1. Contraception IUC ’ s, Sterilization, & More

2. Intrauterine Contraceptives (IUC ’ s) IUC ’ s are made of flexible plastic, available only through prescription Three types – ParaGard (copper) – Mirena (hormone) – Skyla (hormone)

3. IUC ’ s: ParaGard ParaGard contains copper Copper prevents sperm from fertilizing an ovum Copper also makes implantation of fertilized ovum difficult Amount of copper released is less than needed in daily diet Copper intolerance or insensitivity would preclude use of ParaGard

4. IUC ’ s: Paragard Requires insertion into uterus by healthcare provider – Takes only a few minutes – Insertion may cause cramping, dizziness Once inserted, may remain in place for ten years – Patient should not feel IUD Since no hormones present, monthly cycle should remain unchanged Effectiveness: 99%+ against pregnancy Requires monthly checking for IUD slippage

5. IUC ’ s: ParaGard Side effects: heavier and longer periods, cramping, spotting in between periods – May lessen after a few months on ParaGard Complication risks: pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion Copper may provide protective benefit against endometrial cancer Cost: $0-1000 (Planned Parenthood)

6. IUC ’ s: Mirena Progestin-only intrauterine contraceptive Lasts for five years Mirena: – Prevents sperm from fertilizing ovum – Prevents release of egg – Changes uterine lining

7. IUC ’ s: Mirena Insertion: Similar to ParaGard Effectiveness: 99%+ against pregnancy Cost: $0-400 (Consumer Reports) Side effects: Abdominal cramping (10% of users during first few months), acne, breast tenderness, headache, mood changes, back pain – May lessen after a few months – As use continues, less menstrual bleeding Complication effects: ovarian cysts, pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion

8. IUC: Skyla FDA approved in 2013 Hormone Smaller than Mirena Lasts three years instead of five Marketed to women who have not had kids – Mirena marketed to women with child (research done only on this group) – IUC’s appropriate for all women

9. IUC ’ s Internal Birth Control- IUD ’ s (via Youtube) Internal Birth Control- IUD ’ s Paragard insertion (via YouTube, 0-0:53) Paragard insertion Mirena insertion (via YouTube, for healthcare providers) Mirena insertion Insertion of IUC (Medialvideos.us)IUC

10. Sterilization

11. Sterilization = permanent contraception – Women undergo tubal ligation – Men undergo vasectomy The second most common contraceptive method used in the United States, behind the pill – No formalized data collection system exists – Data retrieved from surveys, questionnaires

12. 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

13. Sterilization: Tubal Ligation Tubal sterilization: – Tubal coagulation/cauterization Tubal coagulation/cauterization – Tubes can be tied and cut (Pomeroy & Parkland techniques)Pomeroy &Parkland – Tubes can be clipped, clamped Tubes can be clipped, clamped – These incision methods often performed after childbirth/abortion – Animation (SMART imagebase) Animation

14. 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) Before/after photos

15. 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 Essure implants and insurance questions Essure implants

16. Sterilization: Implants Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting Animation (essure.com) Animation

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

18. 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

19. Sterilization: Vasectomy Cost: $0-1000 (plannedparenthood.com) – Not currently covered via Affordable Care Act (arhp, 1/14)arhp Side effects: bruising, sensitivity/pain, sperm leaking from tubes may lead to small lump (usually clears on its own), antibodies to sperm may develop, reducing chances of fertility in a reversal 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

20. Sterilization: Vasectomy Animation (Medical Politis via YouTube) Animation Video (vasectomymedical.com) Video

21. Contraception in the Future: Nestorone Estrogen and progestin Gel Spray Population Council Announcement, 2010 Population Council Announcement Phase III trials (Antares Pharma)

22. 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)vas deferens video – 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

23. 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 – Photo from BBC

24. 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

25. Contraception: Impact of Heat on Sperm

26. 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)

27. 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)