1. Contraception
Fall 2016

2. Contraception Variety of methods Categorized by methodology
Barriers
Hormonal methods
Fertility awareness methods
Sterilization
Contraceptive issues vary across countries
Contraceptive methods in the U.S. (Guttmacher Institute, 2012)
Under Affordable Care Act, rate for uninsured women reduced 1/3
Contraceptive methods in the U.S., 1995 vs (CDC)
Contraceptive prevalence (Excel, pdf map) across the world (United Nations, 2012)
Contraceptive prevalence by method (United Nations, 2011)

3. Why Does Contraception Matter?
We (taxpayers) pay for many unexpected pregnancies
Rates of unintended pregnancy (Guttmacher Institute)
How much (Guttmacher Institute)
Youth comparisons in Germany, France, Netherlands (Advocates for Youth)

4. You Decide
Contraceptive Issues

5. Contraceptive Issues Effectiveness against pregnancy Cost Side effects
Religion
Life choices
Availability
Sexually transmitted infection risk
Reversibility
Ease of use
Spontaneity

6. Contraceptives – How They Work
Dependent Upon Category
Barriers
Hormone-Based Methods
Sterilization
Fertility Awareness Methods

7. Sterilization

8. Sterilization Female sterilization: 700,000/year (emedicinehealth.com)
Sterilization = permanent contraception
Women undergo tubal ligation or implant
Men undergo vasectomy
The second most common contraceptive method used in the United States (men’s and women’s methods combined)
No formalized data collection system exists
Data retrieved from surveys, questionnaires
Female sterilization: 700,000/year (emedicinehealth.com)
Vasectomies: 500,000/year (WebMD)

9. 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

10. Sterilization: Vasectomy
Vas deferens must be isolated
The vas deferens can be cut and tied, clamped, cauterized, no scalpel technique
Another form of contraception must be used for a few months

11. Sterilization: Vasectomy
Cost: $ (plannedparenthood.com)
Not currently covered via Affordable Care Act
Planned Parenthood may provide no- or low-cost vasectomies; state plans may offer benefit (Oregon, e.g.)
Side effects: bruising, sensitivity/pain, 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
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

12. Sterilization: Vasectomy
Animation (BUPA Health via YouTube, 2:36)
Video (vasectomymedical.com)

13. Sterilization: Tubal Ligation
Surgical technique
Animation (1:35+)
Close fallopian tubes, preventing egg from traveling to uterus, preventing sperm from reaching egg
Neither organs nor glands are removed
Effectiveness: 99%+
Considered irreversible

14. 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

15. Sterilization: Tubal Ligation
Cost: $0-3000
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)

16. 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

17. Sterilization: Implants
Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting
Animation (YouTube)
Thousands of complaints regarding implant complications reported to FDA (NY Times, 2015)

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

19. IUC’s: ParaGard ParaGard contains copper
Copper prevents sperm from fertilizing an ovum
Appears to be disagreement on whether ParaGard also causes inflammatory response in uterine cavity
Copper may also affect the ovum, reducing its ability to become fertilized (Medscape)
Amount of copper released is less than needed in daily diet
Copper intolerance or insensitivity would preclude use of ParaGard

20. 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
Insertion video
Effectiveness: 99%+ against pregnancy
Requires monthly checking for IUD slippage

21. 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: $ (Planned Parenthood)

22. IUC’s: Mirena Hormonal method (pregestogen) Intrauterine device
Lasts for five years
Mirena:
Prevents sperm from fertilizing ovum
Prevents release of egg
Changes uterine lining

23. IUC’s: Mirena Insertion: Similar to ParaGard
Effectiveness: 99%+ against pregnancy
Cost: $ (Planned Parenthood, Bedsider.org)
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

24. IUC’s Internal Birth Control- IUD’s (via Youtube)
Insertion of IUC (Medialvideos.us)

25. Barrier Contraceptive Methods
Physical barriers
Prevent sperm from entering cervix
Block sperm from fertilizing ovum

26. Barrier Contraceptive Methods
Historically, pessaries used
Objects or substances inserted into vagina
Pregnancy prevention effectiveness
Infection effectiveness
Current barrier methods: spermicide, male condom, female condom, diaphragm, cervical cap, sponge

27. Barriers: Spermicide Nonoxynol-9
Ingredient in spermicides, may be included in condom packaging
Originally thought nonoxynol-9 protected against HIV
In late 1990’s, early 2000’s, nonoxynol-9 was no longer thought to provide that protection
Among commercial sex workers in Africa, Thailand
Frequent use
Nonoxynol-9 may increase risk for disease transmission
Increases vaginal irritation, which can lead to lesions/sores
Lesions typically result in disease transmission vulnerability
2007: FDA required manufacturers to provide warning
Effect of Coke on Sperm Motility
Mythbusters (1:04-4:00)

28. Contraception: News, Interesting Info, Future, Past
Silk Parasol (path.org, Silk Parasol via product website)
Proposed panty condom in Uganda (monitor.co.ug, 2015)
Caya – new diaphragm, 2015 (0:30-2:35, product website)
RAPE-AXE female condom, reportedly not available (YouTube)

29. Contraception in the Future
Nestorone
Estrogen and progestin
Gel or spray
Population Council Announcement, 2010
Phase III trials (Antares Pharma)
Eventual availability?
New vaginal ring
90 days
Progestin + microbicide
Microbicide = drug to reduce HIV, herpes, HPV
The Ring Study & ASPIRE
Press release – reduction of HIV by ~30% (2/2016)

30. Contraception: The Future
Vasalgel (human trials in , per Parsemus Foundation)
Similar to India’s RISUG:Reversible Inhibition of Sperm Under Guidance
Contraceptive method for men, not available in U.S.
Injection into vas deferens of male (video, wired.com, :34)
Vasalgel disrupts membranes of sperm so they cannot fertilize
One injection to last 10 years
Marketing challenges

31. Contraception: The Future
Male pills (5-10 years)
Gendarussa – plant-based, interferes with sperm’s ability to fertilize egg
Video (via YouTube, 8:00)
Anti-Eppin – interferes with sperm motility
“Clean sheets” pill - Inhibit ejaculation but allow orgasm
Short-term (<24 hours) method via pill, or longer-term via implant
If no ejaculate, STI risk may decrease

32. 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

33. Contraception: Impact of Heat on Sperm

34. 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 ( )

35. 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 ( )