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Contraception

Contraception. Potpourri. Sterilization. Sterilization: Vasectomy. Vasectomy blocks sperm from traveling through the vas deferens, preventing sperm from mixing into semen No glands or organs are removed Effectiveness: 99%+ Considered irreversible. Sterilization: Vasectomy.

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Contraception

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  1. Contraception Potpourri

  2. Sterilization

  3. Sterilization: Vasectomy • Vasectomy blocks sperm from traveling through the vas deferens, preventing sperm from mixing into semen • No glands or organs are removed • Effectiveness: 99%+ • Considered irreversible

  4. Sterilization: Vasectomy • Vas deferens must be isolated • Similar to tubal ligation, the vas deferens can be cut and tied, clamped, cauterized, no scalpel technique • Another form of contraception must be used for a few months

  5. Sterilization: Vasectomy • Cost: $350-1000 (plannedparenthood.org) • Side effects • Bruising • Sensitivity/pain for up to a few weeks past the procedure • Sperm leaking from tubes may lead to small lump (usually clears up on its own) • Antibodies to sperm may develop, reducing chances of fertility in a reversal

  6. Vasectomy Complications • Rare • Usually associated with infection (fever, pus/blood from incision site, swelling, pain) • Ends of tubes may grow back together (very rare) • Decreased sexual desire (4 out of 1000 cases per Planned Parenthood) - no apparent physical cause

  7. Sterilization: Vasectomy • Animation (BUPA Health via YouTube, 2:36) • Open-ended (no scalpel) vasectomy (medicalvideos.us) • Video (vasectomymedical.com)

  8. Sterilization: Tubal Ligation • Surgical technique • Close fallopian tubes, preventing egg from traveling to uterus, preventing sperm from reaching egg • Neither organs nor glands are removed • Effectiveness: 99%+ • Considered irreversible

  9. Sterilization: Tubal Ligation • Tubal sterilization: • Tubes can be tied and cut (Pomeroy technique) • Tubes can be cauterized • Tubes can be clipped, clamped • These incision methods often performed after childbirth/abortion • Animation (SMART imagebase)

  10. Sterilization: Tubal Ligation • Cost: $1000-3000 • Side effects: thought by many to be rare; hormonal imbalance may lead to increased menstrual bleeding, cramping; adhesions • Complications: infection, internal bleeding, ectopic pregnancy • Before/after photos (private Flickr account)

  11. Sterilization: Implants • Non-incision method • No general anesthesia • Under an hour • Coils inserted into fallopian tubes • In following months, coils and tissue grow together, forming barrier to prevent sperm from reaching egg

  12. Sterilization: Implants • Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting • Demo (YouTube, 1:04)

  13. Long-Term Contraception & Sterilization: Project Prevention • Societal aid or eugenics? • FOX News program (1:30 minutes) • ABC News program (2:19 minutes)

  14. Contraception in the Future: Nestorone • Estrogen and progestin • Gel • Spray • Acrux Announcement, February 2009 • Figure 2: Estrogen content in Nestorone, OrthoEvra, NuvaRing, combination pills • 2012: Combination of nestorone and testosterone reduced sperm count in UCLA study

  15. Contraception: The Future • Male hormonal contraceptive: monthly testosterone injection • 5/ 2009: China clinical trials • 1 in 100 fathered a child • Reversible six months after stopping injections • 1/3 of 1000 participants did not complete; no reason provided • Few side effects reported (acne, weight gain), but more research needed • Contraceptive methods may work better in Asian men vs European men • Photo from BBC

  16. Contraception: The Future • RISUG • Reversible Inhibition of Sperm Under Guidance • Contraceptive method for men • Clinical trials in India • Injection into vas deferens of male (video, wired.com, :34) • RISUG disrupts membranes of sperm so they cannot fertilize • One injection to last 10 years • Reversibility not well tested, though reports on primates appear positive (requires another injection) • Marketing challenges

  17. Contraception: The Future • Male contraceptive pill research at UW (KOMO report, 2009, 2:10, YouTube) • Non-hormonal manipulation of sperm production has been successful in mice (2012) • Vitamin A blocking can reduce fertility (but Vitamin A needed for other bodily functions)

  18. Contraception: The Past • Male Contraceptive: Heat • Prolonged heat exposure can impair sperm production in testes • Ancient method • Effectiveness? • 116 degree bath • 45 minutes • Every day • Three weeks

  19. Contraception: Impact of Heat on Sperm

  20. Contraception: Impact of Heat on Sperm Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

  21. Contraception: Impact of Heat on Sperm • Upper left: coiled tail • Upper right: bent tail • Lower left: double head • Lower right: triple head Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

  22. Temperature Method • Track temperature every morning • Look for slight drop in temperature occurring immediately before ovulation • At ovulation, temperature increases • Temperature changes are small • Look for trends, expect daily fluctuations • Image source: Public domain, Wikimedia Commons

  23. Temperature Method • Use basal thermometer • Smaller scale (1/10 degree) • Chart temperature for at least three months before relying on method • Safe sex time begins 72 hours after temperature has risen, remains until temperature begins to drop • Source: Dr. Sacha Elliott, ND

  24. Temperature Method • Day 10: 98.5 Day 17: 98.8 • Day 11: 98.4 Day 18: 99.0 • Day 12: 98.4 Day 19: 98.7 • Day 13: 98.1 Day 20: 98.7 • Day 14: 97.9 Day 21: 98.8 • Day 15: 98.0 Day 22: 98.6 • Day 16: 97.5 Day 23: 98.5

  25. Cervical Mucus Method • Tracking the variation in mucus consistency throughout cycle • Cervical mucus begins a few days after menstruation • As mucus production increases, it’s yellow or white in color & cloudy, sticky • Will become wet, clear • Clear, slippery mucus = most fertile • Mucus production decreases, cloudy & sticky

  26. Cervical Mucus Method • Tracking Your Cervical Mucus, Babycenter.com • “Safe days” = begin after slippery mucus decreases, continue into cloudy & tacky, and especially dry days • Short cycles = mucus may be hidden in menstrual flow

  27. Calendar Method • Predicting “safe” and “unsafe” days based on length of monthly cycles • Can use traditional calendar, software, phone app, web tools

  28. Calendar Method • Count length of menstrual cycle • Day #1 = first day of menses • Last day = day before menses returns • Eight cycles are recommended before relying on this method (Planned Parenthood) • First fertile day = shortest cycle minus 18 • Last fertile day = longest cycle minus 11

  29. Calendar Method • Cycle 1: 24 Cycle 2: 27 • Cycle 3: 25 Cycle 4: 28 • Cycle 5: 25 Cycle 6: 27 • Cycle 7: 29 Cycle 8: 25 • Shortest day: 24 • Longest day: 29 • Unsafe days: #6-18

  30. Calendar Method • Online calendar method tool - virtualmedicalcentre.com • Irregular period cycles = reduced effectiveness • Calendar method = requires another method for most to experience adequate effectiveness

  31. United Nations: Contraceptive Prevalence Across the World, 2005

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