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

COPPER T

 III

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. THE OLDEST IN

COITUS INTERRUPTUS:
 HISTORICALLY

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. TESE: TESTICULAR SPERM EXTRACTION. MESA: MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION.

3. 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
LOW

IN CASES SUCH AS:

AZOOSPERMIA

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. TESE: TESTICULAR SPERM EXTRACTION. MESA: MICROSURGICAL EPIDIDYMAL SPERM ASPIRATION.

3. 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.

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