About Menstrual cycle, induced ovulation, Birth Control and test tube babies

2. Menstruation is a woman’s monthly bleeding in female. During,
menstruation, our body sheds the lining of the uterus (WOMB). Menstrual blood
flows from the uterus through the small opening in the cervix and passes out of
the body through the vagina. Menstrual periods last for 3-5 days.

3. The first menstruation begins at puberty and it is called Menarche. In human
females,
menstruation is repeated at an average interval of about 28/29days, and the cycle
of
events starting from one menstruation till the next one is called the Menstrual
cycle.
It is found in female primates i.e., monkeys ,apes and human beings. One ovum
is released during the middle of the each menstrual cycle.
The cycle starts with the menstrual phase, the menstrual flow occurs if the
released ovum is not fertilized and it lasts for 3-5 days.
Menstrual flow is due to breakdown of endometrial lining of the uterus and the
breakdown blood vessels forms liquids that comes out through vagina.
Lack of menstruation may be indicative of pregnancy , stress, poor health , etc
The menstrual phase is followed by the Follicular phase.
During this phase the primary follicles in the ovary grow to become a fully
mature Graafian follicle and simultaneously the endometrium of uterus regenerates
through proliferation.

5. The secretion of gonadotropins (LH and FSH) increases gradually during the
follicular phase, and it stimulates follicular development as well as secretion of
estrogens by the growing follicle.
Estrogen plays an important role in building up strong bones and to help keep
them strong as you get older. Estrogen also makes the lining of the uterus
(womb) grow and thicken.
Both LH and FSH attains a peak level in the middle of cycle.
Rapid secretion of LH leading to is maximum level in mid of cycle called LH
surge is rupture Graafian follicle and they by the release of ovum (ovulation).
The remaining parts of the Graafian follicle transform as the corpus luteum.
The corpus luteum secret large amount of progesterone which is essential for
maintenance of the endometrium. It is important because it is necessary for
implantation of the fertilized ovum and other events of pregnancy.
During pregnancy all these events of the menstrual cycle stop and there is no
menstruation. In the absences of the fertilization corpus luteum degenerates and
this causes degeneration of endometrium and leads to menstruation, and make a
new cycle.
In human beings the menstrual cycle, ceases around 50 years of age, that is
termed as Menopause.
Cyclic menstruation is and indicator of normal reproductive phase which
extends between menarche and menopause.

7. Ovulation is the process that happens usually once in every menstrual cycle,
when hormone changes trigger an ovary to release an egg.
Ovulation induction is a treatment protocol designed to increase the number
of eggs that a woman ovulates in a cycle. Ovulation induction uses hormonal
therapy to stimulate egg development and release, or ovulation. Historically,
these drugs were designed to induce ovulation in who did not ovulate on their
own- typically women with irregular menstrual cycles. The goal of induced
ovulation is to produce a single, healthy egg.
The second use of ovulation induction was to increase the number of eggs
reaching maturity in a single cycle, to increase chances for conception..
The initial agents for this treatment used first for In-Vitro Fertilization (IVF)
and only later for simpler treatments were injectable medications. These agents
carry an increased risk of multiple gestation, ovarian hyperstimulation and
increased cost and time commitment.

8. More recently, in the mid 90s. Evidence developed to suggest there may be an
advantage to treating even ovulatory women with fertility medications. These
women with “unexplained infertility” may have subtle defects in ovulation, and
medications may induce two to three eggs to mature, versus only one. This
treatment therefore improves the quality and quantity of ovulations, thus enhancing
pregnancy rate.
In ovulatory women, ovulation induction is always combined with intrauterine
insemination. Ovulation induction should progress only after a complete and
thorough evaluation. All underlying hormonal disorders, such as thyroid
dysfunction, should be treated before resorting to ovulation induction with fertility
drugs.

9. Ovulation is not proper because of confused hormonal signals from the body which
means that ovulation cannot occur in the usual way.
Pituitary dysfunction is a term used to describe a group of disorders in which ovulation
occurs on an infrequent basis. The term pituitary failure is used when ovulation fails to
occur at all (anovulation) and there are no periods (amenorrhoea). The vast majority of
people with ovulation issues experience amenorrhoea. Primary amenorrhoea occurs in girls
under 16 who have not yet menstruated, and is usually due to a hormone deficiency.
Secondary amenorrhoea occurs in women who have previously menstruated but have
stopped for more than six months. This can coincide with:
Being overweight: Body weight can contribute to risk of ovulation problem. It is linked
to PCOs.
Polycystic Ovarian Syndrome: PCOs is a condition where egg matures in the ovaries
but there are not released into the fallopian tubes rather it remains in the ovaries and
develops into a cysts.
Excessive exercise/being underweight: Ovulation can be restored by returning to
moderate exercise and nutrition.
Stress: Emotional and other stress are also reason for delay ovulation
Ovarian Failure: this results in loss of egg supply form the ovary possibly as a result of
early menopause

11. Common fertility drugs used for induced ovulation are:
Clomiphene Citrate (seraphene and clomid)
It is an oral medication that induces ovulation by blocking estrogen receptors. This
artificial Anti-Estrogen effect makes your body believe that estrogen levels are low, which
stimulates the production of more Follicle Stimulating Hormone (FSH).
It acts as fertility agent in women by inducing superovulation.
Monitoring is necessary while consumption. Monitoring includes ultrasounds, blood
estrogen levels, and urinary luteinizing hormone (LH) testing.

12. Human Menopausal Gonadotropin(Pergonal, Humegon and Repronex)
Late egg development in women who do not ovulate spontaneously or who ovulate
extremely irregularly or to increase the number of eggs developed in a single cycle in
women who already ovulate. Due to the variability in response from patient to patient ,
not fixed dosage regimen can be recommended.
This fertility medication can be used with both Intrauterine Insemination(IUI) and
In-Vitro Fertilization(IVF)
Monitoring of the ovarian response is necessary . An combination of blood estrogen
measurement (E2) and Ultrasound is the best approach to minimizes the risk of
complications.
It is available in injectable form. It is self administered injection

13. Human Chorionic Gonadotropin (Profasi, Pregnyl, Ovidrel)
Human Chorionic Gonadotropin (hCG) is a natural hormone that helps with the final
maturation of the egg and triggers the ovaries to release the mature eggs(ovulation). It also
stimulates the corpus luteum to secrete progesterone to prepare the lining of the uterus for
implantation of the fertilized egg. Ovulation occurs after 36 hours after the hCG is given.
It is administered as an injection . It is self administered injection

14. Leuprolide (Lupron ) and Synthetic Gonadotropin (FSH/LH) Inhibitor
Lupron suppresses the brain secretion of Luteinizing hormone (LH) and Follicle
Stimulating Hormone (FSH). Therefore, it is used in preparation for cycles of treatment
with ovulation inducing drugs, such as exogenous hMG-LH/FSH . It improves the
recruitment of follicles by preventing the recruitment of a dominant follicle for the next
menstrual cycle. It also prevents premature ovulation by preventing LH release. To confirm
the effectiveness of the Lupron treatment , an ultrasound is performed before the ovarian
stimulation is begun and blood estrogen level (E2) test may be required. It is available in an
injectable form.

15. Birth control is the spacing or prevention of pregnancies.
In the present day world, birth control is a must for the following reasons:
To maintain an economic standard.
To maintain healthy family.
To avoid lack of accommodation.
For better care and education of children.
To avoid lack of food.
In some cases pregnancy may be threat to the health of the mother.
Limiting the number of pregnancies in necessary in Rhesus incompatibility.
Temporary postponement may be advisable after an operation or debilitating illness.
By birth control a couple can produce only a limited number of children.
They can bear children at long intervals.

16. The prevention of pregnancy or conception is called contraception. The devices used
for contraception are called contraceptive devices.
Any device which allows intercourse to occur but reduces the rate of conception may
be considered to be a contraceptive devices. They are as follow:
TOTALABSTINENCE:
Conception is prevented when the couple abstains from inter-course. This is the real , sure
way of preventing conception.
ABSTINENCE DURING FERTTILE PERIOD:
In an ideal woman, each menstrual cycle has a duration of 28 days. In such women,
ovulation occurs on the 14th day of the cycle.

17. Intrauterine Contraceptive Device:
The Intrauterine Contraceptive Device (IUCD) is in the form of a plastic material
inserted into the uterine cavity and left there undisturbed for three years. The plastic
device is in the form of Lippe’s loop or Copper T or Saf-T-coil.

18. Suppression of Ovulation:
Pregnancy can be prevented by suppressing ovulation. This is done by some oral
Contraceptive agents which are available in the form of tablets or capsules. The oral
contraceptive tablet contains high concentrations of Progesterone and low
concentration of oestrogen.
The tablets should be taken for 21 Days continuously starting on the fifth day of the
menstrual cycle and finishing on the 26th day. Bleeding usually occurs on the 28th day.
The next course of tablet should begin again on the 5th day of the next cycle.

19. Tubectomy:
Pregnancy can be prevented successfully by surgical operation in female genital
organs. It includes the removal of ovaries or a part of the Fallopian tubes or the uterus
itself.
The most common device is Tubectomy. In Tubectomy, the fallopian tubes are cut
and cut ends are made into knots.
Withdrawal:
Coitus takes place in a normal way; but the penis is withdrawn just before
ejaculation.

20. Condom or Sheath:
In this method, the penis is completely covered by a rubber sheath during
intercourse. It prevents ejaculation into the into the vagina. The rubber sheath may
be thin (condom) or thick (washable sheath).
The Niroth is familiar condom. The washable sheath can be used repeatedly after
washing.

21. Vasectomy:
It is a surgical operation done in the male. In vasectomy, the vas deferens is cut on
the sides of testis. The cut ends are made into knots. This operation is simple and is
completed within twenty minutes.
Drugs to Suppress Spermatogenesis:
There are some male pills which suppress sperm atogenesis.

22. Abortion:
Abortion is the expulsion of conception products from the uterus.
It is done by a Physician.
It is a birth control method and should be done before the 20th week of gestation.
In the medical field, abortion is called MTP (Medical Termination of
Pregnancy) and D and C (Dilation and Surgical Curettage).
In MTP, the cervix is dilated with instruments and the embryo is sucked out.

24. The baby created in a culture medium is called test tube baby. It is modern invention
of man. It was devised by the British scientists Dr. Patrick Steptoe and Dr. Robert
Edwards in 1978.
In this method, the human egg is fertilized in a test tube. The fertilized egg undergoes
cleavage. After 48 hours, at the 4-cell stage, the embryo is transferred to the uterus of a
mother. Further development is completed within the uterus of the mother.
So the baby remains only for two days in the test tube. It is a technique of artificial
insemination in the clinic.
Test tube babies are produced in two methods. They are:
Gift method
Fruity method

25. GIFT METHOD:
It is the old method. In this method, the ovum and the sperm are taken out from the
body, the ovum is fertilized in the lab and the fertilized egg is re-introduced into the
uterus. In this method, the success of pregnancy is 330% and only 18% to 20% babies are
born.
It is advantageous for husbands having less sperm count and wives having defective in
fallopian tubes and uterus.

26. FRUITY METHOD:
Fruity method is the latest techniques. In this method, the ovum is not taken out.
The sperm is introduced into the uterus where fertilization takes place. It is a method of
Artificial Insemination.
This method has certain added advantages. Generally, the ovum gets the capacity of
fertilization only 3 to 4 hours after Ovulation. In fruity method, the ovum gets time for
capacitation. Hence the chance of fertilization and pregnancy is more. Abortion is
less.

27. PROCEDURE:
The method of producing test tube babies involves the following stages:
1. Collection of Eggs:
The lady is medically examined. If she is alright, she is given Gonadotrophin
Hormone. The Hormone stimulates the ovary to produce several eggs. With
the help of a Laparoscope, a ripe ovum is sucked out.
2. Collection of Sperms:
The man donating the sperm is medically examined. If he is suitable, his sperm is
collected.
3. Fertilization:
The Sperm is kept in a dish containing a special nutrient medium. The ripe ovum
is added to this sperm suspension. The egg is fertilized. The fertilized egg undergoes
cleavage. In 48 hours, the four – cell stage is reached.
4. Transplantation:
After 48 hours, the embryo is transferred to the uterus of a lady with the help of a
laparoscope. The embryo is implanted in the uterine wall and it progresses in its
development.

28. 5. Delivery:
After 265 days, the baby is delivered by caesarian operation.

29. Advantages:
This method provides baby to infertile couples.
Some ladies can produce fertile eggs; but their health may not permit them to
bear children. Such ladies obtain babies by the Test Tube method.
In some ladies, the tubes are badly damaged due to infection. Such ladies can
obtain children by the Test Tube method.
It provides opportunity to get babies of desired sex.
Disadvantages:
The rate of Success is low.
Sometimes the egg is fertilized by two sperms resulting in the appearance of
triploid embryos. Fortunately, the triploid embryos die early in pregnancy.
The procedure needs high degree of skill, experience and team work.
It creates a lot of legal complications.

30. LAPAROSCOPE:
Laparoscope is an Endoscope for examining the peritoneal cavity. It is a clinical
instrument like a Stethoscope.
It is made up of Optical Fibres. It is highly flexible. It has a light source.
At one end there is a Telescope and at the other end there is an Eye Lens for vision.
The Telescopic end of the laparoscope can be introduced into the peritoneal cavity
through a small hole (about the size of a 25ps coin) made near the naval region.
Some laparoscopes are provided with a forceps or a cannula for collecting the internal
samples.

32. Uses:
1. It is used to observe the internal organs and their diseases.
2. It is used for family planning such as Tubectomy.
3. It is used to diagnose tumor.
4. It is used for collecting samples of internal organs for biopsy and culture
experiments.
Disadvantages:
1. Religious and moral objections.
2. High cost.