1. (c) 2005 The McGraw-Hill Companies, Inc. All rights reserved. Chapter Sixteen: Managing Your Fertility

2. Birth Control vs. Contraception Birth control refers to all procedures (umbrella term) Birth control refers to all procedures (umbrella term) Contraception procedures are used to decrease chances of fertilization of an ovum (more specific) Contraception procedures are used to decrease chances of fertilization of an ovum (more specific)

3. Reasons for Using Birth Control Provide financial support for children (proper timing) Provide financial support for children (proper timing) Prevent having children Prevent having children Reduce STD risks Reduce STD risks Religious doctrine Religious doctrine Alternative lifestyle choices Alternative lifestyle choices Financial and legal considerations for couples Financial and legal considerations for couples Availability of professional services Availability of professional services

4. Theoretical Effectiveness vs. Use Effectiveness Theoretical Effectiveness: measure of a contraceptive method’s ability to prevent a pregnancy as directed during intercourse Theoretical Effectiveness: measure of a contraceptive method’s ability to prevent a pregnancy as directed during intercourse Use Effectiveness: effectiveness of the method in preventing conception when used by the general public Use Effectiveness: effectiveness of the method in preventing conception when used by the general public

5. Selecting Your Contraceptive Methods Safety Safety Effectiveness Effectiveness Reliability Reliability Reversibility Reversibility Affordability Affordability Ease of use Ease of use Interference with sexual expression Interference with sexual expression Considerations to evaluate when choosing contraception

6. Current Birth Control Methods Abstinence no sexual activity 100% effective Chance no method used 15% user rate effective Withdrawal removal of penis from vagina before ejaculation 81% user rate effective

7. Current Birth Control Methods, cont’d Periodic Abstinence (Rhythm Method) Calendar (calculating the unsafe days of ovulation) Calendar (calculating the unsafe days of ovulation) Basal temperature (raise in body temperature could result in ovulation) Basal temperature (raise in body temperature could result in ovulation) Billings Cervical Mucus Method (evaluate consistency of vaginal discharge to predict ovulation) Billings Cervical Mucus Method (evaluate consistency of vaginal discharge to predict ovulation) Sympothermal (combines basal type and mucus together) Sympothermal (combines basal type and mucus together) 75% user rate effective See illustration on next slide

9. Current Birth Control Methods, cont’d Vaginal Spermicides OTC products OTC products 74% user rate effective

10. Current Birth Control Methods, cont’d Condom OTC product 86% user rate effective Condom with Spermicide OTC product 95% user rate effective Female condom OTC product 79% user rate effective Contraceptive Sponge OTC product Removed from the market in 1995, planning on a 2004 return

11. Prescription Birth Control Methods Diaphragm Soft rubber cap, must be fitted by health care professional, used with spermicide 80% user rate effective Cervical Cap Thimble shaped device fits over the cervix 80% user rate effective IUD T-shaped item is inserted into the uterus, is the world’s popular reversible contraceptive method; many experts still don’t know exactly how this works but somehow interferes with implantation of the ovum 98-99% user rate effective

12. Prescription Birth Control Methods, Cont’d Oral Contraceptive Pills Daily ingestion; estrogen works by reducing the ovum development; progesterone reduces ovulation and thickens the cervical mucus side effects Tenderness in breasts Tenderness in breasts Nausea Nausea Headaches Headaches Spotting Spotting Weight gain Weight gain Sex drive fluctuation Sex drive fluctuation Frequent vaginal infections Frequent vaginal infections Mild depression Mild depression potential risks Blood clots, stroke, hypertension, heart attack

14. Prescription Birth Control Methods, Cont’d Minipills Low dosage progesterone Injectable Progesterone “Depo Provera” (99% effective for 3 months) Subdermal Implants “Norplant” progesterone rods inserted in the upper arm release hormone over 5 year period…discontinued in 2002 Contraceptive Patch Estrogen/Progestin on skin/replaced every 3 weeks

15. Prescription Birth Control Methods, cont. FemCap Non-hormonal latex free. Can be worn for over 48 hours at a time, reusable for over 2 years. Claims to be more comfortable than the diaphragm. Fits over the cervix and prevents sperm from entering the uterus. Can store spermicides, available in 3 sizes. user rate effectiveness is unknown as this time. Contraceptive Ring Polymer device containing estrogen and progestin; placed deep in the vagina for a 3 week period 98-99% effective Emergency Contraception Hormonal or IUD insertion aka “morning after” pill Numbers not available at this time

16. Sterilization Vasectomy Vasectomy – separation of the vas deferens Tubal Tubal ligation – separation of the fallopian tubes

17. Abortion – Termination of a Pregnancy First Trimester Procedures First Trimester Procedures Menstrual extraction – withdraw endometrial tissue during the 4 th - 6 th week Menstrual extraction – withdraw endometrial tissue during the 4 th - 6 th week Vacuum aspiration – 6 th -9 th week procedure performed the most by dilating the cervix and removing uterine contents Vacuum aspiration – 6 th -9 th week procedure performed the most by dilating the cervix and removing uterine contents D&C (Dilation & Curettage) - performed during 9 th -14 th week; dilation of cervix and scraping the wall of the uterine D&C (Dilation & Curettage) - performed during 9 th -14 th week; dilation of cervix and scraping the wall of the uterine RU486 (Mifepristone) – blocks the action of progesterone and doesn’t allow implantation to occur RU486 (Mifepristone) – blocks the action of progesterone and doesn’t allow implantation to occur

18. Abortion – Termination of a Pregnancy, cont’d Second Trimester Procedures Second Trimester Procedures D&C (Dilation & Curettage) - performed during 13 th -15 th week; cervix is dilated and contents are removed by suction D&C (Dilation & Curettage) - performed during 13 th -15 th week; cervix is dilated and contents are removed by suction Hypertonic Saline procedure – 16 th week procedure where saline is administered and the uterus is caused to expel contents Hypertonic Saline procedure – 16 th week procedure where saline is administered and the uterus is caused to expel contents Prostaglandin procedure – hormones cause contractions to expel uterine contents Prostaglandin procedure – hormones cause contractions to expel uterine contents

19. (c) 2005 The McGraw-Hill Companies, Inc. All rights reserved. Chapter Sixteen: Managing Your Fertility