NEET (BIOLOGY)

Class 12th

Contents
NOTES

REPRODUCTIVE HEALTH

ETOOS EDUCATION PVT. LTD.

Corporate Office : Plot No. 46, Rajeev Gandhi Nagar,
Kota – 324005, Rajasthan, India
Contact: 9214233303, 9214233343
 REPRODUCTIVE HEALTH
Reproductive Health
* WHO – total well- being in all aspects of reproduction i.e. physical, emotional, behavioral, social
* Reproductively healthy society – people having physically and functionally normal reproductive
organs and normal emotional and behavioral interactions among them in all sex – related aspects
– World population – In 1900 (2 billion/ 2000 million), in 2000 (6 billion)
– Indian population- in 1947 (350 million), in 2000 (1 billion), in May 2000 – crossed one
billion
– Every sixth person in the world is an Indian
– Rapid decline in death rate, MMR and IMR, increase in number of people in reproducible
age are responsible
* 2011 census (2001) report –

IA
– Total population - 1.27 billion
– Literacy rate - 74.04%
– Population density – 382 / sq.km

D
– Sex ratio – 940 female / 1000 male
– Population growth rate 1.7%(17/1000/ year )-2001

*
– N
(2001 census) Doubling rate - 33 years (population explosion)

Average Annual growth rate = (P2-P1/P1 *N) X 100

SI
– P1=Population in current census
– P2= Population in last census
O

– N = No. of year between 2 census

* Population growth rate (%) = BR – DR

O

* Natality /Birth rate = no. of children born / 1000 individuals

* Total fertility rate = average no. of children born to a female in her lifetime , more in developing
ET

country
* Replacement level = no. of children which can replace the couple to maintain ‘zero growth rate’

* Family Planning Program-

– Initiated in 1951
– Periodically assessed
– Hum do humare do (ideal replacement level – 2.1 /couple)

* Reproductive child health care (RCH) program (1997)

1. Spread information about hygienic and safe sex practices, contraceptive usage, STDs,
adolescence and related changes AIDS
2. Prenatal, antenatal, during delivery and post-natalcare of both mother and baby, breast
feeding importance, equal opportunity for male and female child

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
3. Safe abortion/ termination of pregnancy
4. Child immunization(WH0-1974 , India-1985)

* OTHER PROBLEMS & STRATEGIES :

# Awareness about reproduction disorders :
– Audio-visuals , print media , govt & NGO , parents , teachers , relatives
# Sex education –in school , college
# Prevention & management of STDs
– Birth control methods –awareness & dispension of devices
– Maternal & child health-antenatal care , safe hospital delivery ,minimum 3 post delivery
ceckups , immunization ,exclusive breast feeding

IA
# Prevention of sex crime & sex abuse
# Research in reproductive health - eg SAHELI
# Improved medical facilities

D
* Steps to overcome Overpopulation –
1.
2.
3.
Hum do humare do – one child norm
N
Motivate smaller families by contraceptive usage(min 3yr gap b/t children)

Incentives to couples with small families

SI
4. Statutory raising of marriageable age (female 18 years & males 21 years)
O

* Statutory ban on Amniocentesis for sex determination to legally check increasing female foeticide
– A fetal sex determination test based on the chromosomal pattern in amniotic fluid
surrounding developing embryo
O

* Medical termination of pregnancy (MTP)/ induced abortion –

ET

– Intentional or voluntary termination of pregnancy before full term

– 45-50 million MTP’s performed in a year all over world (1/5th of total conception)
– Role in decreasing population but not meant for this purpose
– Indian government legalized MTP in 1971
– Allowed up to 20 week, safe only up to 12 weeks of pregnancy (1st trimester)
– Unsafe and fatal if performed illegally by unqualified quacks
– Misuse of amniocentesis for sex determination of unborn child followed by MTP (illegal,
dangerous for young mother and fetus)
* Indications for MTP –
1. Casual unprotected intercourse
2. Contraceptive failure
3. Rape
4. Where pregnancy continuation could be harmful to mother or fetus or both
Plot No. 46, In front of Skyline Apartments corner Building,
Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
* Methods of MTP –
1. Medical abortion (pills)- up to 9 weeks
A. Mifepristone (RU-486) - anti- progestin pills
B. Misoprostol (PG-F2 alpha) - induce uterine contractions
2. Surgical methods – Vacuum aspiration, Dilatation and Evacuation (D&E)

* Infertility:
– Couple unable to produce children in spite of 2 years of regular unprotected sexual
cohabitation
– Reasons- physical, congenital disease, immunological, drugs, psychological (Mental stress)
et.c

IA
– Legal adoption is as yet one of the best methods for couples looking for parenthood
– 2 types- primary and secondary

D
* Infertility male factors-
– Cryptorchidism
– Blocked / absent vas deferens
– Higher scrotal temp
N
SI
– Alcohol & smoking
– Hydrocele
– Kleinfelter syndrome
O

– Mumps-orchitis
– Drugs
O

– Low fructose levels

– High viscosity of semen
– Gonadotrophin deficiency
ET

– Erectile dysfunction
– Ejaculatory dysfunction

* Infertility female factors-

– Anovulation
– Luteal phase defect (LPD) – reduced Progesterone
– Blocked FT , loss of cilia
– Congenital defect in uterus , vagina
– Uterine fibroid
– Gonadotrophin deficiency
– Drugs

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
* Assisted reproductive technologies (ART) –
– Requires extremely high precision handling by specialized professionals and expensive instrumen-
tation (facility available in few centers, affordable to limited people)
1. AI (Artificial Insemination) –
– Indications–low sperm counts in ejaculate, inability of male partner to inseminate the female (ED)
– Artificial introduction of semen of husband or healthy donor either into vagina or into uterus (IUI)
of female
– Fertilization inside body
– IUI- Intra Uterine Insemination
2. IVF –ET (In Vitro Fertilization -Embryo Transfer)/ test tube baby :
– Ova from the wife / female donor & sperms from the husband/male donor are collected & are

IA
induced to form zygote under simulated conditions in the lab
– Fertilization outside the body in almostsimilar conditions as that in the body
– The zygote at early embryos (with up to 8 blastomere) could then be transfered to the fallopian

D
tube (ZIFT- Zygote Intra Fallopian Transfer) and embryos with more than 8 blastomere into the
uterus (IUT- Intra Uterine Transfer)

o First IVF baby in the world –

N
– Louis Joy Brown in England (25th July 1978)
SI
o First IVF baby in India –
– Dr. Subhash Mukherjee (Durga – 3rd October 1978)
O

3. GIFT – Gamete Intra Fallopian Transfer

O

– Transfer of an ovum collected from a donor into the fallopian of another female who cannot
produce one but can provide suitable environment for fertilization and further development
– Fertilization is inside the body
ET

4. ICSI – Intra Cytoplasmic Sperm Injection

– A single healthy sperm is directly injected into the ovum/ ooplasm by using microneedle
– Indication- very low sperm counts, repeated IVF failure, fertilization failure in IVF, obstructive
azoospermia

Note:- In Obstructive Azoospermia

– TESE– TEsticular Sperm Extraction
– PESA – Percutaneous Epididymal Sperm Aspiration
– MESA- Microsurgical Epididymal Sperm Aspiration
5. Donor eggs/semen/embryo
6. Surrogacy – rented womb
Plot No. 46, In front of Skyline Apartments corner Building,
Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
7. SUZI- SUb Zonal Insemination
8 .POST – Peritoneal Oocyte Sperm Transfer

* Contraceptive methods –
– Ideal contraceptive - Easily Available, Effective, should not Interfere with sexual drive, desire
and sexual act of the user , NO or least side effects, User-friendly, Reversible

– Possible ill effects – nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleed-
ing, breast cancer

IA
Contraceptive Methods
* Natural (3) –
1. Rythm / calander / periodic absteinence –

D
– avoidance of sexual intercourse from day 10 – 17 of menstrual cycle, when ovulation is
expected (fertile period/unsafe period)
– Prevent insemination / fertilization
– No side effects
N
– Strong will power , Chances of failure high
SI
– Regular menstrual cycle

2. Withdrawal / coitus interruptus –

O

– Male partner withdraws his penis from the vagina, just before the ejaculation to avoid the
insemination
O

– Prevent insemination / fertilization

– No side effects
– Strong will power, Chances of failure high
ET

– Chance of pre-ejaculatory semen deposition

3. Lactational Amenorrhea(absence of menstruation)

– Ovulation& hence the cycle do not occur during the intense/exclusive lactation following parturi-
tion (Prolactin suppress estrogen)
– Effective only up to a maximum period of 6 month following a parturition
– Chances of failure high
– No side effects
* Artificial methods –
1. Barrier methods –
– ovum and sperms are prevented from physically meeting with the help of barriers (prevent fertili-
zation)

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
– No expert needed (privacy maintained)
– No side effects

a) Physical barrier –
– Male condoms (Nirodh- thin rubber/latex sheath covers penis in male)
– Female condoms- cover vaginal and cervix (Femshield)
– used just before coitus so that ejaculated semen would not enter into female reproductive tract
and can prevent conception
– protects user from contracting STDs and AIDS
– both male and female condoms –disposable, can be self inserted, gives privacy to user
– Success rate – 99%

IA
– High failure rate , if not used properly

D
N
SI
O
O
ET

* Diaphragms, Cervical caps and Vaults (rubber) –

– Inserted into female reproductive tract to cover cervix before coitus.
– They prevent conception by blocking sperm entry through cervix
– Reusable

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
(b) Chemical barriers
– Foams/ sponges / tablets / jelly soaked with spermicidal agents (destroy sperms) , inserted in
female tract
– Spermicidal creams, jelly and foams are used along with physical barriers to increase their contra-
ceptive efficiency
– Eg. TODAY sponge – spermicidal agent (Non – oxynol- 9)

2. Intra Uterine Contraceptive Device (IUCD/IUDs)

– These devices are inserted by doctors & expert nurses in the uterus through vagina
– Chances of infection (irregular bleeding)
– Three types –

IA
A) Non -medicated IUDs –
– eg : Lippes loop (polyethylene coated with BaSO4)
– Increase phagocytosis of sperms within uterus

D
B) Cu – releasing IUDs – CuT , Cu7, Multiload 375
N
– Cu ions released suppress sperm motility and the fertilizing capacity of the sperms

C) Hormone releasing IUDs – Progestasert, LNG–20 (mirena)/Levonorgestrel

SI
20 (synthetic progesterone) -Life- 3-5 year
– Makes cervix hostile to sperms (cervical mucus thick and sticky, retards sperm entry, retards
fertilization)
O

– Makes uterus unsuitable for implantation Slow growth of endometrium - retards implantation of
fertilized egg
O

– inserted by doctors & expert nurses

– No protection from STD
ET

– Chances of infection (irregular bleeding)

– IUDS are ideal contraceptive for the females who want to delay pregnancy or space children
– Success rate > 99 %
– One of the most widely accepted contraceptive methods in India

3. Oral Contraceptive Pills (OCPs) - used in form of tablets, called pills

A. Combined pills : progesterone (LNG/MPA)–estrogen(Ethinyl-estradiol) combination
– inhibits ovulation by suppressing gonadotropins
– alter the quality of cervical mucus to prevent/ retard sperm entry
– slow growth of endometrium – retards implantation
– Eg. MALA- D, MALA- N, Ovral -G etc
– Taken daily for a period of 21 days, starting preferably within the first 5 days of menstrual cycle

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
– After a gap of 7 days (during which menstruation occurs), it has to be repeated in the same
pattern till the female desire to prevent conception
– Lesser side effects and well accepted by a females
– Success rate > 99 %
– S/E-
1. Fluid retension(mild wt gain)
2. Nausea & vomit
3. Mood swings
4. Headache/migraine
5. Increase in BP

IA
6. Breast cancer( rare)

– Cautious use -
1. Family H/O breast cancer

D
2. Undiagnosed genital bleeding
3. Porphyria
4. Diabetics
5. Hypertensive & cardiac disease
N
SI
6. Epilepsy
7. Liver disease
8. Migraine
O

* Saheli- (non-steroidal,non- hormonal)

O

– preparation by CDRI, Lucknow

– ‘once a week’ pill
– very few side affect
ET

– high contraceptive value

–Centchroman/Ormeloxifen-(antiestrogen), inhibits implantation

(B) Progestogen alone / Minipills :

– Benefits can be given to lactating mother , hypertensive, breast cancer etc
* Emergency contraception
– Casual Unprotected sex, contraceptive failure , rape
– Within 72 hours of coitus
1. Administration of Progestogen (LNG –20 high dose / Unwanted-72/ Morning after pill / I-Pill)
2.Progestogen–estrogen combination(2-3 tablet)
3.IUD insertion within 3-5 days of coitus

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
Prevent Ovulation, prevent fertilization
Note :- Male contraceptive pill –
– Arrest spermatogenesis
– Gossypol (from cotton seeds)
– Success rate- 92-93%
4. Injectables – slow release of hormone , M/A same as pills but longer effective period
– Eg. DMPA (Depot Medroxy Progesterone Acetate) –every 3 months
– NET- EN (Nor- Ethisterone Enanthate) - every 2 months
– Success rate > 99%
5. Implants – slow hormone release

IA
– Eg. Norplant
– 6 silicon tubes, filled with LNG
– Effective for 5 years

D
– Inserted subdermaly/ subcutaneously in upper arm
– Success rate > 99%

N
SI
O
O
ET

* Permanent contraception/ sterilization

– terminal method for couples with family completed
– Blocks ducts carrying gametes – blocks gamete transport – thus prevent conception
– Prevents fertilization
– Highly effective but reversibility is very poor.
* In males - Vasectomy-
– a small part of vas deferens is removed or tied up through a small incision on scrotum
– Semen without sperm
– In female – Tubectomy –
– small part of FT is removed or tied up thorough a small incision in abdomen or through vagina
(fallope / sialastic ring , silicon)

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH

IA
D
– In India , many orphaned & destitute children
– Our law permits legal adoption N
– Legal adoption is as yet , one of the best methods for couples looking for parenthood
SI
* Sexually transmitted diseases STD’s / venereal disease (VD) /
Reproductive Tract Infections(RTI)
O

– Transmitted through sexual intercourse

– Early symptoms – minor – itching, fluid discharge, slight pain, swelling in genital region
O

– Late complication- PID, infertility, ectopic pregnancy, miscarriage /abortions, still birth, cancer of
reproductive tract.
ET

– Incidence high – 15-24 years age group

– Absence or less significant symptoms in early stage of infection and the social stigma attached to
STD’s – deter timely detection and proper treatment

* Prevention –
1. Avoid sex with unknown partners/multiple partners
2. Always use condoms during coitus
3. In doubt, refer qualified doctor for early detection and get complete treatment if diagnosed with
disease
Bacterial STDs:
1. Chlamydiasis - C.trachomatis (obligate intracellular parasite)
– Males-urethritis ( burning / frequent /painful micturition / pus through urethra), prostate , seminal
vesicle infection ,epididymitis , orchitis , infertility
Plot No. 46, In front of Skyline Apartments corner Building,
Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
– Females-cervix and vagina (dischrage /itching / backache) , urethra , FT , Uterus infection ,
infertility , ectopic pregnancy , abortions etc
– Passes from mother to baby during delivery through birth canal (blindness of baby)
– T/t-antibiotics (tetracycline/doxycycline)

2. Gonorrhea/The Clap / The Drip disease - Neisseria gonorrhoeae

– Male-urethra
– Female-vagina/cervix
– Passes from mother to baby during delivery through birth canal (blindness of baby)
– T/t – antibiotics (ceftriaxone + azithromycin / doxycycline)

IA
3. Chanchoid - Haemophilus ducrei (gram-ve)
– Soft, painful ulcer with necrotic base (bleeds on touch), on penis in male and vulva/ vagina in
female

D
– Treatment- antibiotics

4. Syphilis - Treponema pallidum

* Three stages –
N
A. Primary – painless, hard clean ulcer (=chancre) , disappear in 1-4 week
SI
B. Secondary(6-24 weeks later)-skin rash, muscle fatigue, joint pain, fever etc , disappear in 2-3
months
C. Tertiary -organ degeneration
O

– latent period = upto 20 years

– Treatment – penicillin antibiotic (primary , sec , latent )
O

– Dx - VDRL test ( Venereal Disease Research Laboratory test)

Viral STDs:
ET

1. Hepatitis B – HBV (DNA)

– Damages liver (jaundice , cirrhosis , liver failure , carcinoma)
– Incurable
– Recombinant DNA vaccine available (0,1,6)
2. HIV – Human Immuno- deficiency Virus
– Effects helper- T cells (CD4 cells )
– Dx – ELISA (screening) , western blotting (confirmatory)
– Incurable
* HIV & Hep-B also transmitted by-
1. Sharing of injection needles , surgical instruments
2. Transfusion of blood
3. From infected mother to foetus

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH
3. Genital warts- HPV (Human Papilloma Virus)
– Outgrowth / warts on genital area (penis in male and vulva / vagina in female)
– Can cause cancer of reproductive tract
– Treatment – Cryotherapy with liquid nitrogen, Elctrotherapy, Laser, Podophylin application
(resin)

4. Genital herpes – HSV- II

(Herpes Simplex Virus)
– Vesiculo – pustular , painful ulcer at genitilia, itching, burning etc.
– Incurable

IA
– Saline fomentation, painkillers, Acyclovir (anti- viral drug, delays progression of disease)

Protozoal STDs:

D
* Trichomoniasis – flagellated protozoa, Trichomonas vaginalis
– If vaginal acidity disturbed,
– Yellow greenish discharge, foul / fishy smell, itching , burning at vulva
– Treatment – Metronidazole to both partnerso
N
SI
o World Population day – 11th July
o World Health day - 7th April (1948 - WHO headquarters at Geneva)
O

Infertility:
 Couple unable to produce children inspite of 2 years of unprotected sexual cohabitation
 Reasons- physical, congenital disease, immunological, drugs, psychological etc
O

 Legal adoption is as yet one of the best methods for couples looking for parenthood
ET

 Assisted reproductive technologies(ART) -

 Requires extremely high precision handling by specialized professionals and expensive
instrumentation (facility available in few centers, affordable to limited people)
Note: HIV, hepatitis-B,Herpes (genital) are incurable.

Infertility- 2 types- primary and secondary

 ART –
1. AI (Artificial Insemination
 Indications – very low sperm counts in ejaculate, inability of male partner to inseminate
the female (ED)
 Artificial introduction of semen of husband or healthy donor either into vagina or into
uterus (IUI) of female
 IUI- Intra Uterine Insemination

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan
 REPRODUCTIVE HEALTH

2. IVF –ET (In Vitro Fertilization - Embryo Transfer)/ test tube

baby : Fertilization outside the body in almost similar conditions
as that in the body
 Ova from the wife / female donor and sperms from the husband/male donor are collected
and are induced to form zygote under simulated conditions in the lab
 The zygote at early embryos (with upto 8 blastomeres) could then be trasferred to the
fallopian tube (ZIFT- Zygote Intra Fallopian Transfer) and embryos with more than 8
blastomeres into the uterus (IUT- Intra Uterine Transfer)

o First IVF baby in the world – Louis Joy Brown in England (25 July1978)
o First IVF baby in India – Dr. Subhash Mukherjee (Durga - 3rd October 1978)

IA
3. GIFT – Gamete Intra Fallopian Transfer
 Transfer of an ovum collected from a donor into the fallopian of another female who
cannot produce one but can provide suitable environment for fertilization and further

D
development
 Fertilization is inside the body

4. ICSI – Intra Cytoplasmic Sperm Injection

N
 A single healthy sperm is directly injected into the ovum/ ooplasm by using microneedle
SI
 Indication- very low sperm counts, repeated IVF failure, fertilization failure in IVF,
obstructive azoospermia
Note:-
O

 TESE- TEsticular Sperm Extraction

 PESA– Percutaneous Epididymal SpermAspiration
O

 MESA- Microsurgical Epididymal SpermAspiration

5. Donor eggs/semen/embryo
ET

6. Surrogacy – rented womb

7. SUZI- sub zonal insemination
8. POST – Peritoneal Oocyte Sperm Transfer

Plot No. 46, In front of Skyline Apartments corner Building,

Rajeev Gandhi Nagar, Kota, Rajasthan