1. Chapter Fourteen Managing Your Fertility
Fertility refers to the ability to reproduce. How one decides how to control their fertility can have an important effect upon their future. Understanding concepts of fertility will help with making responsible decisions. This chapter will explore options for promoting or delaying conception until that important step is decided in a healthful manner.

2. Birth Control vs. Contraception
Birth control refers to all procedures (umbrella term)
Contraception procedures are used to decrease chances of fertilization of an ovum (more specific)
There are differences between the concept of birth control and contraception. Birth control is an umbrella term referring to all proceudures you might use to prevent a birth of a child.
Contraception refers to a more specific concept of preventing the fertilization of an ovum.

3. Selecting Your Contraception Method
Safety
Effectiveness
Reliability
Reversible
Affordability
Ease of use
Interference with sexual expression
These are reasons for deciding upon what forms of birth control you should use. For a contraceptive method to be acceptable to those who wish to exercise a large measure of control over their fertility, the following should be given careful consideration:
safety: it should not pose a significant health risk for the user.
effectiveness: two rates of effectiveness are given. Theoretical effectiveness refers to the method’s ability to prevent a pregnancy when the method is used precisely as directed during every act of intercourse. Use effectiveness refers to the effectiveness of a method in preventing conception when used by the general public. Failure to use it properly through forgetfulness, failure to follow precise directions, illness, physician or pharmacist error, or a desire subconsciously to experiment can lower effectiveness of the best methods.
reliability: will the technique work the next time and be as effective as the last time.
affordability: How much does the method cost?
Ease of use: how difficult is it to use or to understand?
interference with sexual expression: the selected method should not interfere with sexual behaviors in a consistent manner.

4. Current Birth Control Methods
Theoretical Effectiveness
No method
15%
Withdrawal
96%
Periodic abstinence
91-99%
Cervical cap
91%
Spermicide
94%
Diaphragm with spermicide
Male condom
97%
Male condom with spermicide
99%
Female condom
95%
Listed above are the most current methods of birth control. Their descriptions are listed below:
No method: the ability of using chance or fate to determine if conception does occur.
withdrawal: the erect penis is withdrawn from the vagina before ejaculation. Pre-ejaculatory drops could influence conception before withdrawing the penis from the vagina which lowers the effectiveness rate.
periodic abstinence: consists of using the rhythm method (calendar, basal body temperature, mucus, and symptothermal) to predict when ovulation will take place to either promote or delay conception. Also known as natural family planning.
Cervical cap: a small thimble shaped device that fits over the entire cervix. Spermicide is used in conjunction with the cap.
spermicide: chemical component used in several forms (creams, jelly, foam, film) that kill sperm upon contact.
diaphragm with spermicide: a soft rubber cup with a spring-like metal rim, fitted over the cervix on top of the vagina, covered with spermicide inside the cup.
male condom: colored, natural, smooth, textured, straight or shaped reservoir tipped, that can be dry or lubricated latex rubber or animal membrane, fitted over the penis preventing sperm from reaching the vagina of the female.
Male condom with spermicide: for couples who want to improve their chances of preventing conception, the use of spermicide with a condom or condoms applied with spermicide are inexpensive and readily available, which can improve the reduction of STD’s when nonoxynol-9 is used.
Female condom: a soft, loose fitting polyurethane sheath containing 2 polyurethane rings which is inserted similar to the diaphragm.

5. Current Birth Control Methods (cont’d)
Theoretical Effectiveness
IUD, copper / progestin
99%+ / 98%
Combined pill
99%+
Minipill
Depo-Provera (3 month)
Lunelle (1 month)
Contraceptive Ring
Tubal ligation
Vasectomy
Contraceptive Patch
10) IUD: intra-uterine device is an insertion device made from copper or plastic that contains progestin that help to reduce the chances of conception and implantation of a fertilized egg in the uterus. IUD’s seem to alter the uterine lining and make it difficult to a fertilized egg to implant itself successfully.
11) Combined pill: uses both synthetic estrogen and synthetic progesterone that will either reduce ova development and ovulation.
12) Minipill: prescribed pills containing no estrogen, only low dose progesterone that create an unsuitable environment for the transportation and implantation of the fertilized egg.
13) Depo-Provera: an injection consisting of synthetic progesterone provides a high degree of protection for 3 months.
14) Lunelle: an injection consisting of estrogen and progestin which provides a high degree of protection for 1 month.
15) 16) Tubal ligation: female sterilization of separating the fallopian tubes via a minilaparotomy (small incision through the abdomen).
17) vasectomy: male sterilization consisting of separating the vas deferens through a small incision at the scrotum.

6. Periodic Abstinence Figure 14-1
Periodic abstinence represents the use of the calendar method (one of the natural family planning methods) where plotting the times of the month for at least 6-9 months, and determining the safe and unsafe days to have unprotected sexual intercourse. The above chart predicts ovulation based upon an average 28 day menstrual cycle from a consistent female.

7. Vaginal Spermicide Figure 14-2
The above slide demonstrates how foam spermicide is applied precisely to the cervical region.

8. Birth Control Pills
This slide depicts several types of prescription birth control pills and their designed cases.

9. Cervical Cap Figure 14-4
This slide demonstrates the insertion location of a cervical cap. Cervical caps are designed for your pelvic size and is prescribed by a physician to be used with spermicide at all times but can be taken out when not being used for contraception.

10. Sterilization Figure 14-5
Vasectomy – separating vas deferens
Tubal ligation – separating fallopian tubes
This slide depicts description and location sites of male and female sterilization techniques known as a vasectomy (male) and a tubal ligation (female). Both procedures are relatively safe but the tubal ligation is non-reversible at this present time.

11. Abortion – Termination of a Pregnancy
First trimester procedures
Menstrual extraction
Vacuum aspiration
Dilation and curettage (D&C)
Medical abortion
Mifepristone (RU-486)
Methotrexate
Abortion refers to a termination of a pregnancy. Abortion should never be considered a first-line, preferred form of fertility control. The decision to terminate a pregnancy is a highly controversial, personal one that needs serious consideration by each woman.
Each year, 1.4 million women in the United States make the decision to terminate a pregnancy.
First trimester procedures are described below:
Menstrual extraction: also known as menstrual regulation, menstrual induction, and preemptive abortion is a process carried out between the 4th to 6th week after the last menstrual period. Local anesthetic is used and a small cannula is inserted through the undilated cervical canal into the cavity of the uterus. A small amount of suction is applied by a hand held syringe. By rotating and moving the cannula across the uterine wall, the physician can withdraw the endometrial tissue.
Vacuum aspiration: this procedure is performed during the 6th-9th week. Vacuum aspiration is considered the most commonly used procedure where dilation of the cervical canal is used under local anesthetic. Once dilators have opened the canal, an electric vacuum pump is used and the uterine wall may also be scraped to confirm complete removal of the uterine contents.
dilation and curettage (D & C): performed during the 9th – 14th week, a general anesthetic is used which enlargement of the cervical canal through the insertion of larger metal dilators are used. Once the cervix has been dilated to a size sufficient to allow a curette (metal spoon device) through, the curette is drawn across the uterine wall, fetal parts and soft endometrial tissue is scraped from the wall of the uterus.

12. Abortion – Termination of a Pregnancy (cont’d)
Second trimester procedures
Dilation and evacuation (D&E)
Hypertonic saline solution
Prostaglandin procedure
The following procedures are used during the 2nd trimester (3rd through 6th months). When a woman’s pregnancy continues beyond the 14th week of gestation, termination becomes a more difficult manner. The procedures at this stage are more complicated and take longer to complete. Complications are also more common. The procedures are listed below:
Dilation and Evacuation (D & E): Vacuum aspiration and D & C are combined which increases the likelihood of trauma and post procedural complications.
Hypertonic saline solution: an intrauterine injection of a strong salt solution into the amniotic sac is the procedure most frequently used during the 16th week through the end of the second trimester. The onset of uterine contractions will expel the dehydrated contents within 24 to 48 hours.
Prostaglandin procedure: prostaglandins (hormone-like chemicals that have a variety of effects upon human tissue which influence the contractions of smooth muscle) are administered through a uterine intramuscular injection or a vaginal suppository to expel the fetal contents through strong uterine contractions.

13. Abortion – Termination of a Pregnancy (cont’d)
Third trimester procedures
Hysterotomy
Hysterectomy
By the third trimester, surgical procedures are necessary to remove the fetus (hysterotomy) or a procedure in which the entire uterus is removed (hysterectomy).
These procedures are more complicated and involve longer hospitalization, major abdominal surgery, and an extended period of recovery.

14. Pregnancy Obstacles to fertilization Acid levels in vagina
Thickening of cervical mucus
Location of cervical opening for sperm
Location of current fallopian tube for sperm
There are several physiological obstacles to pregnancy as listed below;
The acidic level of the vagina is destructive to sperm. Low ph of the vagina will kill sperm that fail to enter the vagina quickly.
The cervical mucus is thick during most of the menstrual cycle and sperm movement into the uterus is more difficult, except during the few days of surrounding ovulation.
The sperm must locate the cervical opening and is considered small compared to where sperm is deposited.
Half of the sperm travel through the wrong fallopian tube and the sperm have no way of knowing which tube they should enter.

15. Pregnancy (cont’d) Obstacles to fertilization, cont’d
Distance for sperm
Movement of sperm “upstream”
Location of egg due to contoured folds of tubal walls
5) The distance sperm must travel is relatively long compared with the tiny size of the sperm cells.
6) The sperm’s travel is relatively upstream since the female reproductive organs are considered an uphill route.
7) The contoured folds of the tubal walls trap many sperm and make it difficult for sperm to locate the egg.

16. Pregnancy (cont’d) Aids to fertilization Number of sperm
Deposition of sperm
Accessory gland production
Uterine contractions
Movement of sperm
The following are considered physiological assistors to promote conception:
The number of sperm deposited into the vagina may number million sperm.
Sperm are deposited near the cervical opening.
The male accessory glands (Cowper’s, Prostate, seminal vesicles) help make the semen non-acidic that assist sperm to be better protected in the vagina until they can move into more deeper alkaline environments (uterus, fallopian tube).
Uterine contractions aid sperm movement towards the fallopian tubes.
Sperm cells move rather quickly (1 inch per hour) powered by sugar solutions from the accessory glands and the movement of the tails.

17. Pregnancy (cont’d) Figure 14-7
Aids to fertilization, cont’d
Life of sperm
Consistency of mucus
6) Once inside the fallopian tubes, sperm can live for days.
7) The cervical mucus is thin and watery at the time of ovulation allowing for better passage of sperm through the cervical opening.
Find an illustration of how sperm can reach the uterus and fallopian in order to fertilize the ovum. Once fertilized, the egg works its way down toward the uterus for implantation.

18. Signs of Pregnancy [Probable signs]
Frequency of urination
Increased size of abdomen
Cervix becomes softer
Positive HCG
Aside from pregnancy tests done in a professional laboratory, a woman cal sometimes recognize early signs and symptoms of pregnancy. Listed are probable to positive signs of pregnancy.

19. Childbirth Stage 1 – effacement and dilation of the cervix
Stage 2 – delivery of fetus
Stage 3 – delivery of afterbirth (placenta)
Childbirth or parturition is considered one of the true peak life experiences for both men and women. During the last portions of the third trimester, most fetuses will move deeper into the pelvic cavity (lightening). Many will report that the baby has “dropped”. Braxton Hicks contractions may start to occur at irregular intervals.
Labor begins when uterine contractions become more intense and at regular intervals. The three stages are listed above and will be described below:
Effacement and dilation of the cervix: this is considered the longest stage of the 3 stages. The cervix must open thin and dilate to a diameter of 10 cm. Often this stage will begin with the mucous plug dislodging and possible water bag breaking (amniotic sac bursting). Contractions will start off short (15-60 seconds) with the intervals being from 20 minutes to 5 minutes as the labor stage prolongs.
Delivery of the fetus: Once the cervix is fully dilated, the delivery of the fetus through the birth canal starts. Uterine contractions are less forceful and may last 60 seconds each, with a 1-3 minutes interval. Crowning occurs when the baby’s head is first seen at the vaginal opening. Once the head is delivered, the baby’s body rotates upward to let the shoulders come through. The rest of the body follows quickly.
If the fetus cannot be removed vaginally, a c-section can be performed (surgical removal of the fetus through the abdominal wall.)
3) Delivery of the afterbirth: Usually after 30 minutes after the fetus is delivered, the uterus will contract to expel the placenta (afterbirth). Once the placenta is delivered, the uterus will continue contracting with mild contractions to help control bleeding and start the gradual reduction of the uterus to its normal size.

20. Chapter Fourteen Managing Your Fertility
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