Contraception 10 15 2013 People try not to get pregnant Biblical times crocodile dung mixed with honey and put near cervix Victorian recipe for contraception fudge o Cocoa butter birax silicic acid quinine Humans were formed at the moment of ejaculation oral sex was cannibalism Contraception Aristotle thought pregnancy was semen and period blood Controversial issue Erectile dysfunction ads but not contraception ads More choices today than at any other time Connecticut 1960s contraception was illegal Unintended pregnancy in the US 50 of all pregnancies are unintended Most effective contraception o Sterilization Contraception hierarchy of effectiveness Implanon nexplanon IUD Depo Provera Oral contraception patch nuvaring Condom foam Diaphragm gel cream tCollege students reasons for non use Knew it was risky but took a chance 50 of college students use contraceptive effectively Didn t expect sex to happen o Girls stop taking pill when they get broken up Not really very sexually active Highest rate of pregnancy by year in school seniors I we were too drunk to think about it Effectiveness Theoretical vs actual effectiveness Method versus user failure Let s get rich Developing the perfect method Oral contraception First marketed in the 1960s How does the pill work o Estrogen helps to prevent ovulation o Progesterone helps to prevent ovulation and also thickens cervical mucous Types o Sequential Weren t combined pills Some with either estrogen and progesterone o Combination o Triphasic Combining them would be more effective 3 phases Many different forms triphasil and trinorinyl Not natural Patent was running out on other type o Seasonale Pills for 84 days 4 periods a year o Lybrel Latest one Active pills all the time Don t have period o Mini pill Progestin only Recommended for certain individuals who have problems tolerating estrogen effects Less effective Want to flatten the cycle o LH spike causes ovulation o Trying to lessen the spike DOESN T PREVENT STIs Examples of contraindicates History of cancer History of heart problems History of strokes Migraines Nascence side effects non fatal side effects o Weigh gain o Acne o Reduce libido o Depression o Mood swings o Increase risk of yeast infections o Breasts get larger and more tender o Lighter period more regular o Reduces risk of ovarian and uterine cancer o Reduces risk of benign breast lumps Emergency contraception Plan B progestin only most effective if taken within 72 hours OTC Ella active ingredient is ulipristal effective if taken within 120 17 years and older hours prescription only DOESN T PREVENT STIs Contraception patch combined hormones Pretty much the same as the pill Change patch every 7 days After 3 patches 7 days without Resume new patch on day 29 or day 1 in new cycle Contraindications and side effects similar to the pill o Difference only have to remember 3 times o Reduces user risk more effective DOESN T PREVENT STIs Nuvaring combined hormones Situated around the cervix Left in place for 21 days Removed on day 22 new ring on day 29 or day 1 in new cycle Contraindications and side effects similar to the pill Delivers smaller dose of estrogen and progestin than any other methods DOESN T PREVENT STIs Implanon nexaplanon Implanted under the skin Plastic capsule containing progestin only Effective against pregnancy for up to 3 years Contraindication an side effects similar to the pill Most people don t want it o Subconscious thing about 5 years Top of the list for efficacy o No user failure Does not prevent against STIs Do have your period but may result in amenorrea after a year Cost expensive first time but lasts for 3 years Intrauterine device IUD Unclear how IUDs work Device placed in uterus by practitioner Can be left in for several years Most common type used mirena Used by women not willing to go to the hormonal route copper DeproProvera Injectable Progestin only Effective up to 12 weeks Might delay fertility Amenorrhea in some Condoms Latex lambskin polyurethane Should really be used with spermicide Failure rate usually user failure Move to create different sizes HIV AIDS in 1980 condoms became ubiquitous Prevent STIs True barrier method Female condoms Polyurethane Marketed in US as reality Failure rate not very accurately documented Tend to be noisy Diaphragm Latex with spring rim Fitted for size by practitioner Must be used with spermicide gel or cream Must be left in place for 6 hours after intercourse Contraceptive sponge Polyurethane sponge impregnated with spermicide One size fits all kind of Must be left in place for 6 hours after intercourse Better than nothing just Natural family planning Basal body temperature Cervical mucus billings Computation Takes a great deal of motivation Probably more useful at getting you pregnant 10 15 2013 Pregnancy Infertility Female causes 10 15 of couples are unable to have children 40 relate to male factors 10 20 of couples will have no diagnosable cause of infertility Lack of ovulation fertility drugs Cervical mucous impedes passage into uterus produces antibodies that harms sperm Make male use condom for several months so the cervical mucus doesn t get used to sperm PID block fallopian tubes Endometriosis Male causes Low sperm count Unusually high proportion of defective sperm Poor motility Sperm count o 60 000 000 ml normal fertility Fertility treatment Fewer than 1 of couples who have infertility problems attempt further interventions Major reason is high cost of treatment Intrauterine Insemination Ovaries stimulated to produce eggs Sperm injected into uterus Relatively cheap 2000 Difficult to control how many eggs are fertilized In vitro fertilization Fertilization occurs in lab dish Fertilized eggs 1 4 placed in uterus 2 days after fertilization 10 12000 each cycle Chance of success does not necessarily increase with number of Multiple births common about 20 chance of twins and 4 chance attempts of triplets GIFT gamete intrafallopian transfer Ova and sperm are placed directly into fallopian tubes Fertilization occurs in tube Reported su Intracytoplasmic sperm injection Used when male has extremely low sperm count Sperm injected directly into egg which is then placed in uterus 35 success rate possibility of birth defects Preimplantation genetic diagnosis Screening own embryos to find genetic match Surrogate parenting Several variation of this model Major legal problems Law has not been able to keep up with medical science baby M and other cases Menstruation