CONTRACEPTIVE PHYSIOLOGY By Dr.M.Anthony David MD Professor of Physiology
CONTRACEPTION The prevention of conception is called as contraception. Contraception is useful to prevent population explosion. It is also called as Birth Control methods or Family Planning Methods. This can be done at the female, male or coital stages.
ABORTION Abortion is the abrupt and unsuccessful ending or termination of pregnancy. It can be spontaneous or induced. Induced Abortion is the medical termination of pregnancy. In Abortion, a formed embryo or fetus is killed due to health problems of the mother.
CONTRACEPTION: HISTORICAL Coitus Interruptus was first practised around 4000 BC in ancient Middle east. Intra uterine contraception was first practiced in female camels by Arabians in the middle ages. They used to insert some seeds into the uterus of the shecamels. This served as an Intra Uterine
CONTRACEPTIVE METHODS: A CLASSIFICATION
TERMINAL OR PERMANENT METHODS: There is a permanent stopping of conception. Used by couples who have finished their family. TEMPORARY SPACING METHODS: Used for spacing or giving a gap between children Used to postpone children’s arrival while the couple gets adjusted.
TERMINAL METHODS I. VASECTOMY: MALE
STERILISATION: A SIMPLE OUT PATIENT PROCEDURE. THE ‘VAS DEFERENS’ IS ISOLATED AND CUT. THE TWO ENDS ARE LIGATED. LATEST METHOD: NSV: NON SCALPEL VASECTOMY. LEAST DONE IN INDIA DUE TO PREJUDICE & SUPERSTITIONS.
VASECTOMY
TERMINAL METHODS II. TUBECTOMY: FEMALE
STERILIZATION: PART OF THE FALLOPIAN TUBE IS REMOVED. THE TWO ENDS ARE TIGHTLY LIGATED. CAN BE DONE AS: POST PARTUM STERILIZATION INTERVAL STERILIZATION LAPAROSCOPIC STERELIZATION
TUBECTOMY: TYPES
INTERVAL STERILIZATION
SPACING
METHODS
BARRIER METHODS: A) PHYSICAL BARRIER:
CONDOMS DIAPHRAGM VAGINAL SPONGE FEMALE CONDOM.
B) CHEMICAL BARRIER:SPERMICIDAL
FOAMS CREAMS SUPPOSITORIES
CONDOMS SPERMICIDES
DIAPHRAGM + SPERMICIDE
IUCDs INTRA UTERINE CONTRACEPTIVE DEVICES (IUCD): FUNCTION BY PREVENTING IMPLANTATION.
I
GENERATION:
NON MEDICATED: LIPPE’S LOOP
II
GENERATION: MEDICATED BIOACTIVE
III
COPPER T
GENERATION: HORMONE RELEASING
LIPPE’S LOOP
Cu T & PROGESTASERT
HORMONAL CONTRACEPTIVES
ALSO CALLED ORAL PILLS OR ORAL CONTRACEPTIVES. ARE USUALLY HORMONES OR COMBINATIONS TAKEN BY MOUTH. THEY CAUSE THE TEMPORARY CESSATION OF THE OVARIAN CYCLES.
ORAL CONTRACEPTIVES
COMBINED PILLS: HAS
BOTH ESTROGEN & PROGESTERONE.
POP: PROGESTRONE ONLY PILL. MORNING AFTER PILL EMERGENCY CONTRACEPTION. DEPOT FORMULATIONS
INJECTABLES:
DEPOT PROVERA,‘DMPA’, ‘NET EN’
POST CONCEPTIONAL METHODS MENSTRUAL
REGULATION
(MR) MTP: MEDICAL TERMINATION OF PREGNANCY.
OTHER METHODS
ABSTINENCE: THE BEST PART
OF THE A B C TO PREVENT HIV/AIDS.
COITUS INTERRUPTUS: HISTORICALLY
THE OLDEST IN
HUMANS. THE SEMEN WAS SPILLED ON THE GROUND.
THE MALE PILL: GOSSYPOL
: COTTON SEED OIL KILLS SPERMATIDS. VERY TOXIC AND SO NOT USED.
NATURAL FAMILY PLANNING METHODS
SAFE PERIOD METHOD: DURING
THE FERTILE PERIOD, COITUS IS AVOIDED. THE REST OF THE CYCLE IS ‘SAFE’
OVULATION TESTS: BASAL
BODY TEMPERATURE CHARTS CERVICAL MUCUS : BILLINGS METHOD
SAFE PERIOD METHOD
REVIEW WEIVER
Contraception is the prevention of conception. There two main types: Permanent
or Terminal methods:
Vasectomy or Male sterilization. Tubectomy or Female sterilization.
Temporary
or Spacing methods:
Barriers IUCDs Other methods.
ASSISTED REPRODUCTIVE TECHNOLOGY By Dr.M.Anthony David MD Professor of Physiology
INFERTILITY
What is fertility? The capacity to conceive and bear children is called fertility. Infertility: A couple is said to be infertile if pregnancy does not result after 1 year of normal sexual activity without contraceptives. 25% of couples experience infertility at some point in their reproductive lives.
WHO IS RESPONSIBLE FOR INFERTILITY? The male partner in 40% cases. Artificial insemination is resorted to in such cases. A combination of factors can be the reason for infertility.
ARTIFICIAL INSEMINATION
SPERMS ARE INJECTED INTO THE CERVIX DIRECTLY. DONE IN CASES OF MALE INFERTILITY OR FEMALE TRACT HOSTILITY. AIH: AI WITH THE HUSBAND’S SPERM: THIS
IS IN CASE OF SEVERE CERVICAL HOSTILITY TO SPERMS CONCENTRATED WASHED SPERMS ARE USED
AID: AI WITH DONOR’S SPERMS IN
CASES OF AZOOSPERMIA. DONOR SPERMS ARE TAKEN FROM THE SPERM BANKS OR FROM ELIGIBLE
TECHNIQUES OF OOCYTE RETRIEVAL 1.
2. 3. 4. 5.
IVF –ET: IN VITRO FERTILIZATION & EMBRYONAL TRANSFER: TEST TUBE BABY GIFT: GAMETE INTRA FALLOPIAN TRANSFER ZIFT: ZYGOTE INTRA FALLOPIAN TRANSFER TET: TUBAL EMBRYONAL TRANSFER POST: PERITONEAL OOCYTE & SPERM TRANSFER
II. TECHNIQUES OF SPERM RETRIEVAL & INJECTION 1.
ICSI: INTRA CYTOPLASMIC SPERM INJECTION.
3.
TESE: TESTICULAR SPERM EXTRACTION. MESA: MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION.
4.
1.IVF-ET: THE TEST TUBE BABY!
IN VITRO FERTILIZATION & EMBRYONAL TRANSFER. TEST TUBE BABY IS A MISNOMER FERTILIZATION DONE IN A PETRIDISH. AFTER THE EMBRYO DEVELOPS, IT IS TRANSFERRED INTO THE BODY OF THE UTERUS.
2. GAMETE INTRA FALLOPIAN TRANSFER (GIFT) BOTH THE GAMETES, THE MATURE SPERMATOZOON AND THE OVUM ARE PUT INTO THE FALLOPIAN TUBE. THERE THEY FERTILIZE AND CAUSE CONCEPTION. DONE IN CASES OF:
LOW
MOTILITY FOR SPERMS INCREASED CERVICAL MUCUS HOSTILITY
GAMETE INTRA FALLOPIAN TRANSFER (GIFT)
3. ZYGOTE INTRA FALLOPIAN TRANSFER (ZIFT) THE FERTILIZATION IS DONE OUTSIDE, INVITRO. THE SINGLE CELLED ZYGOTE IS PUT INTO THE FALLOPIAN TUBE. IT THEN DEVELOPS INTO AN EMBRYO AND MOVES INTO THE BODY OF THE UTERUS.
4. TUBAL EMBRYO TRANSFER (TET) TUBAL EMBRYO TRANSFER. THE ZYGOTE IS ALLOWED TO GROW AND BECOME AN EMBRYO IN VITRO. THEN AT THAT STAGE IT IS PUT INTO THE FALLOPIAN TUBE.
5. PERITONEAL OOCYTE & SPERM TRANSFER (POST) BOTH THE GAMETES ARE PUT INTO THE PERITONEAL CAVITY. THEY ARE EXPECTED TO FERTILIZE IN THE PERITONEUM. LATER THE ZYGOTE OR EMBRYO IS TO MOVE INTO THE TUBE AND THE UTERUS.
II. TECHNIQUES OF SPERM RETRIEVAL & INJECTION DONE
IN CASES SUCH AS:
AZOOSPERMIA LOW
SPERM COUNTS HYPO & EPISPADIAS. TECHNIQUES
HELP THE SPERM TO REACH THE OVUM BETTER
II. TECHNIQUES OF SPERM RETRIEVAL & INJECTION 1.
ICSI: INTRA CYTOPLASMIC SPERM INJECTION.
3.
TESE: TESTICULAR SPERM EXTRACTION. MESA: MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION.
4.
1. INTRA CYTOPLASMIC SPERM INJECTION
1. INTRA CYTOPLASMIC SPERM INJECTION
2. TESTICULAR SPERM EXTRACTION (TESE) The sperms are extracted or teased from the testes. Done in cases where there is a block in the ductular system – rete testis, efferent ductules, epididymis & vas deferens. The extracted sperms are used for fertilization.
3. MESA
MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION. DELICATE MICROSCOPIC SURGERY IS DONE. SPERMS ARE ASPIRATED FROM THE EPIDIDYMIS. THEY ARE THEN USED FOR FERTILIZATION.