Chapter 16 Managing your Fertility

Principles of Personal Health

I. Birth Control versus Contraception

A. Birth control- All of the methods and procedures that can prevent the birth of a child.

B. Contraception- Any method or procedure that prevents fertilization.

C. Outercourse- Sexual activity that does not involve intercourse.

II. Reasons for Choosing to Use Birth control

A. Career

B. Decision never to have children

C. Safe participation in sexual behaviors

D. For many, religious doctrine is a factor in the selection of a birth control method.

III. Theoretical Effectiveness versus Use Effectiveness

A. Theoretical effectiveness- Measure of a contraceptive's ability to prevent pregnancy when used precisely as directed

B. Use effectiveness- Effectiveness of a method in preventing conception when used by the general public

C. The theoretical rate is always higher than the use rate

IV. Selecting your Contraceptive Method

A. Considerations:

1. It should be safe

2. It should be effective

3. It should be reliable

4. It should be reversible

5. It should be affordable

6. It should be easy to use

7. It should not interfere with sexual expression

V. Current Birth Control Methods

A. Withdrawal

1.The erect penis is removed from the vagina just before ejaculation

2.Preejaculate fluid can contain viable sperm (capable of fertilization)

B. Periodic Abstinence (attempts to determine the time the woman ovulates)

An ovum is viable for about 24-36 hours

Some sperm can survive up to a week

1. The calendar method

a. Requires examination of at least eight cycles

b. Cycle- from the first day of bleeding to the first day of bleeding of the next cycle

c. First days to abstain- subtract eighteen from the shortest cycle

d. Last day to abstain- subtract eleven from the longest cycle

2. Basal body temperature method

a. Requires the woman to take her body temperature each morning before rising from bed

b. Just before ovulation, the body temperature drops then rises for the rest of the cycle

3. Billings cervical mucus method

a. Requires evaluation of daily mucous discharge

b. Mucous changes in appearance and consistency during ovulation

4. Sympothermal method

a. Combination of all of the periodic abstinence approaches

C. Vaginal Spermicides

1. Use is recommended with other forms of birth control

2. Modern spermicides are safe, effective, reversible, and easy to obtain

D. Condoms

1. Condom- A latex shield designed to cover the erect penis and retain semen upon ejaculation

2. Condoms are safe, effective, reversible, and inexpensive

3. Condoms offer some protection against sexually transmitted diseases

E. Diaphragm

1. Diaphragm- A soft rubber cup designed to cover the cervix

2. Always use a spermicidal cream or jelly with the diaphragm

3. It is relatively effective but must always be fitted and prescribed by a physician

4. May provide some protection against sexually transmitted diseases

F. Cervical Cap

1. Small, thimble-shaped device that covers the cervix and is held in place by suction

2. A spermicide should be used with the cervical cap

3. It is distributed in the U.S. through prescription

G. Intrauterine Device

1. The most popular reversible contraceptive in the world

2. It is safe and effective- Does not offer protection against sexually transmitted diseases

3. It is not clear how the IUD prevents pregnancy- Research is ongoing

4. Only a skilled physician can prescribe and insert an IUD

5. Potential side effects are uterine perforation (The IUD imbeds itself into the uterus) and pelvic inflammatory disease (life-threatening infection)

6. The decision to use an IUD must be discussed with a physician

H. Oral Contraceptives

1. Provides the highest effectiveness rate of any reversible contraceptive

2. Requires a physician’s examination and prescription

3. Contain synthetic hormones (progesterone and estrogen

4. Do not provide protection against sexually transmitted diseases

5. The use of antibiotics may lower the pill’s effectiveness

6. The menstrual cycle will become regulated and cramping is reduced

7. May be linked to a slight increase in cervical cancer risk

8. Possible symptoms may be associated with oral contraceptives:

a. Tenderness in breast tissue

b. Nausea

c. Mild headaches

d. Slight, irregular spotting

e. Weight gain

f. Fluctuations in sex drive

g. Mild depression

h. More frequent vaginal infections

9. Cigarette smoking and advanced age are associated with increased risk of serious side effects

10.Minipills- contain no estrogen and only low doses of progesterone

I. Injectable Contraceptives

1. For Women

a. Depo-Provera- An injectible contraceptive that is effective for three months

b. Common side effects are irregular bleeding followed by amenorrhea (the absence of periods)

c. Women may experience infertility for up to one year after using Depo-Provera

2. For Men

a. Research is currently focusing on the study and development of a male contraceptive

J. Subdermal Implants

1. Norplant uses six soft plastic rods containing synthetic progesterone

2. A physician implants the rods just below the skin of the upper and lower arm

3. The rods release levels of progesterone for five years

4. Common side effects are irregular and persistent menstrual bleeding

K. Sterilization

1. Generally permanent birth control techniques that surgically disrupt the normal passage of ova or sperm

2. Vasectomy- Male sterilization procedure involving the surgical removal of part of the vas deferens

3. Tubal Ligation- Most common method of female sterilization in which the fallopian tubes are cut and tied back

L. Abortion- Induced premature termination of a pregnancy

1. First-Trimester Procedures

a. Menstrual Extraction- Small plastic cannula is inserted into the uterus, suction is applied and the physician withdraws the endometrial tissue

b. Vacuum Aspiration- Most common procedure involving aspiration by an electric pump followed with the scraping of the uterine wall

c. Dilation and Curettage (D & C)- A metal, spoon-shaped instrument is used to scrape the fetal parts and endometrial tissue from the wall of the uterus

d. The Abortion Pill (RU 486)- Designed to induce an abortion

e. Multifetal Pregnancy Reduction- Used with multiple fetuses to reduce the risks during the pregnancy to cause the fetal heart to stop by injecting potassium into the thorax

2. Second-Trimester Procedures

a. Dilation and Evacuation- Vacuum aspiration and D & C are combined

b. Hypertonic Saline Procedure- Injection of a strong salt solution into the amniotic sac

c. Prostaglandin Procedure- Prostaglandin supplements cause uterine contractions to become strong enough to expel the fetal contents

3. Third-Trimester Procedures

a.. The U.S. House of Representatives voted in 1997 to ban "partial-birth abortion"; President Clinton has vetoed the bill.

VI. Unintended Pregnancy

A. Important People in the Decision-Making Process

1. A supportive family and father-to-be make the situation easier to deal with

2. The potential father concerning the woman and the pregnancy are extremely important

3. The families of both parents-to-be play a role in the situation

B. Marriage

1. Recently, unwed motherhood has become less stigmatized and more common

2. 30 percent of births in the U.S. are to unmarried women

C. Abortion

1. The couple must decide whether to become parents, put the child up for adoption or have the pregnancy terminated

2. Couples may face moral, religious, and legal questions when considering abortion

D. Adoption

1. Many women might choose adoption when they are not financially able to support a baby and will not consider aborting the child

E. Parenthood

1. Carrying a baby to term requires great devotion to its care

2. The cost of giving birth and supporting a child can be extensive

3. The mother-to-be should avoid drinking and smoking

F. Prenatal Care and Day Care

1. The average cost for prenatal care is $500

2. Day care facilities can be expensive and often have waiting lists

G. Considering the Consequences

1. The time to prepare for the romantic moment is before you are in a compromising position

2. If you choose to be active sexually, choose a form of contraception that works for you and be consistent with using it

3. Choosing to be celibate is a form of contraception that is 100 percent effective

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