
      • Partial-birth abortion
        • Federal ban
      • Third-trimester abortion procedures
        • Hysterotomy
        • Hysterectomy
    • 27. 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
    • 28. 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
    • 29. Fertilization and Implantation
    • 30. 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
    • 31. 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
    • 32. 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
    • 33. Agents that Can Damage a Fetus
      • Rubella/herpes viruses
      • Tobacco smoke
      • Alcohol
      • Certain OTC drugs
      • Radiation
      • Accutane (acne drug)
    • 34. 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
    • 35. 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
    • 36. Stages of Labor and Childbirth
    • 37. 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
    • 38. Causes of Infertility
      • Low sperm count
      • Poor sperm motility
      • Sperm abnormalities
      • Lack of ovulation
      • Obstruction of fallopian tubes
    • 39. Enhancing Fertility
      • Cold packs on the scrotum (men)
      • Boxer shorts vs. briefs (men)
      • Increase intercourse frequency
    • 40. Treatments for Infertility
      • Artificial insemination
      • Surgical procedures
      • Fertility drugs
      • Assisted reproductive technology
        • In vitro fertilization
        • Gamete intrafallopian transfer
        • Zygote intrafallopian transfer
        • Intracytoplasmic sperm injection
    • 41. Options for Infertile Couples
      • Surrogate parenting
      • Adoption
      • Foster parenting
    • 42. 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
    • 43. Cloning
      • Reproductive cloning
        • Not yet accomplished
        • Banned in selected countries and states
      • Therapeutic cloning
        • Can be used to create stem cells
    • 44. Chapter Thirteen: Managing Your Fertility