TEMPORARY CONTRACEPTION choice, methods.pptx

DEFINITION OF CONTRACEPTION
A method or a system which allows
intercourse and yet prevents
conception is called a contraceptive
method

TEMPORARY CONTRACEPTION
The contraception may be temporary when the
effect of preventing pregnancy lasts while the
couple uses the method but the fertility returns
immediately or within a few months of its
discontinuation.

CHOICE OF CONTRACEPTION
 Availability
 cost
 Age and parity of the couple.
 Reliability (failure rate).
 Side effects, contraindications to a particular method.
 Requirement of follow-up.
 Counselling and allowing the couple to make a suitable choice. The couple
may need to change one contraception to another from time to time
during the reproductive period. Personal, medical and social factors should
be taken into consideration during counselling.

METHODS OF TEMPORARY
CONTRACEPTION
1. Natural methods:
Abstinence during the fertile phase.
Withdrawal (coitus interruptus).
Breastfeeding.
2. Barrier contraceptives:
Use of condoms by male.
Use of spermicidal agents.
Use of diaphragm, or the cervical cap in the vagina,
use of female condom.
Use of hormones which alter the cervical mucus and
prevent entry of sperms into the cervical canal.

3. Intrauterine contraceptive devices (IUCDs).
4. Suppression of spermatogenesis.
5. Suppression of ovulation with hormones—hormonal
contraceptives.
6. Interceptive agents (postcoital contraception).
7. Immunological methods.
 #Surgical method is the only permanent contraceptive method.

1. NATURAL METHODS
Abstinence during the Fertile Phase
 The woman understands about her fertile period within
her menstrual cycle.
 Four methods-
1.Calender method or rhythm method
2. Mucus method ( Billings or ovulation
method)
3. Temperature Method
4. Symptothermal Method

Calendar Method
 Avoidance of sexual intercourse during ovulation.
 The safe period is, therefore, calculated from the first day of the
menstrual period until the 10th day of the cycle and from the 18th
to the 28th day.
 In Knaus–Ogino method, the fertile period is determined by
subtracting 18 days from the shortest cycle and 10 days from the
longest cycle which gives the first and the last day of fertile period,
respectively.
 Irregular ovulation and irregular menstrual cycles may lead to
FAILURE.

Mucus Method
 The properties of the cervical mucus change under the influence of
the ovarian hormones on different days of the menstrual cycle.
 The woman attempts to predict the fertile period by feeling the
cervical mucus.
 Under oestrogen influence, the mucus increases in quantity and
becomes progressively more slippery and elastic until a peak is
reached.
 Thereafter, the mucus becomes thicker, scanty and dry under the
influence of progesterone until the onset of menses.
 Intercourse is considered safe during the ‘dry days’ immediately
after the menses until mucus is detected.
 Thereafter, the couple must abstain until the fourth day after the
‘peak day’

Temperature Method
 Progesterone is known to exert a thermogenic effect on the body.
 Therefore, if the woman records her basal body temperature (BBT) daily on
awakening in the morning and plots the readings graphically, the BBT chart will be
biphasic in an ovulatory cycle
 The day of temperature shift indicates the time of ovulation.
 Difficult method, Hardly practiced

Symptothermal Method
 The first day of abstinence is predicted either from the calendar, by
subtracting 21 from the length of the shortest menstrual cycle in the
preceding 6 months, or the first day mucus is detected, whichever comes
first.
 The end of the fertile period is predicted by use of the ‘BBT’ chart.
 The woman resumes intercourse 3 days after the thermal shift.
 This combination method is more effective
 Apart from the long periods of abstinence required, this method is not
reliable if the woman is lactating or has irregular cycles or develops fever

WITHDRAWAL METHOD (coitus interruptus)
 Coitus takes place in a normal manner but the penis is
withdrawn immediately before ejaculation.
 Advantages of fertility awareness methods are: (i) no
cost, (ii) no contraindications, (iii) no systemic side
effects and (iv) no effect on lactation.
 Disadvantages are: (i) failure rate is high, (ii) requires
motivation and (iii) no protection against HIV and STD.

BREASTFEEDING
 Regular breastfeeding with at least one feed at night is
shown to prevent pregnancy for 6 months,
 This occurs due to prolactin preventing LH surge and
ovulation.
 Beyond 6 months of breastfeeding, prolactin level falls
and ovulation can occur.
 It is the frequency rather than the duration of feed that
decides nonovulation in a nursing mother.

2. BARRIER METHODS
CONDOMS
 In this method, the erectile penis is completely covered by a
very thin rubber (condom) which is used only once.
 It is desirable to use a condom with a water-based
spermicidal agent to improve the efficacy of the method
 The condoms prevent sexually transmitted diseases (STD) and
HIV, but are less protective against STD transmitted from skin-
to-skin contact such as human papilloma virus and herpes
virus.

 ADVANTAGES. 1)It is easily available, cheap, easy to carry, free from side
effects and requires no instruction. 2)It emphasizes the male involvement in
contraceptive effort and is immediately effective. 3)It prevents sperm
allergy. 4)It has no adverse effect on pregnancy, should the method fail.
5) Condoms also prevent transmission of STDs from one partner to the other.
 DISADVANTAGES.1) The method is only partially reliable. 2)vaginal irritation
to the latex. 3)full sexual satisfaction.

SPERMICIDAL AGENTS
 The spermicidal agents kill the sperms before the latter gain access to the
cervical canal.
 These chemical contraceptive agents contain surfactants, such as
nonoxynol-9, octoxynol and menfegol and enzyme-inhibiting agents, and
are available as foam tablets, soluble pessaries, creams, jellies, or as films
along with other contraceptives
 The spermicidal agent remains effective for 1–2 h after the application.
 By causing irritation and abrasions in chronic use, they can cause vaginal
ulceration and perhaps increase the risk of HIV spread rather than prevent
it.

OCCLUSIVE DIAPHRAGM
 These provide a barrier in the vagina against direct
insemination.
 The diaphragm is effective when used in conjunction
with a chemical spermicide in the form of a jelly or cream, and when
sufficient time is allowed for complete destruction of the sperms before the
diaphragm is removed.
 In practice, the diaphragm liberally covered with spermicide can be
inserted at any convenient time and is left in position for a minimum of 8 h
after coitus.
 Types:- 1)Dutch cap or Diaphragm 2)Cervical Cap 3)Dumas Cap
4)Femsheild 5)Today
 Advantages 1)Instant infertility n Reversible in 2–4 months 2) No toxicity
3) No decreased libido 4) cheap and easy to use.
 Disadvantage 1)Scrotal swelling is sometimes reported.

3.INTRAUTERINE CONTRACEPTIVE
DEVICES
 IUCD is an effective, reversible and long-term method of
contraception, which does not require replacement for
long periods and does not
interfere with sexual activity.
 Classification of IUCDs
 Copper carrying devices
 Progestasert and Levonova

Copper carrying devices
 These devices are Copper T 200, Copper 7, Multiload Copper 250, Copper T
380, Copper T 220 and Nova T.
 The copper devices are more expensive than inert devices but are
reported to exert a better contraceptive effect, with fewer side effects.
 They have an effective life of about 3–5 years.
 In these, copper wire of surface area 200 to 250 mm is wrapped round the
vertical stem of a polypropylene frame.

Progestasert and levonova
 Progestasert is a T-shaped device carrying 38 mg of progesterone in silicon
oil reservoir in the vertical stem. It releases 65 mcg of the hormone per day.
 The hormone released in the uterus forms a thick plug of mucus at the
cervical os which prevents penetration by the sperms and thus exerts an
added contraceptive effect.
 Menstrual problems like menorrhagia and dysmenorrhoea noticed with
Copper T are less with this device (40% reduction). It is expensive and
requires yearly replacement.
 levonova, contains 60 mg of levonorgestrel (LNG) and releases the
hormone in very low doses (20 mcg/day). It is thus longer acting (5 years)
and has a low pregnancy rate.
 It can be safely recommended for nursing mothers.

PATIENT SELECTION
 Low risk of STD
 Multiparous woman
 Monogamous relationship
 Desirous of long-term reversible method of contraception, but not yet
desirous of permanent sterilization
 Unhappy or unreliable users of oral contraception or barrier contraception

USES OF IUCD
 As a contraceptive
 Postcoital contraception (emergency contraception)
 Following excision of uterine septum, Asherman syndrome
 Hormonal IUCD (Mirena) in menorrhagia and dysmenorrhoea, and
hormonal replacement therapy in menopausal women
 In a woman on tamoxifen for breast cancer, MIRENA can be used to
counteract endometrial hyperplasia

contraindications
 Suspected pregnancy
 Pelvic inflammatory disease (PID), lower genital tract infection
 Presence of fibroids—because of misfit
 Menorrhagia and dysmenorrhoea, if Copper T is used
 Severe anaemia n Diabetic women who are not well controlled—because
of slight increase in pelvic infection
 Heart disease—risk of infection
 Previous ectopic pregnancy
 Scarred uterus
 Preferably avoid its use in unmarried and nulliparous patients because of
the risk of PID and subsequent tubal infertility
 LNG IUCD in breast cancer
 Abnormally shaped uterus, septate uterus

METHODS OF INSERTION
PUSH IN TECHNIQUE
 The vagina and cervix are inspected by means of a speculum.
 Any vaginal or cervical infection must be treated and cured before a device is
inserted.
 The cervix is grasped with a vulsellum or Allis forceps.
 The device with the introducer is available in a presterilized pack. The device is
mounted into the introducer, and the stop on the introducer is adjusted to the
length of the uterine cavity.
 The introducer is then passed through the cervical canal and the plunger is
pressed home. This is known as ‘push-in technique’.

WITHDRAWAL TECHNIQUE
 The better method is ‘withdrawal technique’ with less chance of uterine
perforation.
 In this, the rod containing IUCD is inserted up to the fundus.
 The outer rod is withdrawn followed by inner rod (multiload). The device
uncoils within the uterine cavity.
 The nylon thread is cut to the required length.
 The forceps and the speculum are removed and the patient is then
instructed to examine herself and feel for the thread every week.

Mechanism of Action.
 The presence of a foreign body in the uterine cavity renders the migration
of spermatozoa difficult.
 A foreign body within the uterus provokes uterine contractility through
prostaglandin release and increases the tubal peristalsis so that the fertilized
egg is propelled down the fallopian tube more rapidly than in normal and it
reaches the uterine cavity before the development of chorionic villi and
thus is unable to implant.
 The device in situ causes leucocytic infiltration in the endometrium. The
macrophages engulf the fertilized egg if it enters the endometrial tissue.
 Copper T elutes copper which brings about certain enzymatic and
metabolic changes in the endometrial tissue which are inimical to the
implantation of the fertilized ovum.
 Progestogen-carrying device causes alteration in the cervical mucus which
prevents penetration of sperm, in addition to its local action. It also causes
endometrial atrophy.

COMPLICATIONS
 Immediate
 Difficulty in insertion
 Vasovagal attack
 Uterine cramps
 Early
 Expulsion (2–5%)
 Perforation (1–2%)
 Spotting, menorrhagia (2–10%)
 Dysmenorrhoea (2–10%)
 Vaginal infection n Actinomycosis
 Late
 PID—2–5%. IUCD does not prevent transmission of HIV
 Pregnancy—1–3 per 100 woman years (failure rate)
 Ectopic pregnancy
 Perforation
 Menorrhagia
 Dysmenorrhoe

MISPLACED IUCD
 It is defined as the condition when the tail of the IUCD is not seen through the os.
 A plain radiograph or pelvic ultrasound will show whether the IUCD is still inside or
has been expelled.
 The causes are:
(i) uterus has enlarged through pregnancy,
(ii) thread has curled inside the uterus,
(iii) perforation has occurred or the IUCD is buried in the
myometrium
(iv) it has been expelled

ADVANTAGES DISADVANTAGES
It is coital-independent A medical or paramedical personnel
is required to screen and insert an
IUCD.
One-time insertion gives continuous
protection for a long period
Certain complications have been
mentioned.
It is cost effective.
It is highly effective, newer IUCDs
being as effective as oral
contraceptives
There is no evidence of reduced
fertility following its removal.
There are no systemic ill effects, unlike
oral contraceptives.

4.SUPPRESSION OF SPERMATOGENESIS
GLOSSYPOL
 It is administered orally 10–20 mg daily for 3 months and thereafter 20 mg
twice weekly.
 The action is directly on the seminiferous tubules inhibiting spermatogenesis
without altering FSH and LH levels.
 The side effects such as weakness, hypokalaemia and permanent sterility in
20% cases limit its use.

TESTOSTERONE ENANTHATE
 Testosterone enanthate 200 mg injection weekly causes azoospermia in 6–
12 months.
 Instead of weekly injection, testosterone decanoate 1000 mg IM followed
by 500 mg 4-weekly is more convenient.
 Side effects—osteopenia, liver and lipid metabolism dysfunction, prostate
enlargement.

GnRH
 The continuous administration of analogues of gonadotropin-releasing hormone (GnRH) causes a fall in the sperm
count and sperm motility.
 The level of testosterone also falls.
 The loss of libido and osteoporosis makes this regime unacceptable over a long period.
 Besides, it is very expensive and needs to be given subcutaneously
#Other anti spermatogenic agents are Medroxyprogesterone Acetate and Desogestrel.
# The hormonal suppression of spermatogenesis causes loss of libido and is toxic in high doses.
#Besides, the injection of hormones is inconvenient to administer regularly.
# The acne, weight gain and decreased HDL are other side effects.

5. Suppression of Ovulation (Hormonal
Contraceptive Agents)

Combined pill
 Combined oral pills contain a mixture of ethinyloestradiol (EE2) in a dose of
20–30 mcg and an orally active progestogen.
 MALA-N(21 TAB ) & MALA-D(28 TAB-7 FERROUS FUMARATE)
 The tablets are taken starting on the second day of the cycle for 21 days
(now started on 1st day).
 A new course of tablets should be commenced 7 days after the cessation
of the previous course.
 They should be taken at a fixed time of the day, preferably after a meal.

MECHANISM OF ACTION
 The combined oral pill suppresses pituitary hormones, FSH and LH peak
and through their suppression prevents ovulation.
 At the same time, progestogen causes atrophic changes in the
endometrium and prevents nidation.
 Progestogen also acts on the cervical mucus making it thick and
tenacious and impenetrable by sperms.
 It also increases the tubal motility, so the fertilized egg reaches the
uterine cavity before the endometrium is receptive for implantation

BENEFITS
 It effectively controls fertility.
 As it causes regular and scanty menstruation, it is useful in menorrhagia and
polymenorrhoea.
 It prevents anaemia by reducing the menstrual loss.
 It has proved to lower the incidence of benign breast neoplasia such as
fibrocystic disease.
 It reduces the incidence of functional ovarian cyst (50%) and ovarian and
uterine malignancy
 The incidence of PID is reduced
 Reduced incidence of ectopic pregnancy is due to suppression of
ovulation and reduction in PID.
 It protects against rheumatoid arthritis.
 Reduces the risk of anorectal cancer by 30–40%.
 It is useful in acne, PCOD and endometriosis.

SIDE EFFECTS
 Intermenstrual spotting
 Menstrual bleeding can become very scanty and occasionally a woman
becomes amenorrhoeic causing undue fear of pregnancy.
 Oral pills are associated with monilial vaginitis. Carcinoma of the
endocervix has been reported if used for more than 5 years but dysplasia is
more frequent.
 OC is proved to increase the risk of breast cancer in a high-risk woman. The
combined pills should not be offered to a woman suffering from cancer of
the breast.
 Lactation is suppressed with combined pills.
 Carbohydrate tolerance may be reduced. Therefore, combined oral pills
are contraindicated or cautiously given to a diabetic woman.
 Headache, migraine, depression, irritability, increased weight and lethargy
can occur due to progestogen.

CONTRAINDICATIONS
 Cardiac disease, hypertension, smoker over 35 years.
 Diabetes.
 History of thrombosis, myocardial infarct, sickle cell anaemia, severe
migraine.
 Chronic liver diseases such as cholestatic jaundice of pregnancy, cirrhosis
of liver, adenoma, porphyrias.
 Breast cancer, gall bladder disease.
 Gross obesity.
 Patient on enzyme-inducing drugs like rifampicin, and antiepileptic except
sodium valproate.
 4–6 weeks prior to planned surgery.
 Lactating woman.
 Monilial vaginitis

TRIPHASIC COMBINED PILLS
 The triphasic preparations of EE2 and LNG contain during the first 6 days of
the cycle 30 mcg EE2 plus 50 mcg LNG, for the next 5 days 40 mcg EE2 plus
75 mcg LNG, and during the last 10 days 30 mcg EE2 and 125 mcg LNG,
followed by one medication-free week.
 These pills have no adverse effect on carbohydrate and lipid metabolism;
therefore, they can be prescribed to diabetic women and without
expecting any increased risk of myocardial infarct.
 They are as effective as the monophasic oral pills but not recommended in
menorrhagia and for other indications.

MINI PILL/PROGESTOGEN ONLY PILL
 The lowdose POP (norethisterone 350 mcg, norgestrel 75 mcg or LNG 30
mcg) have been introduced to avoid the side effects of oestrogen in the
combined pills.
 The tablet is taken daily without a break.
 The pill should be started within 5–7 days of the menstruation and taken at
the same time with a leeway of 3 h on either side of the fixed time each day.
 Minipill does not have some of the major side effects of the combined pill
and it is well suited for lactating women; some progestogens, in fact,
increase milk secretion.
 Drawbacks are irregular bleeding (20%), amenorrhoea, depression,
headache, migraine and weight gain, ectopic pregnancy, functional
ovarian cysts besides a higher failure rate.
 Contraindications to POP are previous ectopic pregnancy, ovarian cyst,
breast and genital cancers, abnormal vaginal bleeding, active liver and
arterial disease, porphyria, liver tumour, valproate, spironolactone and
meprobamate. B

ADVANTAGES
 Lactating women
 Women over 35 years
 Those with focal migraine
 Those intolerant to oestrogen or oestrogen contraindicated
 Diabetic, hypertensive woman, sickle cell anaemia
SIDE EFFECTS
 weight gain
 irregular menstrual bleeding
 Depression
 breast cancer and
 thromboembolism

MECHANISM OF ACTION
 Cerazette (75 mcg desogestrel )suppresses ovulation in 97–100%, whereas
other progesterone only pills suppress ovulation in only 40%.
 It forms a thick plug of mucus in the cervical canal and acts as a barrier to
sperms.
 It increases tubal peristalsis and fertilized egg reaches the uterine cavity too
early for implantation.

DEPOT INJECTIONS
 Depot medroxyprogesterone acetate (DMPA) is given in microcrystalline
aqueous suspension and norethisterone enanthate (NETO) in castor oil
solution, both by deep intramuscular injection (not subcutaneous).
 A monthly injection of DMPA 25–50 mg, combined with 5 mg oestradiol is
considered to be effective.
 Other preparations in use are the DMPA 150 mg 3-monthly, DMPA 300 mg
6-monthly and NETO 200 mg 2-monthly.
Injections are easy to administer, Long-
acting, reversible.
Menstrual irregularity and amenorrhoea
The side effects of lipid and carbohydrate
metabolism are avoided
There is a delay in return of fertility.
The incidence of PID, ectopic pregnancy
and functional ovarian cysts is low, so also
endometrial cancer.
weight gain, depression, bloated feeling and
mastalgia
Avoids oestrogenic side effects. Contraindicated in breast cancer
Can be given to a woman with sickle cell
anaemia
Decreases libido, causes dry vagina
Coital independent. Prolonged use may reduce bone density
mass and induce osteopenia.

SUBDERMAL IMPLANTS
 The subdermal implant has no ‘nuisance value’ of continuous compliance
which often adversely affects motivation.
 Besides, nonoral system avoids ‘hepatic first pass effect and systemic side
effects’.
 Norplant I (Figures 20.13–20.15) containing six silastic capsules has been
withdrawn and replaced by a single rod implant.
 Norplant II (Jadelle) consists of two rods each containing 70 mg LNG. The
daily release of hormone is 50 mcg and provides contraception for 3–5 years.
They are long-acting with
sustained effect
Breakthrough bleeding, irregular
cycles, amenorrhoea
Coital-independent Local infection may occur
Systemic side effects are few and
first pass effect on the liver
avoided.
Requires insertion and removal
with nonbiodegradable capsules
Can be used by lactating mothers
and over the age 40.
The implants are expensive

SILASTIC VAGINAL RINGS
 To reduce the side effects of systemic hormonal contraception and the
surgical method of insertion of implants, silastic vaginal rings carrying
different progestogens have now been introduced.
 contains LNG releasing 20 mcg of hormone daily and 15 mcg EE2.
 The contraceptive effect is mainly on the cervical mucus.
 Nuvaring contains 2.7 mg EE2 1 11.7 mg etonogestrel used continuously for
3 weeks and removed for 1 week.
Self-insertion and removal, good
compliance
Expensive
Quick reversibility Local irritation
Expulsion can occur.

SKIN PATCHES
 Hormonal patch (ortho-EVRA).
 Hormonal patch Elutes 150 mcg of norelgestromin and 20 mcg EE2 daily
and the hormone lasts for 7 days.
 Three patches are required each cycle followed by 1 week patch-free
interval.
 The patch should be applied within 5 days of menses over the buttocks,
abdomen but not over the breasts
 The breakthrough bleeding (18%) and skin reaction (20%) breast discomfort
are the side effects.
 GnRH, given continuously, suppresses FSH and LH and thereby ovulation.
 However, the drug is very expensive and long-term use causes
osteoporosis.

CENTCHROMAN
 Centchroman is a synthetic nonsteroidal contraceptive taken as a 30 mg
tablet, started on the first day of menses and taken twice weekly for 12
weeks and weekly thereafter (half-life is 170 h).
 It does not prevent ovulation. It prevents implantation through endometrial
changes.
 Centchroman is not teratogenic or carcinogenic, exerts no
pharmacological effect on other organs. The only side effect noted is
prolonged cycles and oligomenorrhoea in 8% cases.
 It has been developed by Central Drug Research Institute, Lucknow, and has
been released in India under the name of Saheli.
 Side effects :-Headache, nausea, vomiting,Gain in weight, Does not protect
against HIV and STD, Some delay in return of fertility (up to 6 months). On
Prolonged use—hyperplasia and atypical endometrium.
 Contraindications :- During 6 months of lactation, PCOD, hepatic
dysfunction, cervical dysplasia, allergy to the drug.

6.POSTCOITAL CONTRCEPTION
 Postcoital contraceptive agent interferes with postovulatory events leading
to pregnancy and is therefore known as interceptive.
 It is also known as ‘emergency contraception’ method used to prevent
pregnancy after an unprotected intercourse.
 Emergency contraception is used following rape, unprotected intercourse
or accidental rupture of a condom during coitus taking place around
ovulation.
 The preparations available include: Two tablets of relatively high doses of
combined pill (Ovran/Eugynon 50), containing 100 mcg EE2 and 1 mg
norethisterone, or 500 mcg LNG, taken within 72 h of intercourse followed
by two tablets taken 12 h later.
 MECHANISM OF ACTION:- The hormones may delay ovulation if taken soon
after intercourse, cause corpus luteolysis, and bring about cervical mucus
changes and endometrial atrophy.

LEVONORGESTRAL
 Prostinar tablet contains 0.75 mg LNG.
 One tablet should be taken within 72 h of unprotected intercourse and
another 12 h later. Alternately, two tablets can be taken as a single dose.
 LNG prevents ovulation and causes desynchronization of endometrium
through its receptors.
 Side effects are those of progestogens. The hormone is not teratogenic in
case pregnancy does occur but risk of ectopic pregnancy remains.
 Contraindicated in liver disease, contains lactate, so allergy to galactose.
The drug is also contraindicated in a woman with history of
thrombophlebitis and migraine
 ADVANTAGES:
 It has no oestrogen and its associated side effects.
 It can be offered to hypertensive, cardiac and diabetic woman.
 It can be offered to a lactating woman.
 It can be given as late as 120 h after the unprotected intercourse.
 Single-dose therapy is an advantage

RU 486 (Mifepristone)
 RU 486 is a steroid with an affinity for progesterone receptors.
 It does not prevent fertilization but by blocking the action of progesterone
on the endometrium, it causes sloughing and shedding of decidua and
prevents implantation.
 It is not teratogenic.
 It causes delayed menstruation.
 Ectopic pregnancy is not avoided.
 The drug is expensive as compared to LNG.
ULIPRISTAL
 Ulipristal is a synthetic progesterone hormone receptor modular, attaches
to progesterone receptor and prevents/delays ovulation and suppresses
endometrium, prevents implantation.
 A 30 mg tablet should be taken within 5 days.
 Side effects are headache and mood changes.

7. IMMUNOLOGICAL METHODS
 Immunological approach to family planning is still in a developmental
stage.
 The antigens which are being experimented upon are:
 b-hCG subunit (300 mcg) IM six-weekly 3 3 doses evokes specific antibodies and
thereby produces temporary sterility for 1 year.
 Zona pellucida plays an important role in fertility. The zona pellucida antibodies
can either prevent penetration of ovum by the sperm or prevent shedding of
zona after fertilization so that implantation is impossible.
 Antibodies to sperm antigens. These trials have not yet proved successful in
human beings.
 AntiFSH vaccine (inhibin) is also under trial.

TEMPORARY CONTRACEPTION choice, methods.pptx

TEMPORARY CONTRACEPTION choice, methods.pptx

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