Birth Control Implant Options Notes

Fertility control Introduction

Fertility control is the use of any method or device to prevent pregnancy. It is also called birth control, family planning, or contraception. The fertility control techniques may be temporary or permanent. Several methods are available for fertility control.

Rhythm Method (Safe Period)

The rhythm method of fertility control is based on the time of ovulation. After ovulation, i.e. on the 14th day of the menstrual cycle, the ovum is fertilized during its passage through the fallopian tubes. Its viability is only for 2 days after ovulation and should be fertilized within this period.

• The sperms survive only for about 24-48 hours after ejaculation in the female genital tract. If sexual intercourse occurs during this period, i.e. few days before and a few days after ovulation, there is a chance of pregnancy.

Read And Learn More: Medical Physiology Notes

• This period is called the dangerous period. Pregnancy can be avoided if there is no sexual intercourse during this period. The prevention of pregnancy by avoiding sexual mating during this period is called the rhythm method.
• The periods, when pregnancy does not occur are 4-5 days after menstrual bleeding and 5-6 days before the onset of the next cycle. These periods are together called safe periods.

Advantages and Disadvantages

• It is one of the most successful methods of fertility control provided the woman knows the exact day of ovulation. However, it is not a successful method because of various reasons.
• Basic knowledge about the menstrual cycle is necessary to determine the day of ovulation. Self .strain is essential to avoid sexual intercourse. Because of the practical difficulties, this method is not popular.

Mechanical Barriers – Prevention Of Entry Of Sperm Into Uterus

Mechanical barriers are used to prevent the entry of sperm into the uterine cavity. These barriers are called condoms. The male condom is a leak-proof sheath, made of latex. It covers the penis and does not allow the entrance of semen into the female genital tract during coitus.

In females, the commonly used condom is a cervical cap or diaphragm. It covers the cervix and prevents the entry of sperm into the uterus.

Chemical Methods

Chemical substances, which destroy the sperm, are applied in the female genital tract before coitus. The destruction of sperm is called spermicidal action. The spermicidal substances are available in the form of foam tablets, jelly, cream, and paste.

Oral Contraceptives (Pill Method)

Oral contraceptives are drugs taken by mouth (pills) to prevent pregnancy. These pills prevent pregnancy by inhibiting the maturation of follicles and ovulation. This leads to an alteration of the normal menstrual cycle. The menstrual cycle becomes the anovulatory cycle.

This method of fertility control is called pill method and pills are called contraceptive pills or birth control pills.

These pills contain synthetic estrogen and progesterone. Contraceptive pills are of three types:

1. Classical or combined pills
2. Sequential pills
3. Minipills or micropills.

1. Classical Or Combined Pills

• The classical or combined pills contain a moderate dose of synthetic estrogen-like ethinyl estradiol or mestranol and a mild dose of synthetic progesterone-like nothing- drone or norgestrel.
• The pills are taken daily from 5-25th day of the menstrual cycle. The withdrawal of the pills after the 25th day causes menstrual bleeding. The intake of pills is resumed again after 5th day of the next cycle.

Mechanism of Action

• During the continuous intake of the pills, there is a relatively large amount of estrogen and progesterone in the blood. It suppresses the release of gonadotropins, FSH, and LH from the pituitary by means of a feedback mechanism.
• The lack of FSH and LH prevents the maturation of follicles and ovulation. In addition, progesterone increases the thickness of mucosa in the cervix, which is not favorable for the transport of sperm. When the pills are withdrawn after 21 days the menstrual flow starts.

2. Sequential Pills

Sequential pills contain a high dose of estrogen along with a moderate dose of progesterone.

These pills are taken in two courses:

1. Daily for 15 days from the 5-20th day of the menstrual cycle and then
2. During the last 5 days, i.e. 23-28th day. Sequential pills also prevent ovulation.

3. Minipills Or Micropills

• The minipills contain a low dose of only progesterone and are taken throughout the menstrual cycle. It prevents pregnancy without affecting ovulation. The progesterone increases the
• thickness of the cervical mucosa so that the transport of sperm is inhibited. It also prevents implantation of the ovum.

Disadvantages And Adverse Effects Of Oral Contraceptives

About 40% of women who use contraceptive pills may have minor transient side effects. However, long-term use of oral contraceptives causes some serious side effects. Some of the side effects are rare but may be dangerous.

The disadvantages and adverse effects of oral contraceptives are:

1. The major practical difficulty is the regular intake of the pills
2. May not be suitable for women having disorders such as diabetes, cardiovascular diseases or liver diseases
3. The clotting tendency of blood due to suppressed production of anticoagulants in liver
4. Hypertension and heart attack
5. Increase in the risk of stroke
6. Tenderness of the breast and risk of breast cancer (but may decrease the risk of ovarian and uterine cancer).

Long Term Contraceptives

• To avoid taking pills daily, long-term contraceptives are used. These contraceptives are in the form of implants containing mainly progesterone.
• The implants which are ‘usci-ad beneath the skin release the drug slowly and fertility for 4-5 years. Though it seems to be elective, it may produce amenorrhea.

Intrauterine Contraceptive Device (Iucd) – Prevention Of Fertilization And Implantation Of Ovum

The fertilization and the implantation of the ovum are prevented by inserting some object made from metal or plastic into the uterine cavity. Such an object is called an intrauterine contraceptive device (IUCD).

Mechanism Of Action Of Iucd

• IUCD prevents fertilization and implantation of the ovum. The IUCD with copper content has spermicidal action also. The IUCD which is loaded with synthetic progesterone slowly releases progesterone.
• Progesterone causes thickening of cervical mucus and prevents entry of sperm into the uterus. The common intrauterine contraceptive device is Lippe’s loop, which is ‘S-shaped and made of plastic, and copper T which is made up of copper. It is inserted into the uterine cavity by using a special applicator.

Disadvantages Of Iucd

IUCD has some disadvantages. It has the tendency to:

1. Cause heavy bleeding in some women
2. Promote infection
3. Come out of the uterus accidentally.

Medical Termination Of Pregnancy (Mtp) – Abortion

The abortion is done during the first few months of pregnancy. This method is called medical termination of pregnancy (MTP). There are three ways of doing MTP.

1. Dilatation And Curettage (D AND C)

In this method, the cervix is dilated and the implanted ovum or zygote is removed.

2. Vacuum Aspiration

The implanted ovum is removed by vacuum aspiration method. This is done up to 12 weeks of pregnancy.

3. Administration Of Prostaglandin

Administration of prostaglandins like PGE2 and PGF2 intravaginally increases uterine contractions resulting in abortion.

Surgical Method (Sterilization) – Permanent Method

Permanent sterility is obtained by surgical methods. It is also called sterilization.

Tubectomy

• In tubectomy, the fallopian tubes are cut and both the cut ends are ligated. It prevents entry of the ovum into the uterus. The operation is done through a vaginal orifice in the postpartum period.
• During other periods, it is done by abdominal incision. Tubectomy is done quickly (in a few minutes) by using a laparoscope.
• Though tubectomy causes permanent sterility, if necessary recanalization of the fallopian tube can be done using a plastic tube by another surgical procedure.

Vasectomy

• In vasectomy, the vas deferens are cut and the cut ends are ligated. So the sperms cannot enter the ejaculatory duct and the semen is devoid of sperms.
• It is done by surgical procedure with local anesthesia. If necessary, the recanalization of vas deferens can be done with a plastic tube.