CONTRACEPTIVE

PHYSIOLOGY
By
Dr.M.Anthony David MD
Professor of Physiology
 CONTRACEPTION
 The prevention of conception is
called as contraception.
 Contraception is useful to prevent
population explosion.
 It is also called as Birth Control
methods or Family Planning Methods.
 This can be done at the female, male
or coital stages.
 ABORTION
 Abortion is the abrupt and
unsuccessful ending or termination
of pregnancy.
 It can be spontaneous or induced.
 Induced Abortion is the medical
termination of pregnancy.
 In Abortion, a formed embryo or
fetus is killed due to health problems
of the mother.
CONTRACEPTION: HISTORICAL
 Coitus Interruptus was first
practised around 4000 BC in
ancient Middle east.
 Intra uterine contraception was
first practiced in female camels
by Arabians in the middle ages.
 They used to insert some seeds
into the uterus of the she-
camels.
 This served as an Intra Uterine
CONTRACEPTIVE METHODS: A
CLASSIFICATION
 TERMINAL OR PERMANENT METHODS:
 There is a permanent stopping of
conception.
 Used by couples who have finished
their family.
 TEMPORARY SPACING METHODS:
 Used for spacing or giving a gap
between children
 Used to postpone children’s arrival
while the couple gets adjusted.
 TERMINAL METHODS
I. VASECTOMY:
 MALE STERILISATION:
 A SIMPLE OUT PATIENT
PROCEDURE.
 THE ‘VAS DEFERENS’ IS ISOLATED
AND CUT.
 THE TWO ENDS ARE LIGATED.
 LATEST METHOD: NSV: NON
SCALPEL VASECTOMY.
 LEAST DONE IN INDIA DUE TO
PREJUDICE & SUPERSTITIONS.
VASECTOMY
 TERMINAL METHODS
II. TUBECTOMY:
 FEMALE STERILIZATION:
 PART OF THE FALLOPIAN TUBE IS
REMOVED.
 THE TWO ENDS ARE TIGHTLY
LIGATED.
 CAN BE DONE AS:
 POST PARTUM STERILIZATION
 INTERVAL STERILIZATION

 LAPAROSCOPIC STERELIZATION
TUBECTOMY: TYPES
INTERVAL STERILIZATION
SPACING METHODS
 BARRIER METHODS:
A) PHYSICAL BARRIER:
 CONDOMS
 DIAPHRAGM
 VAGINAL SPONGE
 FEMALE CONDOM.
B) CHEMICAL
BARRIER:SPERMICIDAL
 FOAMS
 CREAMS
 SUPPOSITORIES
CONDOMS
SPERMICIDES
DIAPHRAGM + SPERMICIDE
 IUCDs
 INTRA UTERINE CONTRACEPTIVE
DEVICES (IUCD):
 FUNCTION BY PREVENTING
IMPLANTATION.
I GENERATION:
 NON MEDICATED: LIPPE’S LOOP
 IIGENERATION: MEDICATED
BIOACTIVE
 COPPER T
 III
GENERATION: HORMONE
RELEASING
LIPPE’S LOOP Cu T & PROGESTASERT
HORMONAL CONTRACEPTIVES
 ALSO CALLED ORAL PILLS OR ORAL
CONTRACEPTIVES.
 ARE USUALLY HORMONES OR
COMBINATIONS TAKEN BY MOUTH.
 THEY CAUSE THE TEMPORARY
CESSATION OF THE OVARIAN CYCLES.
 ORAL CONTRACEPTIVES
 COMBINED PILLS:
 HAS
BOTH ESTROGEN &
PROGESTERONE.
 POP: PROGESTRONE ONLY PILL.
 MORNING AFTER PILL
 EMERGENCY CONTRACEPTION.
 DEPOT FORMULATIONS
 INJECTABLES:
DEPOT
PROVERA,‘DMPA’, ‘NET EN’
 POST CONCEPTIONAL
METHODS
 MENSTRUAL REGULATION
(MR)
 MTP: MEDICAL TERMINATION
OF PREGNANCY.
 OTHER METHODS
 ABSTINENCE: THE BEST
 PART OF THE A B C TO PREVENT
HIV/AIDS.
 COITUS INTERRUPTUS:
 HISTORICALLY THE OLDEST IN
HUMANS.
 THE SEMEN WAS SPILLED ON THE
GROUND.
 THE MALE PILL:
 GOSSYPOL : COTTON SEED OIL
 KILLS SPERMATIDS.
 VERY TOXIC AND SO NOT USED.
 NATURAL FAMILY
PLANNING METHODS
 SAFE PERIOD METHOD:
 DURING THE FERTILE PERIOD,
COITUS IS AVOIDED.
 THE REST OF THE CYCLE IS ‘SAFE’
 OVULATION TESTS:
 BASAL BODY TEMPERATURE
CHARTS
 CERVICAL MUCUS : BILLINGS
METHOD

SAFE PERIOD METHOD
REVIEW
WEIVER
Contraception is the prevention
of conception.
 There two main types:
 Permanent or Terminal methods:
 Vasectomy or Male sterilization.
 Tubectomy or Female sterilization.

 Temporary or Spacing methods:

 Barriers
 IUCDs

 Other methods.
ASSISTED
REPRODUCTIVE
TECHNOLOGY
By
Dr.M.Anthony David MD
Professor of Physiology
 INFERTILITY
 What is fertility?
 The capacity to conceive and bear
children is called fertility.
 Infertility: A couple is said to be
infertile if pregnancy does not result
after 1 year of normal sexual activity
without contraceptives.
 25% of couples experience infertility
at some point in their reproductive
lives.
 WHO IS RESPONSIBLE FOR
INFERTILITY?
 The male partner in 40% cases.
 Artificial insemination is resorted
to in such cases.
 A combination of factors can be
the reason for infertility.
 ARTIFICIAL INSEMINATION
 SPERMS ARE INJECTED INTO THE
CERVIX DIRECTLY.
 DONE IN CASES OF MALE INFERTILITY
OR FEMALE TRACT HOSTILITY.
 AIH: AI WITH THE HUSBAND’S SPERM:
 THISIS IN CASE OF SEVERE CERVICAL
HOSTILITY TO SPERMS
 CONCENTRATED WASHED SPERMS ARE
USED
 AID: AI WITH DONOR’S SPERMS
 INCASES OF AZOOSPERMIA.
 DONOR SPERMS ARE TAKEN FROM THE
SPERM BANKS OR FROM ELIGIBLE
 TECHNIQUES OF OOCYTE
RETRIEVAL
1. IVF –ET: IN VITRO FERTILIZATION &
EMBRYONAL TRANSFER: TEST TUBE
BABY
2. GIFT: GAMETE INTRA FALLOPIAN
TRANSFER
3. ZIFT: ZYGOTE INTRA FALLOPIAN
TRANSFER
4. TET: TUBAL EMBRYONAL TRANSFER
5. POST: PERITONEAL OOCYTE &
SPERM TRANSFER
 II. TECHNIQUES OF SPERM
RETRIEVAL & INJECTION
1. ICSI: INTRA CYTOPLASMIC
SPERM INJECTION.

3. TESE: TESTICULAR SPERM

EXTRACTION.
4. MESA: MICROSURGICAL
EPIDIDYMAL SPERM
ASPIRATION.
1.IVF-ET: THE TEST TUBE
BABY!  IN VITRO
FERTILIZATION &
EMBRYONAL
TRANSFER.
 TEST TUBE BABY IS
A MISNOMER
 FERTILIZATION
DONE IN A
PETRIDISH.
 AFTER THE EMBRYO
DEVELOPS, IT IS
TRANSFERRED INTO
THE BODY OF THE
UTERUS.
2. GAMETE INTRA FALLOPIAN
TRANSFER (GIFT)
 BOTH THE GAMETES, THE
MATURE SPERMATOZOON AND
THE OVUM ARE PUT INTO THE
FALLOPIAN TUBE.
 THERE THEY FERTILIZE AND
CAUSE CONCEPTION.
 DONE IN CASES OF:
 LOW MOTILITY FOR SPERMS
 INCREASED CERVICAL MUCUS
HOSTILITY
GAMETE INTRA FALLOPIAN
TRANSFER (GIFT)
3. ZYGOTE INTRA FALLOPIAN
TRANSFER (ZIFT)
 THE FERTILIZATION IS DONE
OUTSIDE, INVITRO.
 THE SINGLE CELLED ZYGOTE IS
PUT INTO THE FALLOPIAN TUBE.
 IT THEN DEVELOPS INTO AN
EMBRYO AND MOVES INTO THE
BODY OF THE UTERUS.
 4. TUBAL EMBRYO TRANSFER
(TET)
 TUBAL EMBRYO TRANSFER.
 THE ZYGOTE IS ALLOWED TO
GROW AND BECOME AN EMBRYO
IN VITRO.
 THEN AT THAT STAGE IT IS PUT
INTO THE FALLOPIAN TUBE.
 5. PERITONEAL OOCYTE &
SPERM TRANSFER (POST)
 BOTH THE GAMETES ARE PUT
INTO THE PERITONEAL CAVITY.
 THEY ARE EXPECTED TO
FERTILIZE IN THE PERITONEUM.
 LATER THE ZYGOTE OR EMBRYO
IS TO MOVE INTO THE TUBE AND
THE UTERUS.
II. TECHNIQUES OF SPERM
RETRIEVAL & INJECTION
 DONE IN CASES SUCH AS:
AZOOSPERMIA
LOW SPERM COUNTS
HYPO & EPISPADIAS.
 TECHNIQUESHELP THE
SPERM TO REACH THE OVUM
BETTER
 II. TECHNIQUES OF SPERM
RETRIEVAL & INJECTION
1. ICSI: INTRA CYTOPLASMIC
SPERM INJECTION.

3. TESE: TESTICULAR SPERM

EXTRACTION.
4. MESA: MICROSURGICAL
EPIDIDYMAL SPERM
ASPIRATION.
1. INTRA CYTOPLASMIC
SPERM INJECTION
1. INTRA CYTOPLASMIC
SPERM INJECTION
 2. TESTICULAR SPERM
EXTRACTION (TESE)
 The sperms are extracted or
teased from the testes.
 Done in cases where there is a
block in the ductular system –
rete testis, efferent ductules,
epididymis & vas deferens.
 The extracted sperms are used
for fertilization.
 3. MESA
 MICROSURGICAL EPIDIDYMAL SPERM
ASPIRATION.
 DELICATE MICROSCOPIC SURGERY IS
DONE.
 SPERMS ARE ASPIRATED FROM THE
EPIDIDYMIS.
 THEY ARE THEN USED FOR
FERTILIZATION.