Contraception Potpourri

Sterilization

Sterilization: Vasectomy Vasectomy blocks sperm from traveling through the vas deferens, preventing sperm from mixing into semen No glands or organs are removed Effectiveness: 99%+ Considered irreversible

Sterilization: Vasectomy Vas deferens must be isolated Similar to tubal ligation, the vas deferens can be cut and tied, clamped, cauterized, no scalpel technique Another form of contraception must be used for a few months

Sterilization: Vasectomy Cost: $350-1000 (plannedparenthood.org) Side effects Bruising Sensitivity/pain for up to a few weeks past the procedure Sperm leaking from tubes may lead to small lump (usually clears up on its own) Antibodies to sperm may develop, reducing chances of fertility in a reversal

Vasectomy Complications Rare Usually associated with infection (fever, pus/blood from incision site, swelling, pain) Ends of tubes may grow back together (very rare) Decreased sexual desire (4 out of 1000 cases per Planned Parenthood) - no apparent physical cause

Sterilization: Vasectomy Animation (BUPA Health via YouTube, 2:36) Open-ended (no scalpel) vasectomy (medicalvideos.us) Video (vasectomymedical.com)

Sterilization: Tubal Ligation Surgical technique Close fallopian tubes, preventing egg from traveling to uterus, preventing sperm from reaching egg Neither organs nor glands are removed Effectiveness: 99%+ Considered irreversible

Sterilization: Tubal Ligation Tubal sterilization: Tubes can be tied and cut (Pomeroy technique) Tubes can be cauterized Tubes can be clipped, clamped These incision methods often performed after childbirth/abortion Animation (SMART imagebase)

Sterilization: Tubal Ligation Cost: $1000-3000 Side effects: thought by many to be rare; hormonal imbalance may lead to increased menstrual bleeding, cramping; adhesions Complications: infection, internal bleeding, ectopic pregnancy Before/after photos (private Flickr account)

Sterilization: Implants Non-incision method No general anesthesia Under an hour Coils inserted into fallopian tubes In following months, coils and tissue grow together, forming barrier to prevent sperm from reaching egg

Sterilization: Implants Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting Demo (YouTube, 1:04)

Long-Term Contraception & Sterilization: Project Prevention Societal aid or eugenics? FOX News program (1:30 minutes) ABC News program (2:19 minutes)

Contraception in the Future: Nestorone Estrogen and progestin Gel Spray Acrux Announcement, February 2009 Figure 2: Estrogen content in Nestorone, OrthoEvra, NuvaRing, combination pills 2012: Combination of nestorone and testosterone reduced sperm count in UCLA study

Contraception: The Future Male hormonal contraceptive: monthly testosterone injection 5/ 2009: China clinical trials 1 in 100 fathered a child Reversible six months after stopping injections 1/3 of 1000 participants did not complete; no reason provided Few side effects reported (acne, weight gain), but more research needed Contraceptive methods may work better in Asian men vs European men Photo from BBC

Contraception: The Future RISUG Reversible Inhibition of Sperm Under Guidance Contraceptive method for men Clinical trials in India Injection into vas deferens of male (video, wired.com, :34) RISUG disrupts membranes of sperm so they cannot fertilize One injection to last 10 years Reversibility not well tested, though reports on primates appear positive (requires another injection) Marketing challenges

Contraception: The Future Male contraceptive pill research at UW (KOMO report, 2009, 2:10, YouTube) Non-hormonal manipulation of sperm production has been successful in mice (2012) Vitamin A blocking can reduce fertility (but Vitamin A needed for other bodily functions)

Contraception: The Past Male Contraceptive: Heat Prolonged heat exposure can impair sperm production in testes Ancient method Effectiveness? 116 degree bath 45 minutes Every day Three weeks

Contraception: Impact of Heat on Sperm

Contraception: Impact of Heat on Sperm Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

Contraception: Impact of Heat on Sperm Upper left: coiled tail Upper right: bent tail Lower left: double head Lower right: triple head Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

Temperature Method Track temperature every morning Look for slight drop in temperature occurring immediately before ovulation At ovulation, temperature increases Temperature changes are small Look for trends, expect daily fluctuations Image source: Public domain, Wikimedia Commons

Temperature Method Use basal thermometer Smaller scale (1/10 degree) Chart temperature for at least three months before relying on method Safe sex time begins 72 hours after temperature has risen, remains until temperature begins to drop Source: Dr. Sacha Elliott, ND

Temperature Method Day 10: 98.5 Day 17: 98.8 Day 11: 98.4 Day 18: 99.0

Cervical Mucus Method Tracking the variation in mucus consistency throughout cycle Cervical mucus begins a few days after menstruation As mucus production increases, it’s yellow or white in color & cloudy, sticky Will become wet, clear Clear, slippery mucus = most fertile Mucus production decreases, cloudy & sticky

Cervical Mucus Method Tracking Your Cervical Mucus, Babycenter.com “Safe days” = begin after slippery mucus decreases, continue into cloudy & tacky, and especially dry days Short cycles = mucus may be hidden in menstrual flow

Calendar Method Predicting “safe” and “unsafe” days based on length of monthly cycles Can use traditional calendar, software, phone app, web tools

Calendar Method Count length of menstrual cycle Day #1 = first day of menses Last day = day before menses returns Eight cycles are recommended before relying on this method (Planned Parenthood) First fertile day = shortest cycle minus 18 Last fertile day = longest cycle minus 11

Calendar Method Cycle 1: 24 Cycle 2: 27 Cycle 3: 25 Cycle 4: 28 Shortest day: 24 Longest day: 29 Unsafe days: #6-18

Calendar Method Online calendar method tool - virtualmedicalcentre.com Irregular period cycles = reduced effectiveness Calendar method = requires another method for most to experience adequate effectiveness

United Nations: Contraceptive Prevalence Across the World, 2005