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DR NILESH KATE
MBBS,MD
ASSOCIATE PROF
ESIC MEDICAL COLLEGE, GULBARGA.
DEPT. OF PHYSIOLOGY
CONTRACEPTIVE
METHODS.
OBJECTIVES
 Aims of contraception
 Ideal contraceptive.
 Contraceptive methods in females.
 Spacing methods
 Terminal methods
 Pregnancy vaccines.
 Contraceptive methods in males.
 Spacing methods.
 Terminal methods.
 Miscellaneous methods.
Thursday, May 21, 2015
Introduction.
 DEFINITION :-
Prevention Of Pregnancy.
 AIMS:-
Family Planning
Prevents STD’S – AIDS.
Medical Grounds – To control stress of
pregnancy, labour & lactation.
The characteristics of an ideal
contraceptive are listed below:
 Highly effective.
 No side effects.
 Independent of
intercourse.
 Rapidly reversible.
 Cheap.
 Widespread
availability.
 Acceptable to all
cultures and religions.
 Administration and
healthcare
personnel not
required.
 Easily distributed.
Thursday, May 21, 2015
CONTRACEPTIVE METHODS IN
FEMALES
 Spacing methods
 Terminal methods
 Pregnancy vaccines.
SPACING METHODS.
 Rhythm Methods.
 Barrier Methods.
 Chemical Methods.
 Intrauterine contraceptive devices.
Rhythm Methods.
 Calender method / safe period method /
natural method.
 Depend on time of ovulation.
 Dangerous period – ovulation occurs on 14 day &
ovum viable for 48-72 hrs & sperm remain alive
for 24-48 hrs. so pregnancy occurs if coitus occur
in this period.
Thursday, May 21, 2015
Rhythm Methods.
 Safe period – rest of cycle i.e. 5-6 days after
mensturation & 5-6 days before next cycle.
 Advantage – most natural
 Disadvantage – most unreliable when cycle
are irregular & ovulation time is variable.
Thursday, May 21, 2015
Barrier Methods.
 Mechanical .
 Diaphargm. –
 Flexible rim made up of spring.
 Cup shaped synthetic rubber
or plastic.
 Inserted into vagina over the
cervix.
 Cervical caps.
 Smaller than Diaphargm,
 Applied on cervix itself.
Thursday, May 21, 2015
Mechanical
 Advantages.
 Inexpensive.
 Do not require medical consultation.
 Disadvantages.
 Demonstration by trained person needed for proper
use.
 Failure most common – due to displacement of
device.
 Cervicitis ( inflammation of cervix) & local irritation.
Thursday, May 21, 2015
Chemical
 Spermicidal agents.–
destroy sperms.
 Ricinoleic acid
 Nanoxynol-9.
 Octoxynol-3.
 Available in different forms–
foam tablet, pastes, creams,
jellies & vaginal sponge
( TODAY --Polyurethane sponge
imprignated with nanoxynol-
9.)
 Advantages –
inexpensive, well
tolerated, provide good
protection.
 Disadvantages –
messiness, local irritation
& burning sensation.
 Combined
Thursday, May 21, 2015
Chemical Methods.
 Locally applied chemicals – anti-
spermicidal.
 Foams, jellies.
 Drugs –
 Steroidal –
 Oral contraceptives and depot preparation.
 Non-steroidal --
Steroidal
 ORAL CONTRACEPTIVE PILLS (OCP)
 Recommended in women of younger age group
( up to 35 yrs )
 Mechanism of action.
 Synthetic preparation of estrogen & Progesterone.
 When taken orally, hormone level rises
 Negative feedback effect act on Anterior pituitary
 Inhibit Gonadotrophins (FSH & LH)
 Inhibit Ovulation.
Thursday, May 21, 2015
Types.
 Combined pill.
 Sequential pill.
 Minipill pill.
 Postcoital (Morning
After) pill.
Thursday, May 21, 2015
Combined pill.
 Contains both
 Oestrogen (ethyl
estradiol/mestranol) 20-
50 Mg.
 Progesterone(norethister
one, norgestrel) 0.5-2mg.
 Availability
 MALA-N (21 Tab) &
MALA-D (28 Tab-7 ferrous
fumarate)
Thursday, May 21, 2015
Combined pill.
 Dosage –
 Everyday orally at night
for 21 days. ( from 5th
day
to 25th
day of cycle)
 7 day break for MALA-N
 During this bleeding
occurs, which is not
menstrual bleeding but
is withdrawal bleeding.
 Mechanism of action.
 Prevents Ovulation.
 Prevents Implantation.
 Makes cervical
secretions thick & viscid
& prevent entry of
sperm in female genital
tract.
Thursday, May 21, 2015
Sequential pill Mini-pill.
 High dose of estrogen
with moderate dose of
progesterone.
 Dose – oestrogen 5th
- to
15th
day, then both
oestrogen+progesterone
for 5 days.
 High incidence of
endometrial carcinoma so
not used.
 Micro-pill.
 Only progesterone.
 Dose – daily through whole
of menstrual cycle.
 Action – ovulation not
inhibited but prevents
fertility.
 Makes cervical mucosa
thick & decrease motility of
fallopian tube.
Thursday, May 21, 2015
POSTCOITAL
 Within 72 hrs of
unprotected intercourse.
 Dose – 2 combined pills
immediately followed by
2 pill after12 hrs.
 Indication – only in
emergency– rape,
contraceptive failure, or
unprotected sex.
 Mechanism of action.
 Prevents fertilization &
implantation by
hypermotility of
fallopian tube & uterus.
 If ovulation &
fertilization occurred
then it prevents
implantation of
blastocyst.
Thursday, May 21, 2015
OCP
 Advantages– 100 %
effectivity
 Dis-Advantages. –
 Hypertension.
 Thromboembolism.
 Metabolic effects –
diabetes & obesity.
 Carcinogenic effect –
breast & cervix.
 Contra-indications.
 Women having
carcinoma of breast &
uterus.
 Liver diseases
 Hyperlipidemia.
 Age group above 35 yrs.
Thursday, May 21, 2015
Depot preparation.
Injectable
 Oily solutions given
intramuscularly.
 Progestrin –
 Medroxyprogesterone
acetate (DMPA) – IM every
3-6 months, 150-400mg.
 Norethindrone enanthate
(NET-EN) – IM every 3
months , 200 mg.
 Combined –
 Both estrogen &
progesterone
 IM , monthly .
 MOA –
 Prevent ovulation &
alter cervical mucosal
secretions.
Thursday, May 21, 2015
Sub-dermal implants
 Types –
 Norplant – 6 flexible
silastic (silicon) tubes
 35 mg progesterone.
 Norplant 2 – 2 rods of
levonorgesterol
 Location – beneath skin
of arm or forearm.
 Contraception – 5-6 yrs.
Thursday, May 21, 2015
vaginal rings.
 Contains norgestrel.
 Progesterone
absorbed through
vaginal mucosa.
 Advantages –
 No daily intake
 Long lasting.
 Dis-Advantages –
 Leads to sterility.
 Alterations in
menstrual bleeding
pattern.
Thursday, May 21, 2015
Non-steroidal contraceptives
 Centchroman.
 Developed by Central
Drug Research Institute
(CDRI)
 Trade name – Saheli
 Dose – 30mg
twice/week for 12
weeks followed by once
in a week.
 Mechanism of action
 Suppress corpus luteal
function.
 Interfere with motility
of fallopian tube
 Advantages.
 Menstrual cycle remains
normal.
 Complete reversibility
after withdrawal..
Thursday, May 21, 2015
Intrauterine contraceptive
device (IUCD)
 Ideal candidate.
 Has born one child.
 Normal menstrual
cycle.
 No pelvic
inflammation.
 Ready to check the
device.
 Mechanism of action.
 Prevents implantation & growth
of ovum.
 By aseptic inflammation & causing
endometrium not suitable for
implantation.
 Sperm phagocytization – by
neutrophils & macrophages.
 Cu affects enzymes, motility
 Makes cervical mucus thick
prevent entry of sperm.
Thursday, May 21, 2015
Intrauterine contraceptive device
(IUCD)
Types.
 Non-medicated.
 1ST
generation IUCD.
 Lippes Loop- serpentine
or S shaped.
 Made up of Plastic.
 Medicated.
 2nd
generation Cu made
 2 types.
 Cu T
 Cu T 200
 Newer like NOVA-7, NOVA-T
 3rd
generation.
 Hormone releasing containing
progesterone reservoir
release continuously for 1 yr.
Thursday, May 21, 2015
Cu – T.
 Most commonly used .
 Made up of Cu.
 ‘T’ shaped attached
with a nylon thread.
(tail)
Thursday, May 21, 2015
Method of insertion.
 Withdrawl method.
 Ideal time – during
mensturation or
within 10 days. ( As
cervical cavity
diameter is more)
 Also during 1st
after
delivery.
Thursday, May 21, 2015
IUCD
 Advantages.
 Safe
 Effective
 Reversible
 Easily pulled out when
not required.
 Long term
contraception without
adverse effect.
 Disadvantages.
 May cause heavy bleeding.
 May come out accidently.
 Risk of ectopic pregnancy.
 Contraindications.
 Suspected pregnancy.
 Pelvic inflammation.
 Heavy bleeding during
mensturation.
 Suffering from carcinoma
cervix.
Thursday, May 21, 2015
Terminal methods.
 Permanent method.
 Indication.
 When family is
complete.
 Medical grounds.
Thursday, May 21, 2015
Terminal
methods.
 Surgical methods.
 Tubectomy.
 Fallopian tubes identified ,
cut , cut ends ligated &
buried.
 Laparoscopic occlusion.
 Tubes occluded using silicon
rubber bands, rings or clips
 Method – quicker, simple, no
hospitalization.
Thursday, May 21, 2015
MEDICAL TERMINATION OF
PREGNANCY.
 Medical termination of pregnancy or MTP or
abortion is allowed under MTP act 1971.
 Criteria.
 Person who can do MTP
 Place where it should be performed.
Thursday, May 21, 2015
MEDICAL TERMINATION OF
PREGNANCY.
 Indications.
 Medicals – continuation of pregnancy is hazardous
to the mother.
 Eugenic – substantial risk to the child if born.
 Humanitarian ground.– when pregnancy is result
of rape.
 Failure of contraceptive methods.
Thursday, May 21, 2015
MEDICAL TERMINATION OF
PREGNANCY.
 Methods –
 Dilatation & curettage (D & C).
 Cervix dilated with dilator & implanted ovum removed
by curettage of the endometrium.
 Vacuum aspiration. (up to 12 weeks)
 Same cervix is dilated & contents are aspirated by
vacuum / suction.
 Administration of prostaglandins.
 Prostaglandins are administered intravaginally
 Causes uterine contractions – expulsion of product of
conception.
Thursday, May 21, 2015
Thursday, May 21, 2015
Pregnancy vaccines.
 Under experimental trials.
 2 types.
 Active immunization.
 Β subunits of HCG – antibodies against beta
HCG destroy HCG produced by
syncytiotrophoblast.
 Tetanus toxoid – increases antigenecity
capacity.
 Vaccine against Zona Pellucida proteins
Thursday, May 21, 2015
CONTRACEPTIVE METHODS
IN MALES
Methods
 Spacing methods.
 Natural.
 Barrier.
 Chemical.
 Terminal methods.
 Miscellaneous methods.
Thursday, May 21, 2015
Spacing Methods
Natural Method ( Coitus Interruptus)
 Oldest method of voluntary fertility.
 Male withdraws penis before ejaculation into
vagina.
 Failure rate – high
 As precoital secretions may contain sperm & even a
drop is enough to cause fertilization.
 Wrong Timing of Withdrawl
Thursday, May 21, 2015
Barrier method–
 Condom
 Most widely used.
 Made up of fine latex sheath.
 Instructions –
 Should be worn on erect penis
before intercourse.
 Air must be expelled
 Held carefully when
withdrawing from vagina.
 A new condom should be used
for each sexual act.
Thursday, May 21, 2015
NIRODH
Barrier method
 Mechanism of action,
 Prevents deposition of semen into vagina.
 Advantages –
 Easily available , safe, inexpensive
 Use dose not require medical supervision.
 Provide protection against STD.
 Dis-advantage
 May slip off or tear off.

Interfere with sexual sensation.
Thursday, May 21, 2015
Chemical method.
 Antispermatogenic Drugs – inhibit
spermatogenesis.
1. Male pill (Gossypol)
2 Hormonal preparation
-- Testosterone
-- Testosterone with Danazol
-- Cyproterone acetate
3 calcium channel blocker--
Nifedipine
Male pill ( Gossypol)
 Composition –
Gossypol, phenolic
derivatives of
cottonseed oil.
 Dose – orally.
200mg/D.– 2 months
followed by 60mg/wk.
 Mechanism of action –
exact action not known.
 Causes azoospermia.
 Advantages – neither
hormone nor antihormonal
activity
 No change in libido &
potency.
 Disadvantages –
permanent azospermic
after 6 months
Thursday, May 21, 2015
Hormonal preparation
 Testosterone
 400 mg orally causes
azospermia.
 Testosterone with
Danazol.
 Cyproterone acetate.
 Related to progesterone.
 Potent anti-androgenic
agent.
 Causes oligozoospermia &
loss of libido.
Thursday, May 21, 2015
Calcium channel blockers.
 Block Ca channel on cell membrane of sperm.
 Prevents Ca influx – membrane becomes
rigid & loaded with cholesterol.
 Rigid membrane prevents its binding to Zona
Pellucida.
 So patient on Ca channel blockers
(Nifedipine) for hypertension becomes
sterile.
Thursday, May 21, 2015
Terminal methods.
Vasectomy
Vas Occlusion with No-scalpel
technique
1. Elastomeric Plugs
2 SHUG
3 RISHUG
Vasectomy
 One cm vas deference
removed after clamping.
 Both ends ligated &
sutured.
 Mechanism of action –
entry of sperm into
semen prevented.
 Sperm production &
hormones not affected.
Thursday, May 21, 2015
Vasectomy
 Post-operative
instructions – use
contraceptive
measures (condom) as
he is not sterile ,after
30 ejaculations semen
is free from sperm.
 Advantages.—
 Simple, fast, less
expensive & no
hospitalization.
 Disadvantages.
 Failure rate -0.15%
 Spontaneous
recalalization.
 Autoimmune response.
Thursday, May 21, 2015
No scalpel vas occlusion.
 Newer technique.
 Safe, convenient &
acceptable
 Principle – Elastomer
injected get hardened
insitu within 20 min &
occlude it.
 Methods
 Elastomer plugs.
 MEDICAL GRADE
POLYURETHANE (MPU)
 MEDICAL GRADE
SILICON RUBBER(MSR)
 SHUG – preformed
silicon plug used.
 RISUG – reversible
inhibition of sperm
under guidance.
Thursday, May 21, 2015
Miscellaneous methods.
 Hot baths.
 Hot bath (460
for few weeks.)
 Suspensories.
 It holds testes close to the body.
 Insulated scrotal sack
Thursday, May 21, 2015
THANK YOU

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CONTRACEPTIVE METHODS

  • 1. DR NILESH KATE MBBS,MD ASSOCIATE PROF ESIC MEDICAL COLLEGE, GULBARGA. DEPT. OF PHYSIOLOGY CONTRACEPTIVE METHODS.
  • 2. OBJECTIVES  Aims of contraception  Ideal contraceptive.  Contraceptive methods in females.  Spacing methods  Terminal methods  Pregnancy vaccines.  Contraceptive methods in males.  Spacing methods.  Terminal methods.  Miscellaneous methods. Thursday, May 21, 2015
  • 3. Introduction.  DEFINITION :- Prevention Of Pregnancy.  AIMS:- Family Planning Prevents STD’S – AIDS. Medical Grounds – To control stress of pregnancy, labour & lactation.
  • 4. The characteristics of an ideal contraceptive are listed below:  Highly effective.  No side effects.  Independent of intercourse.  Rapidly reversible.  Cheap.  Widespread availability.  Acceptable to all cultures and religions.  Administration and healthcare personnel not required.  Easily distributed. Thursday, May 21, 2015
  • 5. CONTRACEPTIVE METHODS IN FEMALES  Spacing methods  Terminal methods  Pregnancy vaccines.
  • 6. SPACING METHODS.  Rhythm Methods.  Barrier Methods.  Chemical Methods.  Intrauterine contraceptive devices.
  • 7. Rhythm Methods.  Calender method / safe period method / natural method.  Depend on time of ovulation.  Dangerous period – ovulation occurs on 14 day & ovum viable for 48-72 hrs & sperm remain alive for 24-48 hrs. so pregnancy occurs if coitus occur in this period. Thursday, May 21, 2015
  • 8. Rhythm Methods.  Safe period – rest of cycle i.e. 5-6 days after mensturation & 5-6 days before next cycle.  Advantage – most natural  Disadvantage – most unreliable when cycle are irregular & ovulation time is variable. Thursday, May 21, 2015
  • 9. Barrier Methods.  Mechanical .  Diaphargm. –  Flexible rim made up of spring.  Cup shaped synthetic rubber or plastic.  Inserted into vagina over the cervix.  Cervical caps.  Smaller than Diaphargm,  Applied on cervix itself. Thursday, May 21, 2015
  • 10. Mechanical  Advantages.  Inexpensive.  Do not require medical consultation.  Disadvantages.  Demonstration by trained person needed for proper use.  Failure most common – due to displacement of device.  Cervicitis ( inflammation of cervix) & local irritation. Thursday, May 21, 2015
  • 11. Chemical  Spermicidal agents.– destroy sperms.  Ricinoleic acid  Nanoxynol-9.  Octoxynol-3.  Available in different forms– foam tablet, pastes, creams, jellies & vaginal sponge ( TODAY --Polyurethane sponge imprignated with nanoxynol- 9.)  Advantages – inexpensive, well tolerated, provide good protection.  Disadvantages – messiness, local irritation & burning sensation.  Combined Thursday, May 21, 2015
  • 12. Chemical Methods.  Locally applied chemicals – anti- spermicidal.  Foams, jellies.  Drugs –  Steroidal –  Oral contraceptives and depot preparation.  Non-steroidal --
  • 13. Steroidal  ORAL CONTRACEPTIVE PILLS (OCP)  Recommended in women of younger age group ( up to 35 yrs )  Mechanism of action.  Synthetic preparation of estrogen & Progesterone.  When taken orally, hormone level rises  Negative feedback effect act on Anterior pituitary  Inhibit Gonadotrophins (FSH & LH)  Inhibit Ovulation. Thursday, May 21, 2015
  • 14. Types.  Combined pill.  Sequential pill.  Minipill pill.  Postcoital (Morning After) pill. Thursday, May 21, 2015
  • 15. Combined pill.  Contains both  Oestrogen (ethyl estradiol/mestranol) 20- 50 Mg.  Progesterone(norethister one, norgestrel) 0.5-2mg.  Availability  MALA-N (21 Tab) & MALA-D (28 Tab-7 ferrous fumarate) Thursday, May 21, 2015
  • 16. Combined pill.  Dosage –  Everyday orally at night for 21 days. ( from 5th day to 25th day of cycle)  7 day break for MALA-N  During this bleeding occurs, which is not menstrual bleeding but is withdrawal bleeding.  Mechanism of action.  Prevents Ovulation.  Prevents Implantation.  Makes cervical secretions thick & viscid & prevent entry of sperm in female genital tract. Thursday, May 21, 2015
  • 17. Sequential pill Mini-pill.  High dose of estrogen with moderate dose of progesterone.  Dose – oestrogen 5th - to 15th day, then both oestrogen+progesterone for 5 days.  High incidence of endometrial carcinoma so not used.  Micro-pill.  Only progesterone.  Dose – daily through whole of menstrual cycle.  Action – ovulation not inhibited but prevents fertility.  Makes cervical mucosa thick & decrease motility of fallopian tube. Thursday, May 21, 2015
  • 18. POSTCOITAL  Within 72 hrs of unprotected intercourse.  Dose – 2 combined pills immediately followed by 2 pill after12 hrs.  Indication – only in emergency– rape, contraceptive failure, or unprotected sex.  Mechanism of action.  Prevents fertilization & implantation by hypermotility of fallopian tube & uterus.  If ovulation & fertilization occurred then it prevents implantation of blastocyst. Thursday, May 21, 2015
  • 19. OCP  Advantages– 100 % effectivity  Dis-Advantages. –  Hypertension.  Thromboembolism.  Metabolic effects – diabetes & obesity.  Carcinogenic effect – breast & cervix.  Contra-indications.  Women having carcinoma of breast & uterus.  Liver diseases  Hyperlipidemia.  Age group above 35 yrs. Thursday, May 21, 2015
  • 20. Depot preparation. Injectable  Oily solutions given intramuscularly.  Progestrin –  Medroxyprogesterone acetate (DMPA) – IM every 3-6 months, 150-400mg.  Norethindrone enanthate (NET-EN) – IM every 3 months , 200 mg.  Combined –  Both estrogen & progesterone  IM , monthly .  MOA –  Prevent ovulation & alter cervical mucosal secretions. Thursday, May 21, 2015
  • 21. Sub-dermal implants  Types –  Norplant – 6 flexible silastic (silicon) tubes  35 mg progesterone.  Norplant 2 – 2 rods of levonorgesterol  Location – beneath skin of arm or forearm.  Contraception – 5-6 yrs. Thursday, May 21, 2015
  • 22. vaginal rings.  Contains norgestrel.  Progesterone absorbed through vaginal mucosa.  Advantages –  No daily intake  Long lasting.  Dis-Advantages –  Leads to sterility.  Alterations in menstrual bleeding pattern. Thursday, May 21, 2015
  • 23. Non-steroidal contraceptives  Centchroman.  Developed by Central Drug Research Institute (CDRI)  Trade name – Saheli  Dose – 30mg twice/week for 12 weeks followed by once in a week.  Mechanism of action  Suppress corpus luteal function.  Interfere with motility of fallopian tube  Advantages.  Menstrual cycle remains normal.  Complete reversibility after withdrawal.. Thursday, May 21, 2015
  • 24. Intrauterine contraceptive device (IUCD)  Ideal candidate.  Has born one child.  Normal menstrual cycle.  No pelvic inflammation.  Ready to check the device.  Mechanism of action.  Prevents implantation & growth of ovum.  By aseptic inflammation & causing endometrium not suitable for implantation.  Sperm phagocytization – by neutrophils & macrophages.  Cu affects enzymes, motility  Makes cervical mucus thick prevent entry of sperm. Thursday, May 21, 2015
  • 25. Intrauterine contraceptive device (IUCD) Types.  Non-medicated.  1ST generation IUCD.  Lippes Loop- serpentine or S shaped.  Made up of Plastic.  Medicated.  2nd generation Cu made  2 types.  Cu T  Cu T 200  Newer like NOVA-7, NOVA-T  3rd generation.  Hormone releasing containing progesterone reservoir release continuously for 1 yr. Thursday, May 21, 2015
  • 26. Cu – T.  Most commonly used .  Made up of Cu.  ‘T’ shaped attached with a nylon thread. (tail) Thursday, May 21, 2015
  • 27. Method of insertion.  Withdrawl method.  Ideal time – during mensturation or within 10 days. ( As cervical cavity diameter is more)  Also during 1st after delivery. Thursday, May 21, 2015
  • 28. IUCD  Advantages.  Safe  Effective  Reversible  Easily pulled out when not required.  Long term contraception without adverse effect.  Disadvantages.  May cause heavy bleeding.  May come out accidently.  Risk of ectopic pregnancy.  Contraindications.  Suspected pregnancy.  Pelvic inflammation.  Heavy bleeding during mensturation.  Suffering from carcinoma cervix. Thursday, May 21, 2015
  • 29. Terminal methods.  Permanent method.  Indication.  When family is complete.  Medical grounds. Thursday, May 21, 2015
  • 30. Terminal methods.  Surgical methods.  Tubectomy.  Fallopian tubes identified , cut , cut ends ligated & buried.  Laparoscopic occlusion.  Tubes occluded using silicon rubber bands, rings or clips  Method – quicker, simple, no hospitalization. Thursday, May 21, 2015
  • 31. MEDICAL TERMINATION OF PREGNANCY.  Medical termination of pregnancy or MTP or abortion is allowed under MTP act 1971.  Criteria.  Person who can do MTP  Place where it should be performed. Thursday, May 21, 2015
  • 32. MEDICAL TERMINATION OF PREGNANCY.  Indications.  Medicals – continuation of pregnancy is hazardous to the mother.  Eugenic – substantial risk to the child if born.  Humanitarian ground.– when pregnancy is result of rape.  Failure of contraceptive methods. Thursday, May 21, 2015
  • 33. MEDICAL TERMINATION OF PREGNANCY.  Methods –  Dilatation & curettage (D & C).  Cervix dilated with dilator & implanted ovum removed by curettage of the endometrium.  Vacuum aspiration. (up to 12 weeks)  Same cervix is dilated & contents are aspirated by vacuum / suction.  Administration of prostaglandins.  Prostaglandins are administered intravaginally  Causes uterine contractions – expulsion of product of conception. Thursday, May 21, 2015
  • 35. Pregnancy vaccines.  Under experimental trials.  2 types.  Active immunization.  Β subunits of HCG – antibodies against beta HCG destroy HCG produced by syncytiotrophoblast.  Tetanus toxoid – increases antigenecity capacity.  Vaccine against Zona Pellucida proteins Thursday, May 21, 2015
  • 37. Methods  Spacing methods.  Natural.  Barrier.  Chemical.  Terminal methods.  Miscellaneous methods. Thursday, May 21, 2015
  • 38. Spacing Methods Natural Method ( Coitus Interruptus)  Oldest method of voluntary fertility.  Male withdraws penis before ejaculation into vagina.  Failure rate – high  As precoital secretions may contain sperm & even a drop is enough to cause fertilization.  Wrong Timing of Withdrawl Thursday, May 21, 2015
  • 39. Barrier method–  Condom  Most widely used.  Made up of fine latex sheath.  Instructions –  Should be worn on erect penis before intercourse.  Air must be expelled  Held carefully when withdrawing from vagina.  A new condom should be used for each sexual act. Thursday, May 21, 2015 NIRODH
  • 40. Barrier method  Mechanism of action,  Prevents deposition of semen into vagina.  Advantages –  Easily available , safe, inexpensive  Use dose not require medical supervision.  Provide protection against STD.  Dis-advantage  May slip off or tear off.  Interfere with sexual sensation. Thursday, May 21, 2015
  • 41. Chemical method.  Antispermatogenic Drugs – inhibit spermatogenesis. 1. Male pill (Gossypol) 2 Hormonal preparation -- Testosterone -- Testosterone with Danazol -- Cyproterone acetate 3 calcium channel blocker-- Nifedipine
  • 42. Male pill ( Gossypol)  Composition – Gossypol, phenolic derivatives of cottonseed oil.  Dose – orally. 200mg/D.– 2 months followed by 60mg/wk.  Mechanism of action – exact action not known.  Causes azoospermia.  Advantages – neither hormone nor antihormonal activity  No change in libido & potency.  Disadvantages – permanent azospermic after 6 months Thursday, May 21, 2015
  • 43. Hormonal preparation  Testosterone  400 mg orally causes azospermia.  Testosterone with Danazol.  Cyproterone acetate.  Related to progesterone.  Potent anti-androgenic agent.  Causes oligozoospermia & loss of libido. Thursday, May 21, 2015
  • 44. Calcium channel blockers.  Block Ca channel on cell membrane of sperm.  Prevents Ca influx – membrane becomes rigid & loaded with cholesterol.  Rigid membrane prevents its binding to Zona Pellucida.  So patient on Ca channel blockers (Nifedipine) for hypertension becomes sterile. Thursday, May 21, 2015
  • 45. Terminal methods. Vasectomy Vas Occlusion with No-scalpel technique 1. Elastomeric Plugs 2 SHUG 3 RISHUG
  • 46. Vasectomy  One cm vas deference removed after clamping.  Both ends ligated & sutured.  Mechanism of action – entry of sperm into semen prevented.  Sperm production & hormones not affected. Thursday, May 21, 2015
  • 47. Vasectomy  Post-operative instructions – use contraceptive measures (condom) as he is not sterile ,after 30 ejaculations semen is free from sperm.  Advantages.—  Simple, fast, less expensive & no hospitalization.  Disadvantages.  Failure rate -0.15%  Spontaneous recalalization.  Autoimmune response. Thursday, May 21, 2015
  • 48. No scalpel vas occlusion.  Newer technique.  Safe, convenient & acceptable  Principle – Elastomer injected get hardened insitu within 20 min & occlude it.  Methods  Elastomer plugs.  MEDICAL GRADE POLYURETHANE (MPU)  MEDICAL GRADE SILICON RUBBER(MSR)  SHUG – preformed silicon plug used.  RISUG – reversible inhibition of sperm under guidance. Thursday, May 21, 2015
  • 49. Miscellaneous methods.  Hot baths.  Hot bath (460 for few weeks.)  Suspensories.  It holds testes close to the body.  Insulated scrotal sack Thursday, May 21, 2015