1. Unit 14: Fertility Management

2. Factors to consider when choosing a fertility management plan What is the nature of the individual/couple’s sexual activities and relationships? Personal religious and moral beliefs Effectiveness Theoretical effectiveness is what clinical tests have shown Actual effectiveness is how effective it actually is in the overall population

4. Factors to consider when choosing a fertility management plan Safety Cost Accessibility Convenience Comfort, aesthetic considerations

5. Factors to consider when choosing a fertility management plan Interference with spontaneity of sex STI protection effectiveness – Only condoms provide this Active versus passive methods: – a passive method is something you do once and then you don’t have to think about it ex. Tubal ligation. – An active method is something you have to continuously do ex. Condom

6. VARIOUS METHODS OF CONTRACEPTION

7. Abstinence Continuous abstinence – 100% effective at pregnancy, STI prevention Periodic abstinence – Must know cycle well (see next slide)

8. Predicting fertility The ovum lives 1 or 2 days after it is released Sperm can live inside woman for 5-7 days Therefore, women can only get pregnant 9 days a cycle – 7 days before ovulation, – the day of ovulation – maybe the day after

9. Predicting Fertility Determining Ovulation So how do you know when a woman is ovulating? 1. temperature method: the temperature of the body increases by 0.4°C to 0.8°C during ovulation 2. mucous method: the mucous in the vagina becomes clear and slippery (instead of cloudy and sticky) during ovulation 3. calendar method: if you count the day that bleeding starts as day 1, day 14 is typically the day of ovulation (There’s even an iPhone app for this!)

10. Female Reproductive System Hormonal Changes http://www.biologyreference.com/images/biol_02_img0171.jpg

11. Withdrawal Another name “Coitus interruptus” or “pulling out” When the man pulls his penis out of the vagina before he ejaculates and ejaculates outside of the vagina “Requires skill and trust” Actual effectiveness 73%

12. Barrier method Condoms, diaphragm, cervical cap provide a barrier to sperm Condoms: easy to obtain, few side effects, can offer some protection against STI’s Diaphragm and cervical caps: soft barriers that cover the uterus both must be used in addition to spermicide

13. Female condom Diaphragm Cervical cap

14. Oral contraceptives (“the pill”) Contains hormones which regulate the menstrual cycle may reduce PMS symptoms, regulation of periods, may reduce menstrual cramping, lower incidence of breast and ovarian cysts, pelvic inflammatory disease, and ovarian cancer (Kelly, 2006) Side effects include: nausea, fluid retention, missed menstrual period, depression, anxiety, decreased sex drive, weight gain/loss, breast tenderness, mood changes (Kelly, 2006) Long term risk: possibility of blood clots, increase risk of heart disease and cervical cancer after discontinuing the pill for 10 years risk are the same as those who never used the pill (Kelly, 2006)

15. Oral Contraceptives (“the pill”) Warning signs if you are on the pill: abdominal pain or gastrointestinal disorders may signal the development of liver disease, Crohn’s disease or ulcerative colitis ( Kelly, 2006) Drugs which can interfere with the effectiveness : certain antibiotics -ampicillin and tetracycline – interfere with absorption; tranquilizers, barbiturates, sleeping pills, some anti-inflammatory medication and some sulfa drugs. (Kelly,2006) Cost – Retail$10.78 – 11.78 / month with an increase 3.5%/yr (SOGC, 2009) The pill should not be taken if you smoke more than 20 cigarettes per day

16. Oral Contraceptives (“the pill”) Combined oral contraceptive – estrogen and progestin taken 21 days Progestin –only pill (minipills) – progestin – crucial for it to be taken everyday at the same time (lose effectiveness) Three months in 91 day regimen for 84 days pills in a row called the Seasonale pill. Period every three months becoming popular, accepted by Health Canada in 2007 (Kelly, 2006)

17. Hormonal Contraception Injected contraceptives Vaginal ring Implanted contraceptives The “patch” All work by changing the hormone levels in the human body

18. Injected Contraceptives Depo- Provera – depot medroxyprogesterone acetate (DMPA) doesn’t allow the embryo to implant into uterine lining Types available: either for 1-3 months 1 st shot 5 days after menses. Should not be taken longer than 2 yrs( Family Doctor, 2010) Side effects: weight gain, hair loss, heavy menstrual bleeding, disruption of periods, emotional reactions, and fatigue usually reduce after 1 month Long term risk: risk of cervical cancer, not associated with increase risk of liver cancer or endometrial cancer Cost: $35 +/month (Kelly, 2006)

19. Vaginal Ring NuvaRing- estrogen and progestin 21 days taken out for 7 days for menstruation to occur- need a new ring each month (Kelly, 2006) Thought to have the similar benefits as the birth pill – women have to learn to insert it correctly! Side effects: headache, vaginal irritation, discomfort or discharge, nausea, and breast tenderness, bleeding between periods found in 5% of women ( SOGC, 2007) Cost: $35- 40 +/ month

20. Implanted Contraceptives Contraceptive implants – 6 slender silicone rubber rods containing levonorgestrel (form of progestin) Place inside of the woman’s upper arm Prevent ovulation and increase mucus thickness Good for 5 years! Implanon costs $249.00

21. The “Patch” Ortho Evra – estrogen and progestin Health risk issued as of 2005 increasing risk of blood clot more than the pill Increase dose of estrogen Used for three weeks straight followed by 1 wk break for menses to start View Warning at: http://www.hc-sc.gc.ca/ahc-asc/media/advisories- avis/_2005/2005_132-eng.php Cost: 30-35+/month

22. Intrauterine Device Most widely used method of birth control worldwide Placed inside a woman’s uterus – release progestin IUD’s prevent fertilization, or implantation Has a plastic string for removal and to ensure it is in properly Stays in for 5 years Cost ~$ 8 /month if worn for 5 yrs

23. IUD

24. Emergency Contraception aka “morning after” Aimed at preventing pregnancy after unprotected vaginal intercourse Can be in the form of a pill (75-90% effective) or an IUD (90%+ effective) Should not be used as a main form of birth control! – Prevention is always better – Expensive – Many lingering side effects – Cost $30 and up!

25. PERMANENT METHODS OF BIRTH CONTROL

26. Tubal sterilization “getting your tubes tied” procedure called tubal ligation An operation that closes the fallopian tubes, (recall: where fertilization occurs) Everything else pretty much stays the same

27. Vasectomy Permanent birth control for men Blocks the vas deferens (recall: the tube that transfers sperm out of the testes) Does not affect sexuality – Will still ejaculate (minus sperm) – Will still become erect – Will still secrete testosterone

28. Before you get pregnant!!!! Be prepared- schedule a doc visit regularly Think Twice!!- parenthood – lack of sleep, changing plans because the baby is sick, enduring tantrums Eat well!!! – Folic acid (400-800 mg/day) -through out pregnancy helps develop the brain and nervous system needed especially in 1 st Trimester Avoid harmful substance- alcohol, mercury, smoke, or illicit drugs = brain damage Get moderate exercise – walking and swimming are healthful and safe Drink your water!!!!!! (Kelly, 2010)

29. ABORTION

30. Abortions in Canada Nearly 100,000 abortions were performed in 2005; rate seems to be decreasing Most common among women in their 20s (52%) Having an abortion when the mother is younger reduces the ensuing complications Cost: $500 – $1200 There are no legal restrictions on abortion – “The state has no business in the bedrooms of the nation” –Pierre Trudeau

31. Legal and Social Issues (USA) Supreme court decision in famous Roe vs. Wade case made abortions legal in the US – In the first trimester the woman has the right to make the decision – In the second trimester, the state can impose rules such as where she can have the abortion – In the third trimester, abortions are illegal unless the mother’s life is at risk