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People try not to get pregnantBiblical times=crocodile dung mixed with honey and put near cervixVictorian recipe for contraception fudgeCocoa butter, birax, silicic acid, quinineHumans were formed at the moment of ejaculation- oral sex was cannibalismAristotle thought pregnancy was semen and period bloodContraceptionControversial issueErectile dysfunction ads but not contraception ads?More choices today than at any other timeConnecticut1960s contraception was illegalUnintended pregnancy in the US50% of all pregnancies are unintendedMost effective contraceptionSterilizationContraception (hierarchy of effectiveness)Implanon/nexplanonIUDDepo ProveraOral contraception/patch/nuvaringCondom/foamDiaphragm/gel/creamtCollege students reasons for non-useKnew it was risky but took a chance50% of college students use contraceptive effectivelyDidn’t expect sex to happenGirls stop taking pill when they get broken upNot really very sexually activeI/we were too drunk to think about itHighest rate of pregnancy by year in school-seniorsEffectivenessTheoretical vs actual effectivenessMethod versus user failureLet’s get rich!Developing the perfect methodOral contraceptionFirst marketed in the 1960sHow does the pill work?Estrogen helps to prevent ovulationProgesterone helps to prevent ovulation and also thickens cervical mucousTypesSequentialWeren’t combined pillsSome with either estrogen and progesteroneCombinationCombining them would be more effectiveTriphasic3 phasesMany different forms (triphasil and trinorinyl)Not naturalPatent was running out on other typeSeasonalePills for 84 days4 periods a yearLybrelLatest oneActive pills all the timeDon’t have periodMini pillProgestin onlyRecommended for certain individuals who have problems tolerating estrogen effectsLess effectiveWant to flatten the cycleLH spike causes ovulationTrying to lessen the spikeDOESN’T PREVENT STIsExamples of contraindicatesHistory of cancerHistory of heart problemsHistory of strokesMigrainesNascence side effects- non fatal side effectsWeigh gainAcneReduce libidoDepressionMood swingsIncrease risk of yeast infectionsBreasts get larger and more tenderLighter period, more regularReduces risk of ovarian and uterine cancerReduces risk of benign breast lumpsEmergency contraceptionPlan B- progestin only, most effective if taken within 72 hours, OTC 17 years and olderElla- active ingredient is ulipristal, effective if taken within 120 hours, prescription onlyDOESN’T PREVENT STIsContraception patch (combined hormones)Pretty much the same as the pillChange patch every 7 daysAfter 3 patches, 7 days withoutResume new patch on day 29 (or day 1 in new cycle)Contraindications and side-effects similar to the pillDifference: only have to remember 3 timesReduces user riskmore effectiveDOESN’T PREVENT STIsNuvaring (combined hormones)Situated around the cervixLeft in place for 21 daysRemoved on day 22-new ring on day 29 (or day 1 in new cycle)Contraindications and side-effects similar to the pillDelivers smaller dose of estrogen and progestin than any other methodsDOESN’T PREVENT STIsImplanon/nexaplanonPlastic capsule containing progestin onlyImplanted under the skinEffective against pregnancy for up to 3 yearsContraindication an side-effects similar to the pillMost people don’t want itSubconscious thing about 5 yearsTop of the list for efficacyNo user failureDoes not prevent against STIsDo have your period, but may result in amenorrea after a yearCost expensive first time, but lasts for 3 yearsIntrauterine device (IUD)Unclear how IUDs workDevice placed in uterus by practitionerCan be left in for several yearsMost common type used-mirenaUsed by women not willing to go to the hormonal route- copperDeproProveraInjectableProgestin-onlyEffective up to 12 weeksMight delay fertilityAmenorrhea in someCondomsLatex: lambskin, polyurethaneShould really be used with spermicideFailure rate usually user failureMove to create different sizesHIV/AIDS in 1980 condoms became ubiquitousPrevent STIsTrue barrier methodFemale condomsPolyurethaneMarketed in US as realityFailure rate not very accurately documentedTend to be “noisy”DiaphragmLatex with spring rimFitted for size by practitionerMust be used with spermicide (gel or cream)Must be left in place for 6 hours after intercourseContraceptive spongePolyurethane sponge impregnated with spermicideOne size fits all.. kind ofMust be left in place for 6 hours after intercourseBetter than nothing… just!Natural family planningBasal body temperatureCervical mucus (billings)ComputationTakes a great deal of motivationProbably more useful at getting you pregnantInfertility10-15% of couples are unable to have children40% relate to male factors10-20% of couples will have no diagnosable cause of infertilityFemale causesLack of ovulation- fertility drugsCervical 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 spermPID- block fallopian tubesEndometriosisMale causesLow sperm countUnusually high proportion of defective spermPoor motilitySperm count60,000,000/ml=normal fertilityFertility treatmentFewer than 1% of couples who have infertility problems attempt further interventionsMajor reason is high cost of treatmentIntrauterine InseminationOvaries stimulated to produce eggsSperm injected into uterusRelatively cheap $2000Difficult to control how many eggs are fertilizedIn-vitro fertilizationFertilization occurs in lab dishFertilized eggs (1-4) placed in uterus 2 days after fertilization$10-12000 each cycleChance of success does not necessarily increase with number of attemptsMultiple births common-about 20% chance of twins and 4% chance of tripletsGIFT- gamete intrafallopian transferOva and sperm are placed directly into fallopian tubesFertilization occurs in tubeReported suIntracytoplasmic sperm injectionUsed when male has extremely low sperm countSperm injected directly into egg which is then placed in uterus35%success rate, possibility of birth defectsPreimplantation genetic diagnosisScreening own embryos to find genetic matchSurrogate parentingSeveral variation of this modelMajor legal problemsLaw has not been able to keep up with medical science“baby M” and other casesMenstruationproliferative phaseIncrease in FSH from pituitaryEndometrium thickens- to receive fertilized eggGraafian follicle stimulated- pushes it outLevel of ovarian estrogen peaksDecrease in FSH, increase in LH (short

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UMD HLTH 377 - Contraception

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