1. 17.03.07Fertility Control1 Dr. K. Sivapalan.

2. 17.03.07Fertility Control2 Fertility Regulation Fertility is a natural phenomenon. Do we have the right to interfere with it? In the past, Reproductive tract infections, pregnancy wastage and other factors caused reduced fertility. High child mortality also necessitated high fertility. Now, as a result of improved health care, fertility and child survival have increased. The family size needs planning. China- only one child per family, India- two and Sri Lanka- three. In our context, the population has declined and the family size must be increased.

3. 17.03.07Fertility Control3 Perspectives Of Fertility Control Population summit of the world’s academics in 1993: If the population grows as predicted and human activity remains unchanged, science and technology may be powerless to prevent widespread poverty and irreversible damage to the environment. Prevention of unwanted pregnancy while maintaining sexuality. Increasing the time space between pregnancies. Empowerment of women to take charge of their lives, pursue carriers for economic development, and contribute to society as men. As the unit of the society is the family, one of the parents can contribute to the society and the other should look after the family and children or both must share both aspects equally.

4. 17.03.07Fertility Control4 Factors Affecting Fertility Regulation Attitudes favouring high fertility [value of women is determined by the number of children she has] Men dominating in decisions about fertility regulation and choice of contraceptives. Disadvantages of contraceptive methods causing failure or rejection. Lower fertility rates are associated with employment, education, urban location, land shortages, increased costs of child rearing, late marriage and participation of women in decision making.

5. 17.03.07Fertility Control5 Impact Of Environment On Fertility Effects of environmental factors: sub fertility, intrauterine growth retardation, spontaneous abortion, and various birth defects. Infectious diseases, malnutrition, and poor living conditions are important in developing countries. Chemical pollution, radiation and stress have become major threats in developed countries Average sperm count was 113 million/ml in 1940 and 66 million in 1990, and the volume of the semen was 3.4 ml and 2.75 ml respectively

6. 17.03.07Fertility Control6 Infertility 60-80 Million couples are infertile worldwide. Only 3-5 % is core infertility. Rest – acquired and therefore, preventable. Acquired causes of infertility: –Abstinence or separation at the fertile days. –Reproductive tract infection by a variety of organisms; commonly sexually transmitted. –In Females pelvic infections or reproductive tract infections after abortion or child birth. Husband, wife or both could be infertile.

7. 17.03.07Fertility Control7 Infertility ctd. Alcohol is associated with oligozoospermia, poorly motile, abnormal sperms, Impotence. Stigma of infertility often leads to marital disharmony, divorce, or ostracism [of the wife]. In most couples defects can be corrected and they could have normal conception. When it fails, assisted fertilization can be of help [success rate is only 33% at present].

8. 17.03.07Fertility Control8 Contraception Coitus interruptus- often fails because it disturbs orgasm. Rhythm method- sexual intercourse in safety period. –Four days before and after ovulation: difficult to determine the day of ovulation. Male and female condoms. Pills with estrogens and progesterone. Progesterone only pills. Injection of progesterone. IUCD Vasectomy and tubectomy.

9. 17.03.07Fertility Control9 New Developments In Fertility Control Vaginal hormonal implants which can be removed when bleeding is desired Anti progesterones as post ovulatory and post coital contraceptives. Condoms made of new polymers- to permit better transmission of physical sensation. Transcervical methods for female sterilization- permanent or removable block. Simplified techniques of vasectomy.

10. 17.03.07Fertility Control10 Miscarriage. Fertilized ovum may not be implanted or die off in the early pregnancy due to congenetal abnormalities which are not generally identified. Misscarriage between 12 to 24 weeks may occur due to several reasons. Delay in placental secretion of hormones. Poor socio-economic status. Smoking Infections of genital tract. Abnormalities of uterus or cervix. Abnormal site of implantation.

11. 17.03.07Fertility Control11 Theraputic Abortion. In Sri Lanka, voluntary termination is illegal. Theraputic abortion is permitted only if two VOGs agree that the continuation of the pregnancy poses serious risk to the life of the mother. Many families and unmarried females wish to terminate unwanted pregnancies. Illegal or criminal abortion is unavoidable in places where abortion is prohibited.

12. 17.03.07Fertility Control12 Criminal Abortion Interfering with pregnant uterus under unhygienic and un-prepared conditions This can result in life threatening infections and hemorrhage and several defects in the female genital tract causing pain and infertility. Criminal abortion can be prevented by only by educating about contraception to avoid unwanted pregnancy or by legalizing it to be done in well equipped hospitals.