I dare someone to do it in 6 hours

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Considering your

Reproductive

Choices

Chapter 6

Conception and Contraception

 Conception refers to the fertilization of an ovum by a sperm. It must involve:

• A viable egg

• A viable sperm

• Access to the egg by the sperm

 Contraception refers to methods of preventing conception. 2 methods of effectiveness include:

• Perfect failure rate: risk of pregnancy during the first year of use if the method is used w/o error

• Typical failure rate: risk of pregnancy during the first year of use w/ normal number of errors

Methods Of Fertility Management

 Barrier methods: use of a physical or chemical block to prevent the egg and sperm from joining

• Male condom – latex sheath designed to fit over erect penis catching ejaculate.

• Foams, suppositories, jellies and creams contain chemical spermicides which kill sperms & some STIs

• Female condom is soft loose fitting polyurethane sheath that covers the external genitalia.

• Diaphragm w/ spermicide provides chemical and physical barrier to sperm

• Cervical cap – small latex cap that fits snugly over the cervix to keep sperm out of uterus

Hormonal Methods

 Hormonal methods introduce synthetic hormones into the women’s system that prevent ovulation, thicken cervical mucus or prevent a fertilized egg from implanting.

 Oral contraceptives combine synthetic estrogen and progesterone to prevent release of an ova from the ovary, preventing pregnancy.

 Progestin-only pills contain small doses of progesterone and are used when suffer from side- effects related to estrogen or are nursing a baby – slightly less effective than combination pills.

Early Warning Signs of Medical Complications for Pill Users

Figure 7.6

Hormonal Methods

 Ortho Evra is a hormonal patch which is worn for one week and replaced on the same day of the week for 3 weeks. The user is patch free the 4th week.

 NuvaRing is a soft, flexible transparent ring that is inserted into the vagina and left in place for 3 weeks. It provides a steady flow of estrogen & progesterone.

 Depo-Provera is a long acting synthetic progesterone injected intramuscularly every 3 months.

 Norplant is currently not on the market due to legal issues. It is an FDA approved method but has come under scrutiny for causing severe menstrual bleeding and complications during removal.

Surgical Methods

 Sterilization

• Female

• Tubal ligation is a method where surgery ties or cuts and cauterizes the uterine tubes. This blocks the sperm’s access to released eggs.

• Hysterectomy is the surgical removal of the uterus. It’s usually done only when there is disease or damage to the uterus.

• Male

• Vasectomy is a procedure where both ductus deferens are surgically cut and tied shut.

Sterilization

Figure 7.7

Other Methods

 Intrauterine devices (IUD) are inserted into the uterus by a physician and are believed to interfere with sperm’s fertilization of the egg.

• ParaGard can be left in place 10 years. Contains copper and has no hormones.

• Mirena is newer and effective for 5 years and releases small amounts of progestin levonorgestrel.

 Withdrawal – not very effective b/c there can be up to ½ a million sperm in the drop of fluid at the tip of the penis before ejaculation.

Other Methods

 Emergency contraceptive pills (ECP’s) are used up to 72 hours after unprotected sexual intercourse to prevent pregnancy. They are ordinary birth control pills containing estrogen and progestin.

 Abstinence 100% effective but not entirely realistic for most adults

 “Outercourse” everything but ejaculation near vagina. Oral-genital contact can transmit STIs.

Fertility Awareness Methods  FAM considers basic physiology and the couple must

consider that ovum can survive for up to 48 hours after ovulation and that sperm can live for up to 5 days in the vagina.

 Cervical mucus – prior to ovulation there is a change in normal vaginal secretion – it becomes more stringy and creamy

 Body temperature – after ovulation the basal body rises so the women must chart her temperature to understand her body’s fluctuations. To avoid pregnancy she must avoid intercourse several days prior to temperature increase. Conversely this method works well to increase odds of becoming pregnant.

The Fertility Cycle

Figure 7.8

Costs of Contraception

Table 7.2

Methods Of Abortion

 Abortion is a medical means of terminating a pregnancy.

 Surgical abortions

 Vacuum aspiration – suction to remove fetal tissue from the uterus

 Dilation and evacuations (D&E) – fetal tissue is sucked and scraped out of the uterus

 Dilation and curettage (D&C) – the cervix is dilated and the uterine walls scraped clean

Medical Abortions

 Mifepristone (formerly known as RU-486) “the abortion pill” – actually involves more steps than a clinical abortion.

• First visit involves physical exam and dosage of pills

• Patient returns 2 days later for a dose of prostaglandins

• Females stays under observation for 4 hours

• A return visit 12 days later to verify complete fetus expulsion

Emotional Aspects Of Abortions

 Feelings include:

• Regret

• Guilt

• Sadness

• Relief

• Happiness

Planning A Pregnancy

 Emotional health

 Maternal health

 Paternal health

 Financial evaluation

 Contingency planning

Pregnancy

 Prenatal care

 Choosing a practitioner

• Obstetrician-Gynecologist

• Family practitioner

• Midwives

 Alcohol and drugs

• Fetal alcohol syndrome

 Smoking

 X-rays

 Nutrition and exercise

Fertilization

Figure 7.11

The Process Of Pregnancy

 Early signs: missed pregnancy, fatigue, breast tenderness

 First trimester: organ systems develop. 1st 2 months, the developing baby is called an embryo; at the start of the 3rd month the baby is called a fetus.

 Second trimester: more physical changes in mother and placenta (network of blood vessels that carries nutrients and oxygen to the fetus) is well developed.

 Third trimester: period of greatest fetal growth. Respiratory and digestive organs develop.

 “Fourth” trimester: the first 6 weeks of an infant’s life

Prenatal Testing And Screening

 Amniocentesis: amniotic fluid is analyzed for abnormalities. Is recommended for women over 35. Newer blood tests can produce the same results but must be done btwn weeks 11 and 13.

• Amniotic sac: protective pouch surrounding the fetus.

 Chorionic villus sampling (CVS) is an option for couples who are at high risk of Down’s syndrome or debilitating hereditary disease. Involves taking tissue sample from the fetal sac.

Amniocentesis

Figure 7.12

Childbirth Considerations  Choosing where to have your baby – home is

becoming a more popular option and usually involves a midwife

 Labor and delivery

• First stage – amniotic sac breaks

• Second stage – expulsion

• Third stage – delivery of placenta

 Managing labor

• Medical

• Non-medical

 Birth alternatives

 Postpartum period

The Birth Process

Figure 7.13a

The Birth Process (continued)

Figure 7.13b

Complications

 Preeclampsia and eclampsia: related to high blood pressure, edema and protein in the urine. Treatment includes rest and monitoring of symptoms.

 Cesarean section (C-section)

 Miscarriage

 Rh factor: mismatched blood type

 Ectopic pregnancy: fertilized egg is implanted outside uterus and can result in miscarriage

 Stillbirth: baby is born dead, often for no apparent reason

 Sudden Infant Death Syndrome (SIDS): death of an infant under one and for no apparent reason

Infertility

 Causes in women

• Endometriosis

• Pelvic Inflammatory Disease (PID)

 Causes in men

• Low sperm count

Infertility Treatment

 Fertility drugs

 Alternative insemination

 In vitro fertilization

 Gamete intrafallopian transfer (GIFT)

 Intracytoplasmic sperm injection (ICSI)

 Nonsurgical embryo transfer

 Surrogate motherhood

 Adoption