Family Planning and Infertility

Transcription

1 Family Planning and Infertility Chapter 20 Objectives Discuss types of reversible contraception Natural methods Mechanical barrier methods Hormonal contraceptives Discuss types of permanent contraception Identify factors related to fertility Discuss infertility management options Reversible Contraception Natural Methods Fertility Awareness Mechanical Barrier Method Hormonal Contraceptive Vaginal Spermicides 1

2 Abstinence Eliminates the possibility of sperm entering the vagina Completely effective in preventing pregnancy Effective in avoiding STDs Fertility Awareness Basal body temperature Cervical mucous method (Billings method) Symptothermal method Chemical predictor test Rhythm method (calendar method) Basal Body Temperature Method (BBT) Temperature taken every morning before getting out of bed Temperature is slightly increased during ovulation until menstruation or pregnancy occurs Temperature pattern can be disrupted by stress, anxiety, illness and fatigue Record 3-6 months to identify trends 2

3 Cervical Mucus Method Billing s or ovulation method Based upon changes in cervical mucus as a result of hormones Mucus at ovulation=increase in amount/stretchability (spinnbarkeit). Vaginal infections, semen and douching affect outcome of mucus assessment Symptothermal Method Combination of BBT, cervical mucus, and self-recognition of ovulation symptoms Other ovulation signs: Weight gain Abdominal bloating Rectal discomfort Abdominal pain Increased libido 3

4 Chemical Predictor Test Ovulation kit Available over the counter There is a surge of luteal hormone hours before ovulation Test strip changes color when there is a high level of luteal hormone Rhythm Method Calendar Method Based upon assumption that ovulation occurs approx. 14 days (+/- 2 days) before onset of next menstrual period Assumes that sperm are viable for hours Record x 6 months to identify trends 4

5 Mechanical Barrier Methods Male condom Female condom Diaphragm Cervical cap Intrauterine Device Male Condom Inexpensive Accessible Effective when used properly Decreasing STD spread Small, disposable No side effects May decrease spontaneity May change sexual sensation Natural skin condoms do not prevent STDs Female Condom Can be inserted up to 8 hours before sex Disposable Stronger than latex, less likely to tear Available OTC Typical failure rate of 21% in first year May decrease spontaneity/sensation 5

6 Diaphragm No known SE except allergy Increased spontaneity when inserted up to 4 hrs in advance Must be fitted/refitted after wt. change >10 lbs or pregnancy Requires practice to insert properly Contraindicated with hx of TSS/UTIs Spermicide must be inserted with each time intercourse repeated No STD protection Cervical Cap Can be inserted up to 48hrs before sex Limited sizes Fitting checked yearly and after childbirth, vaginal/uterine surgery Not indicated if hx abnormal Pap, TSS, or vaginal/cervical infection 6

7 Intrauterine Device Continuous pregnancy prevention Releases hormone for 5 yrs Effective in controlling abnormal uterine bleeding Check placement after each menstrual period Not recommended for women with multiple sex partners and high risk of STDs Intrauterine Device Hormonal Contraceptives Oral contraceptives Hormonal skin patch Vaginal ring Injectable contraceptives 7

8 Oral Contraceptives Most popular hormonal contraceptive Suppresses ovulation through hormonal action Changes cervical mucus and decidua of uterus to prevent implantation 99% effective if taken as directed Taken for 3 weeks, then off a week for menses Extended therapy now available, reduces menstruation to 4 times a year Should be taken at the same time each day to keep hormone levels stable Oral Contraceptives Benefits: regular cycle cramping blood loss & anemia risk of ovarian & endometrial CA by 50% Risks: No protection from STDs risk for thrombosis, breast tenderness, stroke, nausea, headaches Medication interactions Oral Contraceptives Side effects: Nausea Breakthrough bleeding Thrombus formation Contraindications: Thromboembolism Stroke Atherosclerosis Hypertension Diabetes with neuropathy Smoking >35 yrs old Pregnancy Migraines with aura 8

9 Oral Contraceptives What to do when you miss pills: 1 pill missed: take as soon as remembered 2 pills missed: take 2 pills for the next 2 days & use a back up method of contraception 3 pills missed: throw away pack, start new pack on first day of menstrual flow & use a back up method of contraception Hormonal Skin Patch Consistent level of hormones Avoid liver metabolism Avoid risk of forgetting to take a daily pill Unreliable pregnancy protection if >200lbs Can loosen or fall off Skin irritation Vaginal Ring Consistent level of hormones Avoid liver metabolism Side effects: leukorrhea, vaginal infections Fertility rapidly returns after d/c 9

10 Injectable Contraceptives Depo-Provera Long-acting, progestin Alters cervical mucus, impairs ovulation and implantation Single injection lasts 3 months Side effects: spotting, headache, wt. gain, depression, skin changes, libido changes May have effect for up to 1 year after injection Permanent Contraception Informed consent required by law Used to permanently prevent any future pregnancy Procedure is viewed as permanent Failure rate is very low Thorough discussion of risks, benefits, and alternatives Male Sterilization (Vasectomy) Postop: Ice for pain/swelling x 1 wk Scrotal support Teaching: Takes 6 weeks and up to 36 ejaculations to clear remaining semen F/U semen sample at 6 months SE: immediate discomfort, hematoma, infection 10

11 Female Sterilization (Tubal Ligation) Fallopian tube is isolated, crushed, ligated, electrocoagulated, banded or plugged Complications: Coagulation burns to the bowels Infection Hemorrhage Adverse anesthesia effects 11

12 Types of Infertility Primary: unable to conceive after 1 yr. of unprotected sex Secondary: after 1 successful preg., unable to conceive a second time Unsuccessful pregnancies: conceive but lose the fetus before viability repeatedly Single: single woman desires pregnancy without a male partner Factors in Fertility Coital frequency Age Smoking Exercise, weight loss Diet Stress Medical conditions Drug use Exposure to chemicals Male Infertility Causes: Defect in transport system of sperm Defect in sperm production Inability to deposit sperm into the woman Alcohol, tobacco, illicit drugs To increase sperm count: Wear loose-fitting underwear Avoid saunas, St. John s wort, and anabolic steriods Eat healthy diet 12

13 Assisted Reproductive Technology Ovulation induction Surgical procedures Therapeutic insemination: instillation of ova or sperm into uterus to aid conception In vitro fertilization: technique that involves bypassing blocked or absent fallopian tubes Gamete intrafallopian transfer: both the sperm and ova are placed into the ampullary portion of the fallopian tube and allows fertilization at the site where it naturally occurs