Chapter 10 Choosing a Fertility Control Method

1. Chapter 10Choosing a Fertility Control Method

2. Fertility Control • Reasons for practicing fertility control: • Enhancing sexual pleasure • Family planning • Increasing women’s life choices • Health considerations • World overpopulation

3. Fertility Control Effectiveness • A fertility control method’s effectiveness is measured in terms of its failure rate, which is the percentage of women who, on average, are likely to become pregnant using that method for one year. • Except for abstinence from sexual intercourse, no method is 100% effective.

4. Fertility Control Effectiveness • There are two types of failure rates: • Lowest observed failure rate is a measure of how a method performs when used consistently and as intended. • Typical failure rate is a measure of how a method performs when allowing for all the errors and problems typically associated with that method.

5. Withdrawal • The withdrawal method (coitus interruptus) requires the man to withdraw the penis from the vagina before ejaculation. • Provides protection from pregnancy similar to that of vaginal barrier methods. • This method offers no protection from STDs. • Pregnancy is still possible if sperm are released near the vagina, where the sperm could possibly enter later.

6. Douching • Douching, or rinsing of the vagina with fluid after sexual intercourse, is an almost totally ineffective method of fertility control. • It also is not necessary because the vagina constantly cleanses itself.

7. Hormonal Contraceptives: Birth Control Pills • Worldwide, over 150 million women use birth control pills. • Birth control pills are 95% to 99.9% effective in preventing conception when used correctly. • Combination fertility control pills are the most common hormonal contraceptives: • Made up of synthetic estrogen and progesterone (progestin or progestogen)

8. Hormonal Contraceptives: Birth Control Pills • Combination pills contain between 20 and 35 micrograms of estrogen and between 0.5 and 1.5 mg of progestin. • Effectiveness of birth control pills may be decreased when taken with other medications such as antibiotics, anticonvulsants, and a variety of pain relievers and anti-inflammatory drugs.

9. Hormonal Contraceptives: Birth Control Pills • Possible side effects include: • Nausea • Weight gain • Breast tenderness • Headaches • Spotting • Decreased menstrual flow • Reduced risk of certain diseases

10. Hormonal Contraceptives: Birth Control Pills • For a small percentage of women, oral contraceptives present severe health risks. • Women most at risk are over age 35 and those who smoke cigarettes. • Birth control pills offer no protection against STDs.

11. Progestin-Only Contraceptives • Progestin-only contraceptives are available as pills, injectables, and implants. • This method works by inhibiting ovulation and thickening the cervical mucus, making it difficult for the sperm to reach the egg. • Prolonged use can cause bone loss.

12. Depo-Provera • Depo-Provera is a 12-week supply of progestin that is injected intramuscularly by a health care provider. • At the end of 12 weeks, a replacement injection is obtained. • It is 99.7% effective. • It is reversible. • It offers no protection against STDs.

13. Intrauterine Device • The intrauterine device (IUD) is a small device, containing copper or the hormone progesterone, implanted inside the uterus by a health care professional. • Progestasert and ParaGard are two types available in the United States. • IUDs increase risk for pelvic inflammatory disease (PID), uterine perforations, and ectopic pregnancy. • IUDs offer no protection against STDs.

14. Intrauterine Device

15. Barrier Methods • Prevent the sperm from meeting the egg • Diaphragm • Cervical cap • Vaginal spermicides • Condoms

16. Diaphragm • Dome-shaped latex cup placed in the vagina to cover the cervix. • Can be inserted up to 6 hours before intercourse. Should be left in place for at least 6 hours after intercourse but not longer than 24 hours • Cannot be used during vaginal bleeding or infection • Must be fitted by a physician or nurse practitioner and refitted after weight gain or loss • Should last about 1 to 2 years • Not effective in preventing STDs

17. Diaphragm

18. Cervical Cap • Cup-shaped rubber device that snugly covers the cervix • Must be used with a spermicide

19. Cervical Cap • Advantages include: • Low cost. • Convenience. • Insertion may occur any time of the day intercourse is anticipated. • Sexual activity can take place any time during the next 24 hours.

20. Cervical Cap • Disadvantages include: • Difficult to insert and remove • Occasional discomfort during intercourse • Dislodgment during intercourse • Irritation to the cervix • No protection against STDs

21. The Contraceptive Sponge • The sponge contains spermicide. • Once inserted, it can be left for 24 hours. • It is less effective than a diaphragm or cervical cap. • It is more effective than just spermicide. • If left for more than 24 hours, it can cause toxic shock syndrome.

22. Vaginal Spermicides • These are substances that kill sperm. • A variety of fertility control methods consist solely of a spermicidal chemical (usually nonoxynol-9). • Spermicides are available in foams, gels, creams, and vaginal suppositories. • Typical failure rate is about 18 pregnancies per 100 women per year.

23. Male Condoms • Membranous sheath that covers the penis and catches the sperm before it enters the vagina. • About 99% of male condoms are made of latex or polyurethane. • Condoms must be used with water-based lubricant.

24. Male Condoms • Primary reason condoms fail is error in use. • Used in conjunction with another barrier method, such as a diaphragm or spermicidal foam, condoms are nearly 100% effective.

25. Female Condoms • It is a loose-fitting polyurethane plastic pouch that lines the vagina. • It has two flexible rings: • An inner ring at the closed end, used to insert the device inside the vagina and hold it in place • An outer ring that remains outside the vagina and covers the external genitalia

26. Female Condoms • Advantages: • Warms up instantly to body temperature once it is inserted, enhancing sensation for both partners. • Provides protection from STDs, including HIV, and prevents pregnancy. • Disadvantages: • Outer ring may be pushed inside the vagina. • Difficult insertion and removal. • Minor irritation and may not be aesthetically pleasing. • Discomfort or breakage.

27. Female Condoms

28. Fertility Awareness Methods • Used to determine the woman’s most fertile days. • User must estimate when ovulation is most likely to occur. • A woman is most fertile 14 days before her next period. • Advantages include: • No health risks from the method itself • Inexpensive • Only method accepted by all religions

29. Fertility Awareness Methods • Disadvantages: • Cannot predict with absolute certainty because woman’s cycle varies from month to month and may be affected by: • Stress • Lack of sleep • Illness • Effectiveness is lowest of the common methods, about 20 pregnancies per 100 women per year, that is, a failure rate of 20%.

30. Fertility Awareness Methods • Calendar rhythm • Temperature method • Mucus method • Sympto-thermal method • Chemical methods

31. Calendar RhythmMethod

32. Temperature Method

33. Sterilization • Sterility is the condition of being permanently unable to have children; this can be accomplished surgically. • For married couples over age 30, sterilization has become the most frequently chosen fertility control method. • Sterilization is nearly 100% effective, relatively safe, and carries a low one-time cost.

34. Male Sterilization • Vasectomy is sterilization for the male. • Involves cutting and tying the vas deferens; when the tubes are cut, sperm cannot be emitted during ejaculation. • Done under local anesthesia, short outpatient procedure • Can sometimes be reversed • Uncomplicated and causes few problems

35. Vasectomy

36. Female Sterilization • Tubal ligation is the cutting and tying of the fallopian tubes. • Most are performed under local anesthesia in a relatively short period of time. • Culpotomy is a vaginal tubal ligation. • Two types of abdominal tubal ligation include minilaparotomy and laparoscopy. • Reversal is sometimes possible.

37. Tubal Ligation

38. Responsibility for Fertility Control • A method must be chosen and it must then be used consistently and correctly. • Both the male and female share the responsibility for fertility control. • Fertility control must be discussed before engaging in sexual intercourse.

39. Talking About Fertility Control • A couple shares the responsibility for fertility control. • The best time to discuss fertility control is before sexual intercourse. • Most men and women welcome a discussion about sexual matters and fertility control.

40. Why PeopleDo Not Use Fertility Control • Low motivation • Lack of knowledge about conception and fertility control • Negative attitudes about fertility control • Relationship factors

41. Emergency Contraception • Designed to prevent pregnancy after unprotected vaginal intercourse. • Provided in two ways: • Emergency hormonal contraception consists of two large doses of certain oral contraceptives taken 12 hours apart and within 72 hours of unprotected intercourse. Plan B pill can be obtained only with a doctor’s prescription. • Emergency IUD insertion within 5 days of unprotected intercourse.

42. Abortion • Abortion is the intentional premature termination of pregnancy. • About 1.5 million abortions are performed annually in the United States. • Medical abortions use the medications methotrexate or mifepristone combined with misoprostol to end a pregnancy. • Must take place within the first 7 to 8 weeks of pregnancy.

43. Abortion • Early abortion (up to 12 weeks): Suction curettage or vacuum abortion is safest and most common. • Late medical abortion (after 12th week): Dilation and curettage (D&C) or dilation and evacuation (D&E) is performed early in the second trimester. Can be performed up to the 24th week. • After 24 weeks of pregnancy: Only done when serious threat to the woman’s life or health, or the fetus is severely deformed.

44. Legal and Moral Aspects of Abortion • In the United States, abortion was illegal from 1900 until 1973. • U.S. Supreme Court decided that abortion laws violated a woman’s right to privacy. • The decision of the pregnancy is determined by the woman up to 12 weeks. • Beyond 12 weeks, the states are able to prohibit abortion.