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© 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Thirteen: Managing Your Fertility.

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1 © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Thirteen: Managing Your Fertility

2 © 2011 McGraw-Hill Higher Education. All rights reserved. Birth Control vs. Contraception Birth control refers to all procedures and methods that can prevent the birth of a child Contraception refers to procedures used to prevent fertilization

3 © 2011 McGraw-Hill Higher Education. All rights reserved. Theoretical Effectiveness vs. Use Effectiveness Theoretical effectiveness: Measure of a contraceptive method’s ability to prevent a pregnancy when the method is used precisely as directed during every act of intercourse Use effectiveness: Measure of a contraceptive method’s ability to prevent a pregnancy when used by the general public

4 © 2011 McGraw-Hill Higher Education. All rights reserved. Selecting Your Contraceptive Method Safety Effectiveness Reliability Reversibility Affordability Ease of use Interference with sexual expression Considerations when choosing contraception

5 © 2011 McGraw-Hill Higher Education. All rights reserved. Behavioral Contraceptive Methods AbstinenceNo sexual activity100% effective ChanceNo method used15% use effectiveness Withdrawal (“coitus interruptus”) Removal of penis from vagina before ejaculation 73% use effectiveness

6 © 2011 McGraw-Hill Higher Education. All rights reserved. Behavioral Contraceptive Methods (cont.) Periodic abstinence (rhythm method) Calendar (calculating the unsafe days of a women’s menstrual cycle) Temperature (rise in body temperature correlates with timing of ovulation) Cervical mucus method (evaluate consistency of vaginal discharge to predict ovulation) Symptothermal (combines basal temperature and mucus methods) Standard days (appropriate for women whose cycle is between 26- 32 days) 75% use effectiveness

7 © 2011 McGraw-Hill Higher Education. All rights reserved. Periodic Abstinence

8 © 2011 McGraw-Hill Higher Education. All rights reserved. Over-the-Counter Contraceptive Methods Spermicides  Foams  Creams  Jellies  Films  Suppositories Condoms  Male  Female Contraceptive sponge

9 © 2011 McGraw-Hill Higher Education. All rights reserved. Over-the-Counter Contraceptive Methods Vaginal spermicides OTC agents that are capable of killing sperm 71% use effectiveness

10 © 2011 McGraw-Hill Higher Education. All rights reserved. Over-the-Counter Contraceptive Methods (cont.) Male condomOTC latex shield designed to cover erect penis and retain semen upon ejaculation 85% use effectiveness Male condom with spermicide Latex condom in combination with spermicide 95% use effectiveness Female condomPolyurethane sheath inserted into the vagina 79% use effectiveness Contraceptive sponge Small, pillow-shaped contraceptive that contains spermicide; placed in the vagina to cover the cervical opening 84% use effectiveness

11 © 2011 McGraw-Hill Higher Education. All rights reserved. Use of a Male Condom Keep a supply on hand Handle condoms with care Put condom on before genital contact Lubricate the condom Take care the condom is not dislodged from penis Inspect condom for tears before discarding

12 © 2011 McGraw-Hill Higher Education. All rights reserved. Prescription Contraceptive Methods Diaphragm Lea’s Shield FemCap Intrauterine device (IUD) Oral contraceptives  Combined pills  Minipills Injectable contraceptive Contraceptive implant Contraceptive ring Contraceptive patch

13 © 2011 McGraw-Hill Higher Education. All rights reserved. Prescription Birth Control Methods DiaphragmSoft rubber cup that covers the cervix Fitted by health care professional Used with spermicide 84% use effectiveness Lea’s Shield or FemCap Lea’s shield: Reusable oval silicone device that covers the cervix FemCap: Reusable hat-shaped silicone cap that covers the cervix Use similar to diaphragm 86% use effectiveness Intrauterine device (IUD) T-shaped device inserted into the uterus Medicated or unmedicated Somehow interferes with implantation of the ovum World’s most popular reversible contraceptive method 99%+ use effectiveness

14 © 2011 McGraw-Hill Higher Education. All rights reserved. Use of a Diaphragm

15 © 2011 McGraw-Hill Higher Education. All rights reserved. Prescription Birth Control Methods (cont.) Oral contraceptive pills Daily pills Estrogen works by reducing ovum development Progesterone reduces ovulation and thickens cervical mucus 92% use effectiveness Side effectsTenderness in breasts Nausea Headaches Spotting Weight gain Sex drive fluctuation Frequent vaginal infections Mild depression Potential risksBlood clots, stroke, hypertension, heart attack

16 © 2011 McGraw-Hill Higher Education. All rights reserved.

17 Prescription Birth Control Methods (cont.) MinipillsDaily pill Low-dose progesterone 92% use effectiveness Injectable contraceptive Each shot effective for a 3-month period Prevents ovulation and thickens the cervical mucus 97% use effectiveness Contraceptive ring (NuvaRing) Polymer device containing estrogen and progestin Placed deep in the vagina for a 3-week period 92%+ use effectiveness Contraceptive patch Skin patch containing estrogen and progestin Worn for 3 weeks, then 1 week off, then new patch 92%+ use effectiveness

18 © 2011 McGraw-Hill Higher Education. All rights reserved. Prescription Birth Control Methods (cont.) Contraceptive implant Protection is good for 3 years Can be used while breastfeeding Physician must insert and remove May cause temporary irregular bleeding Possibility of cardiovascular problems 99% use effectiveness

19 © 2011 McGraw-Hill Higher Education. All rights reserved. Emergency Contraception Contraceptive measured used to prevent pregnancy within a few days of unprotected intercourse Hormonal or IUD insertion “Morning after” pill; not RU-486 (“abortion pill”) Plan B available behind the pharmacy counter  Those under age 18 must have a prescription  Will not cause abortion or affect established pregnancy

20 © 2011 McGraw-Hill Higher Education. All rights reserved. Sterilization = Generally permanent birth control techniques that surgically disrupt the normal passage of ova or sperm Vasectomy: Removal of a section of the vas deferens Tubal ligation: Fallopian tubes are cut and the ends tied back

21 © 2011 McGraw-Hill Higher Education. All rights reserved. Male Sterilization: Vasectomy

22 © 2011 McGraw-Hill Higher Education. All rights reserved. Female Sterilization: Tubal Ligation

23 © 2011 McGraw-Hill Higher Education. All rights reserved. Abortion: Termination of a Pregnancy First Trimester Procedures  Manual vacuum aspiration Procedure performed by dilating the cervix and removing uterine contents  Dilation and suction curettage (D&C) Procedure in which the cervical canal is dilated to allow the uterine wall to be scraped  Medication abortion RU-486 (mifepristone) blocks the action of progesterone and causes the lining of the uterus to break down

24 © 2011 McGraw-Hill Higher Education. All rights reserved. Abortion: Termination of a Pregnancy (cont.) Second Trimester Procedures  Dilation and Evacuation (D&E) Performed between 13 and 16 weeks of pregnancy Cervix is dilated and contents are removed by suction Partial-Birth Abortion  Federal Ban Third Trimester Procedures  Hysterotomy  Hysterectomy

25 © 2011 McGraw-Hill Higher Education. All rights reserved. Dilation and Evacuation

26 © 2011 McGraw-Hill Higher Education. All rights reserved. Pregnancy Obstacles to Fertilization Acid level in the vagina Cervical mucus thickness Location of cervical entrance for sperm Location of the correct fallopian tube for sperm Distance sperm travels Motility of sperm

27 © 2011 McGraw-Hill Higher Education. All rights reserved. Aids to Fertilization 200-500 million sperm cells are deposited into the vagina during ejaculation Sperm are deposited near the cervical opening Male accessory glands help make the semen nonacidic Uterine contractions aid sperm movement in the proper direction Sperm cells move fairly quickly Sperm can live for days Cervical mucus is thin and watery at the time of ovulation

28 © 2011 McGraw-Hill Higher Education. All rights reserved. Fertilization and Implantation

29 © 2011 McGraw-Hill Higher Education. All rights reserved. Signs of Pregnancy (Presumptive) Missed menstrual period after sexual intercourse the previous month Morning sickness Increase in size and tenderness of breasts Darkening of the areolar tissue around the nipples

30 © 2011 McGraw-Hill Higher Education. All rights reserved. Signs of Pregnancy (Probable) Increased frequency of urination Increased in the size of the abdomen Cervix becomes softer by the sixth week Positive pregnancy test

31 © 2011 McGraw-Hill Higher Education. All rights reserved. Signs of Pregnancy (Positive) Determination of a fetal heart beat Feeling of the fetus moving (“quickening”) Observations of the fetus by ultrasound or optical viewers

32 © 2011 McGraw-Hill Higher Education. All rights reserved. Agents that Can Damage a Fetus Rubella/herpes viruses Tobacco smoke Alcohol Certain OTC drugs Radiation Accutane (acne drug)

33 © 2011 McGraw-Hill Higher Education. All rights reserved. Intrauterine Development Three trimesters (13 weeks each) First trimester  Zygote  Blastocyst  Embryo  Fetus (after 8 weeks) Second trimester: Organs develop, fetal heartbeat and bone structure evident, prominent weight gain in the mother Third trimester: Fetus increases weight from 2-3 pounds; absorption of major nutrients allowing increased growth and weight

34 © 2011 McGraw-Hill Higher Education. All rights reserved. Maintaining a Healthy Pregnancy Arrange for prenatal care Consume a well-balanced diet Take a supplement with folic acid Exercise according to your physician’s recommendation Avoid and treat infections Avoid alcohol, tobacco, and other drugs Limit your caffeine intake Stay away from x-rays, hot tubs, saunas, toxic chemicals

35 © 2011 McGraw-Hill Higher Education. All rights reserved. Three Stages of Labor Effacement/dilation of the cervix:  Uterine contractions thin the cervix and enlarge the cervical opening  Cervix opens to 10 cm during this stage Delivery of the fetus:  Uterine contractions are aided by mother’s voluntary contractions of abdominal muscles  Fetus moves through the birth canal Delivery of the placenta:  Placenta detaches from uterine wall

36 © 2011 McGraw-Hill Higher Education. All rights reserved. Stages of Labor and Childbirth

37 © 2011 McGraw-Hill Higher Education. All rights reserved. Cesarean Deliveries (C-section) Fetus is removed from the uterus through the abdominal wall Possibly due to one or more of the following factors:  Fetus is improperly positioned  Mother’s pelvis is too small  Fetus is especially large  Fetus shows signs of distress  Umbilical cord is compressed  Placenta is being delivered before the fetus  Mother’s health is at risk

38 © 2011 McGraw-Hill Higher Education. All rights reserved. Causes of Infertility Low sperm count Poor sperm motility Sperm abnormalities Lack of ovulation Obstruction of fallopian tubes

39 © 2011 McGraw-Hill Higher Education. All rights reserved. Enhancing Fertility Cold packs on the scrotum (men) Boxer shorts vs. briefs (men) Intercourse no more than every 36 hours preceding ovulation  Frequent intercourse tends to lower sperm counts

40 © 2011 McGraw-Hill Higher Education. All rights reserved. Treatments for Infertility Artificial insemination Surgical procedures Fertility drugs Assisted reproductive technology  In vitro fertilization  Gamete intrafallopian transfer  Zygote intrafallopian transfer  Intracytoplasmic sperm injection Ethical Questions?

41 © 2011 McGraw-Hill Higher Education. All rights reserved. Options for Infertile Couples Surrogate parenting Adoption Foster parenting

42 © 2011 McGraw-Hill Higher Education. All rights reserved. Cloning Techniques Procedures involve the following:  Surgical removal of an egg from female donor  Nucleus of the egg is removed  Cell is taken from a cloning subject (male/female)  Through an electrical jolt, the cell is fused with the enucleated egg, creating a clonal zygote  Embryo is implanted in the womb of a surrogate mother  After nine months, a genetically matched reproduction is born

43 © 2011 McGraw-Hill Higher Education. All rights reserved. Cloning Reproductive cloning  Not yet accomplished  Banned in selected countries and states Therapeutic cloning  Can be used to create stem cells

44 © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Thirteen: Managing Your Fertility


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