Act as barrier between the sperms and the
ovum and sperm.
Available for both-
It is cylindrical shaped.
Measuring 15 to 20 cm length, 3 cm
diameter, and 0.003 cm thick.
It is closed at one end with a teat- end and
open at the other end, with an integral rim.
This condom is a thin sheath that covers the
penis to collect sperm and prevent it from
entering the woman's body. Male condoms
are generally made of latex or polyurethane
Cheaper with no contraindications.
No side effects.
Easy to carry,simple to use and disposable.
Protection against sexually transmitted
diseases, eg. Gonorrhea, Chlamydia, HPV and
Protection against pelvic inflammatory
Useful where the coital act is infrequent and
May accidentally break or slip off during
To discard after one coital act.
Failure Rate: 15 to 20 per 100 women years of
A sheath made up of thin, transparent, soft
plastic, closed at smaller end and opened at
the wider end.
Advantages of female condom
Protect against sexually transmitted diseases
It is expensive
An intravaginal device made of latex with
flexible metal or spring at the margin
Diameter varies from 5-10 cm
It requires a medical or paramedical
personnel to measure the size of the device.
Diaphragm should completely cover the
Device is introduced up to 3 hours before
intercourse and is to be kept for at least 6
hours after the last coital act.
Advantages of diaphragm method
Can be used repeatedly for a long time
Reduces PID/STI to some extent
Requires help of a doctor or paramedical
person to measure the size required.
Risk of vaginal irritation and urinary tract
infection are there.
Not suitable for women with uterine prolapse.
It is thimble shaped. It is like diaphragm but
It covers the vaginal portion of the cervix,
thus acting as a barrier.
Woman inserts the cervical cap with
spermicide, in the proper position in the
vagina before having sexual intercourse.
These are the contraceptives that a women
places in her vagina shortly before sex. These
are all spermicides. These methods are
grouped as follow
Creams, jellies, pastes.
The foam tablets contain the spermicide
‘Chloramine-T’ or Phenyl mercuric acetate.
A few drops of water are poured on it and
then introduced high up the vagina.
Foam is produced and spreads to all parts of
vagina. The commercial name is ‘Today’.
This contains Nonoxynol-9 spermicides,
which paralyses the sperm.
The effect lasts for about 1 hour.
Creams and Paste
These have a soapy base.
This has an acqueous base.
They also contain Chloramine T or Phenyl
For example Delfen cream, volper cream,
orthogynol jelly, perception jelly, etc.
They are simple, safe and easy to use.
They offer contraception just when needed.
Do not require medical assistance.
Burning or irritation
Local allergic reaction and urinary tract
It is quite high, i.e. 25 pregnancy per 100
An IUD is a small stiff but flexible, nontoxic,
polyethylene plastic frame, incorporated with
Barium sulphate, copper prevents conception.
The IUD has two strings, made up of nylon,
which hang through the opening of the cervix
into the vagina, to check by the user to know
whether it is in situ or not.
It is a double – S. shaped device made up of
polythene, which is non toxic non tissue
reactive and extremely durable.
It is a an old method of I.U.D which is not
During 1970s, it was found that metallic
copper has a strong antifertility effect.
The different copper bearing IUDs are:
Earlier devices- T Cu200, T Cu 200 B
Newer devices- T Cu-220 C, T Cu- 380 A
These are also “T” shaped devices, made up
of permeable, polymer membrane,
incorporated with a slow releasing
progesterone hormone, which prevents
pregnancy, i.e.LNG- 20.
IUDs cause foreign body reaction resulting in
cellular and biochemical changes.
It cause hyperemia, edema and infiltration of
leukocytes in the endometrium of uterus.
So the viability of the ovum is impaired, thus
reducing the chance of fertilization.
Postplacental insertion:- This means insertion
of IUD immediately following delivery of the
placenta. This can be done at any time
between 10 minutes and 48 hours after
Postpartum insertion:- Insertion of IUD
about 6 to 8 weeks after delivery. This also
called post puerperal insertion.
Postabortum insertion:- Insertion of IUD
about 12 weeks after abortion.
However, following spontaneous abortion,
IUD can be inserted after the first menstrual
Inexpensive and reversible
Simplicity in techniques of insertion and most
cost effective of all methods.
Prolonged contraceptive protection after
Systemic side effect minimal
Reversibility to fertility is prompt after
Does not interfere with lactation.
Absolute contraindications are pregnancy,
Previous ectopic pregnancy
Pelvic pathology such as infections, tumors,
Congenital defects in the uterus
Cancer of cervix
Relative contraindications are multiple sexual
partners and anemia.
Failure Rate:- It is 2 to 3 per 100 WY.
Restoration of fertility after removal
Fertility is not impaired after removal of IUD,
provided there is no episode of PID.
70% of IUD users conceive within one year of
COMBINED ORAL CONTRACEPTIVES (PILLS)
The combined oral steroidal contraceptives is
the most effective reversible method of
contraception. In the combination pill, the
commonly used progestins are either
levonorgesterrel or norethisterone or
desogestrel and the estrogens are principally
confined to ethinyl- oestradiol .
Mode of action
Inhibition of ovulation
Producing static endometrial hypoplasia
Alteration of the character of the cervical
Interferes with tubal motility and alters tubal
Advantages of combine oral contraceptives
Good cycle control
Well tolerated in majority
Reversibility rate is prompt
Disadvantages of combined oral
Requires education and motivation
Requires initial check up and periodic
Inconvenience caused in its use due to daily
Risk of drug interactions
Costly but free supply through government.
Missed pills:- Pills should be taken every day to
be most effective. If not taken correctly there
will be a risk of becoming pregnant.
Missed 1 Pill:- She should take it as soon as
she remembers and take the rest as usual.
Missed 2 pills or more, in the first two rows(
i.e. the first 14 pills):- She should take one
pill as soon as she remembers and the rest as
usual. Use another method also.
Missed 2 pills or more in the third row:- She
should take the pill as soon as she
remembers and takes a rest as usual
meanwhile she must also use another method
such as condoms for 7 days or avoid
intercourse for one week.
Missed any pill in the fourth row:- She should
throw the missed pill away and take the rest
as usual. Start a new packet as usual on the
next day. Thus, forgetting to take placebos,
she is still protected from pregnancy.
PROGESTIN ONLY CONTRACEPTION (MINIPIL)
It contains very low dose of progestin in any
one of the following form – levonorgestrel 75
micro gram, norethisterone 350 micro gram.
Mechanism of action
It works mainly by making cervical mucus
thick and viscous, therby prevents sperm
Advantages of minipill
Sideffects attributed to oestrogen in the
combined pill are totally eliminated
No adverse effect on lactation and hence can
be suitably prescribed in lactating women.
Reduce the risk of PID and endometrial
Disadvantages of minipill
Simple cyst of ovary may be seen.
Emergency Oral Contraception can prevent
Therefore, often it is called ‘ morning after’
should not be used in place of family
Used to prevent unplanned pregnancy.
Used under the following circumstances:
Rape, sexual assault
Failure of contraceptive method such as
rupture of condom, displacement of IUD,
missing two or more mini pills.
Premature ejaculation among couples
practicing coitus interruptus.
This emergency method is recommended
within 48 to 72 hours of unprotected
They act by stopping ovulation or by
interfering with implantation of the ovum.
Consists of a set of 6 small, silicon rubber
soft capsules, about the size of a small
match- stick, each containing 35 mgm of
synthetic progestogen ( Levonorgestrel).
provide contraceptive effect for at least 5
Mechanism of action
It inhibits ovulation.
It has got its supplementary effect on
endometrium and cervical mucus as well.
The capsule is inserted subdermally, in the
inner aspect of the non dominant arm,6-8 cm
above the elbow fold. It is inserted between
biceps and triceps muscles
Highly effective for long term use and rapidly
Suited for women who have completed their
family but do not have permanent
DMPA ( Depo-Provera)
Depot Medroxyprogesterone Acetate (DMPA),
is similar to the hormone called
progesterone, which is produced in the body
by the ovaries.
Provides protection against pregnancy for
Mainly works by stopping the ovaries from
releasing an egg (ovulation).
99% and 94% effective.
When to give
Contraceptive injection is given as an
injection into the buttock, or sometimes into
the muscle of the upper arm.
It is usually given during the first five days of
the menstrual cycle .
Bleeding often becomes irregular and can
sometimes last longer than before, but heavy
bleeding is not very common.
Oldest and probably the most widely
accepted contraceptive method used by
It necessitates withdrawl of penis shortly
96 percent effective.
Advantages of coituss
No appliance is required
Disadvantages of coitus interruptus
Requires sufficient self control by the
Women may develop anxiety neurosis,
vaginismus or pelvic congestion.
Chance of pregnancy is more :
precoital secretion may contain sperm
accidental chance of sperm deposition
into the vagina
This method is based on identification of
the fertile period of a cycle and to abstain
from sexual intercourse during that period.
Disadvantages of rhythm method
Difficult to calculate the safe period
Compulsory abstinence from sexual
act during certain periods.
Not applicable during lactational
amenorrhoea or when the periods are
After ovulation quality of mucus
changes,mucus produced under the
influence of progesterone is thicker,
stickier and its quantity is reduced
Sperm cannot swim through the
mucus, and it forms the barrier to
sperm entry into the uterine cavity.
Monitor resting body temperature each day
before ovulation women’s temperature is
After ovulation temperature slightly raises.
If temperature slightly rises, abstain from
intercourse for 3 days.
This method is effective when:
The mother practices exclusive breastfeeding.
menstrual cycle does not returned back.
child is less than 6 months of age.
It is a simple safe, very effective, cheap,
convenient, permanent and quick, surgical
method of family planning for men, who
decide that they do not want any more
It does not affect the testes and it does not
affect sexual ability.
A small incision is made in the scrotum on
either side above the testes under local
anaesthesia, under aseptic precautions, vas-
deferens tubes are lifted, cut and tied with
thread or clamped and the incisions are
closed with stitches. Then bandages is put.
Instruction after surgery
Rest for two days.
should not do any heavy work.
The wound should be kept clean and dry.
If possible put ice on the scrotum for four
hours to lessen swelling.
Wear snug underwear or pants for two to
three days to help.
Can have intercourse within 2 to 3 days after
Vasectomy is highly effective and permanent
Failure rate is about 0.15 pregnancies per 100
It is simple highly effective.
Prolonged sexual pleasure because no need to
worry about pregnancies.
Compare to tubectomy vasectomy easy to
Does not need hospitalization.
This is also known as ‘Voluntary surgical
contraception, and ‘ Tubal ligation’ and
It is a simple , safe, very effective, cheap,
convenient and permanent method of
contraception for women, who do not want
any more children.
It consists of blocking both the fallopian
tubes. The procedure is permanent and
probably cannot be reserved.
A small incision of 2 to 5 cm is made in the
anesthetized area, just above the pubic hair
line, under aseptic precautions.
The uterus is raised and turned with the
elevator to bring each of the fallopian tubes
under the incision.
Each tube is tied and cut or else closed with a
clip or ring. Incision is closed with stitches
and bandage is put.
Instructions after surgery:
Rest for 2 to 3 days and avoid strenuous work
for one week.
Keep the wound clean and dry.
Not to have sex for at least one week or until
all pain gone.
Effectiveness:- Failure rate is about 0.5
pregnancies per 100 women years.
It is simple, safe, very effective, permanent,
lifelong method of family planning.
No interference during intercourse.
No effect on breast milk.
No long- term side effect.
Helps to protect against ovarian cancer.
Usually painful for several days after surgery.
Postoperative infection or bleeding.
Does not protect against STDs including
The nursing staff is a key element in the
implementation, execution and continuity of
family planning practices.
Give accurate information and respond to
To be aware of the needs of people that they
attend entirely, promoting health and
creating quality of life.
The nurse must guide, inform and educate
the user about it and warning signs.
Importance of check-ups: users should be
informed about the importance of attending
consultation for regular check-ups.
Title :Use of contraception among women who request
first trimester pregnancy termination in Norway.
Journal name :Contraception
Author : Strøm-Roum EM, Lid J, Eskild A
Objective : proportion of women who reported having
used contraceptionwhen they became pregnant, and the
contraceptive method that they had used.
Results : 36.5% of the women who requested pregnancy
termination , reported having used contraception when
they became pregnant. Of all women, 16.6% reported
having used the combined contraceptive pill/progestin
pill, 11.5% the condom, and 1.1% long-acting reversible
contraceptives (1.0% intrauterine contraception).
“A woman of
reproductive age who
has not conceived after
1 year of unprotected
intercourse, in the
absence of any known
cause of infertility”
Primary infertility; couple have failed to conceive
Secondary infertility; woman has previously been
pregnant regardless of the outcome of the pregnancy
and now unable to conceive.
Conception depends on the fertility potential
of both the male and female partner. The
male is directly responsible in about 30-40
percent, the female in about 40-55 percent
and both are responsible in about 10 percent
A study done in 2014 in India on Environmental
& lifestyle factors in deterioration of male
reproductive health found that The presence of
abnormal semen parameters was significantly
higher among the lifestyle and/or environmental
exposed subjects as compared to the non-
These findings indicated that various lifestyle
factors such as tobacco smoking, chewing and
alcohol use as well as exposure to toxic agents
might be attributed to the risk of declining
semen quality and increase in oxidative stress
and sperm DNA damage.
Objectives of investigation
To detect the etilogical factors
To rectify the abnormality in an attempt to
improve the fertility.
To give assurance with explanation to the
couple if no abnormality is detected
Investigations for male
Seminal fluid analysis-normal semen value as
suggested by WHO
Volume 2 ml or more
Sperm concentration 20 million/ml or more
Total sperm count >40 million per ejaculate
Motility 50 percent or more
Viability 75% or more living.
Investigations for female
General medical history
Sexually transmitted disease
Pelvic inflammatory disease
Abdominal or pelvic surgery
Previous obstetric history
Number of pregnancies
Interval between them
Pregnancy related complications
Other contraceptive devices.