Choosing a Fertility Control MethodUNIT 10

objectives

Define contraceptive failure rate

Explain the drawbacks of withdrawal & douching

Describe & list the advantages & disadvantages of combination & progestin-only hormonal contraceptives

Explain how an IUD is used

Describe barrier methods of contraception

Describe 5 fertility awareness methods of contraception

Describe male & female sterilization techniques

Identify factors affecting fertility control decision making

Describe methods of medical & surgical abortion

USA Pregnancies

6.3 million /year 49% are unintended

Approx. 50% of these unintended pregnancies occurred WHILE CONTRACEPTION WAS USED BUT FAILED

Approx. 50% of those unintended pregnancies end in abortion

50% OF ALL WOMEN AGED 15-44 HAVE AT LEAST 1 UNINTENDED PREGNANCY

Webmd.com Birth Control Slide Show

FAILURE RATE

A fertility control method’s effectives is measured in terms of its failure rate

Reported as the % of women, who on avg., are likely to become pregnant using a particular method for 1 year.

The LOWEST OBSERVED FAILURE RATE = measures how a method performs when used consistently & as intended

The TYPICAL FAILURE RATE = measure of how a method performs allowing for all errors & problems typically associated with it.

(see handout)

DRAWBACKS

WITHDRAWAL –

aka - coitus interruptus Requires great control & restraint

to withdraw in time

Pre-ejaculate may contain sperm

Sperm not deposited inside the vagina at first may survive long enough and find its way inadvertently through body-body contact

Diminishes the sexual pleasure

Does not protect against STDs

DOUCHING Almost totally ineffective

Not enough time to “rinse” millions of sperm

Force from douche spray may propel sperm further into the uterus

Changes the healthy bacteria of the vagina

Does not protect against STDs

HORMONAL CONTRACEPTIVES

Combination hormonal contraceptives

Contains 2 kinds of synthetic hormones: estrogen & progestogens

Works by “managing” the ovulation cycle

Available as pills, patch, vaginal insert & injection

Progestin only contraceptives

Works by inhibiting ovulation & thickening the cervical mucus, making it difficult for sperm to reach the egg

Combination Hormonal contraceptives

advantages Decreased menstrual flow,

Cramps, length of bleeding days

Lowering of sex drive

Acne

Regularity of cycle

May protect against pelvic inflammatory disease, cysts, anemia, endometrial cancer, rheumatoid arthritis, ovarian cancer

Disadvantages Less effective when taken with other drugs

i.e. ST john’s wort, herbs, antibiotics, anticonvulsants, pain relievers and anti inflammatory drugs

Lowering of sex drive

Increased frequency of vaginitis, depression

Likely experience nausea, weight gain, breast tenderness

Mild headaches, spotty bleeding between periods,

Increased Risk of fatal blood clots/heart attacks in small # of women

Increased Risk of gallbladder, liver disease, high bp & stroke increases

Progestin only contraceptives

Mini pill21 progestin only pills + 7 days of no pills

Disadvantages

Menstrual irregularities

Weigh gain, depression, fatigue, decreased sex drive, acne, headaches, oily skin.

Implantation method

1.5 inch hormone containing plastic rod planted under the skin for 3 years, dripping the hormone into the blood

i.e. Implanon

Disadvantages

irregular bleeding, prolonged bleeding, frequent bleeding, absence of menstruation

Injectable methodi.e. depo provera

12 week supply injected for a steady drip of hormone into the muscle

Disadvantages

prolonged use can lead to bone loss

IUD – intrauterine device

Inserted into uterus by MD

Device contains copper or progesterone

Short string hangs inside vagina

Must be checked monthly for placement

Works by killing/weakening sperm & altering embryo’s movement

Disadvantages: heavier menstrual flows, cramps, increased risk of PID- pelvic inflammatory disease, risk of uterine perforation, risk of ectopic pregnancy

Barrier methods

DiaphragmRubber, Dome shaped device worn over cervix

Used with spermicide jelly or cream

Advantage: no major med. Problems, can be inserted up to 6 hours prior to intercourse

Disadvantage: possible dislodgement during sex, increased risk of TSS, women or their partners may be allergic to the latex or spermicides, developing UTI’s, discomfort while putting it in place- must be left in place for up to 24 hours following sex

Cervical capSimilar to diaphragm

Advantage- can be inserted up to 24 hours prior to sex

Disadvantage- difficult to insert & remove, occasional discomfort during sex, dislodgment, possible irritation of the cervix. Cannot be left in place for more than 48 hours

Contraceptive spongeDome shaped device made of spongy material that contains spermicide.

Advantage: available without a Rx, can be left in place for 24 hours

Disadvantage:

Less effective

Risk of TSS increases

Barrier methods cont’d

Male condom

Aka rubber

Latex or polyurethane are more effective than “skin” condoms mfr. From lamb intestines.

Advantage: protects against STDs

Disadvantage; pleasure diminished

Female condomAdvantage; warms up instantly to body temp, enhancing sensation for both partners, protects against STDs

Disadvantage: outer ring may be pushed inside, problems inserting & removing, minor irritation, discomfort or breakage

Vaginal spermicidesCannot be used alone

Kills sperm through foams, gels, creams, & suppositories.

Fertility awareness methodsaka natural family planning, rhythm method or periodic abstinence

Calendar rhythmEstimates least likely days to get pregnant based on the ovulation cycle

Ovulation takes place approx. 12-16 days before the next period.

Egg is capable of being fertilized for up to 24 hours

Sperm can live for up to 3 days

Temperature methodBBT – basal body temperature = lowest temperature in a healthy person during waking hours.

Woman can determine ovulation based on a 1 degree increase in BBT

Takes 5 min to take Temp

Must be taken same time daily to be somewhat accurate

Mucus methodTouching, noting & recording for one month the consistency, color, and amount of cervical mucus discharged daily.

Disadvantages- foams, jellies, sex, and arousal can interfered with quality of mucus discharged

Must be done with another awareness method

Fertility awareness methods (cont’d)

Sympto-thermal method

Using the temperature & mucus method together

Chemical method

Use a kit that Measures LH (luteinizing hormone) found in woman’s urine that peaks during ovulation

Sterilization- permanent fertility control

VasectomyMale sterilization

Local anesthesia only

Not 100% effective – some tubes may reopen

Occasionally reversible

Tubal ligationFemale sterilization

Local anesthesia

Not 100% effective – some tubes may reopen

Reversal may be possible

hysterectomyFemale procedure but not recommended for sterilization alone

Greater risk of post op complications

More expensive

Negative psychological effects greater than tubal ligation

Emergency Contraception“The morning after pill”

Pill Type Plan B, One-Step, Next Choice,

Ella

Avail. From pharmacists

<17 requires an Rx

>17 – no Rx required

IUD Type Copper-T IUD inserted up to 5

days after unprotected intercourse

Fertility Control Responsibilities

Consider the following physical and psychological consequences of pregnancy

control methods

failure rates

safety of the method

Which one can be used consistently & correctly.

one’s sexual activity & relationship

one’s religious values

one’s personal values

Talk about options & best choices with partner

Why people do not use fertility control

Low motivation

Lack of knowledge

Negative attitudes about fertility control

Relationship issues

Abortion

The intentional, premature termination of a pregnancy

Legal & moral aspects of abortion

Restrictive abortion laws did not prevent women from having abortions

1/22/1973 Roe v Wade- Supreme Court ruled states could not prohibit abortions since it was a violation of a woman’s right to privacy

Decision about Abortions should be between a woman and her doctor for abortions up to 12 weeks.

Decisions about abortions in the 2nd trimester could be regulated for only 1 purpose- to protect the woman's health

Many people have mixed feeling/opinions about abortion

Abortion

Surgical methods MVA – manual vacuum aspiration

Done up to 10th week

D & C – dilation & suction or vacuum aspiration

Done between the 6th & 14th week

D & E – dilation & evacuation

Done after the 15th week

Medical/Non-surgical methods RU-486 followed by misoprostol

Done up to 7th or 8th week

Can cause severe birth defects

Risk of TSS; which can be fatal

If unsuccessful, will be followed up by surgical method

Saline/Urea and prostaglandin

Saline/urea kills the fetus

Prostaglandin induces contractions

Review 1

A variety of safe, reliable & effective fertility control methods are available.: combination & progestin only hormonal contraception, barrier methods, fertility awareness methods, the IUD & sterilization

A contraceptive’s effectiveness is measured in terms of lowest observed & typical failure rates.

Although most fertility control methods are designed for use in the woman’s body, both partners share the responsibility for fertility control.

Communication and cooperation are keys to shared responsibility.

People who say the y do not want to have a baby, yet do not practice fertility control, tend to have low motivation, lack of knowledge of human reproduction and fertility control methods, negative attitudes toward fertility control, or are in relationships that hinder correct fertility control practice.

Medical & surgical abortions are available

Abortion became legal in the US in 1973 with the supreme court decision in Roe v Wade.