Contraception
and sterilization
dr.feda thekr allah
Done by shaden haddad
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Every woman ovulates only once in each cycle.
If in the rare occasion two or more ovulation occur, they will occur within 24
hours.
After ovulation, the egg can be fertilized for a maximum of 18 hours.
After intercourse, male sperm will remain active and fertile in the female
body for a maximum of 3-5 days.
This means that there are six days in every cycle when a woman can get
pregnant: five days before ovulation and on the day she ovulates
Methods of contraception:
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Natural methods: periodic abstinence
coitus interruptus
lactational amenorrhea
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Barrier method and spermicides:
male condoms
female condoms
diaphragm
cervical cap
spermicides
Intrauterine devices
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Hormonal contraceptive methods
Natural methods
“periodic abstinence”
 Rhythm
or calendar method
 It emphasizes fertility awareness and abstinence
shortly before and after ovulation period
 Ovulation assessment method:
use ovulation prediction kits
basal body temperature
menstrual cycle tracking
cervical mucous evaluation
 Effectiveness: 55-80%
 Advantages: uses neither chemical nor mechanical
barriers (some religious reasons).
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They can be used to collect a
sample right in the urine stream,
making them a great for
couples trying to become
pregnant.
With a high sensitivity of 25
mIU/mL (lower is better),
ovulation test strips can be used
to detect ovulation surge,
which occurs just before the
best time to conceive.
The test strips work by detecting
LH, a hormone released
released in greater quantities as
ovulation surge approaches
Ovulation
prediction kits
Natural methods
“coitus interruptus”
 Withdrawal
of penis from vagina before
ejaculation
 Majority of semen is deposited outside the
female reproductive tract.
 Effectiveness : rate of failure is high 27%
 Failure due to deposition of semen into
vagina before orgasm or deposition of
semen near introitus after intercourse.
Natural methods
“lactational amenorrhea”
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Lactational amenorrhea is the natural postnatal
infertility that occurs when a woman is amenorrheic
and fully breastfeeding. If not combined with
chemicals or devices, Lactational amenorrhea method
(LAM) may be considered natural family planning
Method of action: after delivery, restoration of
ovulation is delayed because of nursing induced
hypothalamic suppression of ovulation
“prolactin induced inhibition of GnRH from
hypothalamus resulting in suppression of ovulation” .
Effectiveness :
- duration of ovulatory suppression is variable
- 50% of lactating mothers will begin to ovulate before 612 months of delivery even while breast feeding
-(the return of ovulation occurs before the return of
menstruation .)
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Natural methods
“lactational amenorrhea”
Effectiveness enhancement by :
- breast feeding only form of nutrition for
infant
The infant must breastfeed at least every four
hours during the day and at least every six hours
at night.
The infant must be less than six months old
- this method used only as long as woman is
experiencing amenorrhea
- should only be used for max 6 months after
delivery.
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Barrier methods
“male condoms”
Barrier methods prevents sperms from entering endometrial
cavity ,fallopian tube and peritoneal cavity
 Male condoms:
- made of latex rubber sheaths
- placed over the erect penis before ejaculation
-it is important to leave a space at the tip to collect the ejaculate
and to prevent the leak
 Effectiveness:
-98% effective in preventing contraception
-efficacy increased by using spermicides
 Side effects: hypersensitivity to latex, lubricant or spermicide in
the condom
 Advantages: widely available, moderate cost
prevent transmission of many STD
protect against HIV
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Male condoms:
Barrier methods
“female condoms”
 Vaginal
pouch made of polyurethane
 Has flexible ring at each end (one ring fits
into depth of vagina ,other stays outside
vagina near introitus)
 Effectiveness:
-failure rate higher by 25% than male
condoms
 Advantages: protects against STD
 Disadvantages: cost and overall bulkiness
Female condoms
Barrier methods
“diaphragm”
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Dom-shaped latex rubber sheet stretched over a thin
coiled rim
Spermicidal jelly placed on rim and sides of diaphragm
then placed into vagina to cover the cervix
Placed into the vagina before intercourse and left in place
6-8 hours after intercourse
If after 6-8 hours further intercourse is going to happen
additional spermicide should be placed without removing
diaphragm.
Upon removal, a diaphragm should be cleansed with
warm mild soapy water before storage. The diaphragm
must be removed for cleaning at least once every 24 hours
and can be re-inserted immediately.
Effectiveness: 49% effective , if with spermicide 85%
Barrier methods
“diaphragm”
Side effects:
-bladder irritation….UTI
-colonization of staph aureus …..toxic shock syndrome
-hypersensitivity to rubber, spermicides
 Disadvantages:
-cost effective
-need to be replaced every 2 years or if patient loses
or gains more than 20% of body weight
-needs rechecking after each pregnancy
-women not experienced well to fit it due to pelvic
relaxation
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diaphragm
Barrier methods
“cervical cap”
Fem cap ,small soft silicon cap that fits directly over cervix
 Held in place by suction
 Act as a barrier to sperms and must be used with spermicidal jell.
 Fitted by a doctor
 Effectiveness :
- 68%-80%
-depends on woman’s parity (failure in parous women)
-dislodgment common cause of failure
 Advantages:
-inserted up to 6 hours before intercourse and can be left up to 1-2
days
 Disadvantages:
-foul discharge after first day
-needs refitting after pregnancy or weight gain
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Cervical cap
Barrier methods
“spermicides”
Varying forms : cream ,gels ,suppositories
Most used :nonoxynol-9
octoxynol-9
 Mechanism of action:
- disrupt cell membrane of spermatozoa
-act as a mechanical barrier to cervical canal
-placed in vagina 30 min before intercourse
-used alone or with previous contraception method
 Effectiveness:
-95% if with condom
-75%if used alone
 Side effects:
-irritates vaginal mucosa and external genitalia
 Disadvantages:
-no protection against STD (most woman susceptible to STD due to vaginal
mucosa irritation)
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Intrauterine devices
Most widely used method of reversible contraception in the world
 IUD indicated for :
-women with the following medical conditions:
Diabetes
Thromboembolism
Menorrahagia
Breast feeding (copper only till 4 to 6 wks
postpartum
Breast cancer ( copper only )
Liver disease (copper only)
- multiparous and nulliparous women at low risk for STDs
- women who desire long term reversible contraception
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Method of action:
-IUD introduced into the endometrial cavity using a cervical cannula
-2 monofilament strings extend through cervix
-IUDs act by killing sperms and preventing fertilization
-produce a sterile inflammatory response therefore sperms engulfed
and immobilized and destroyed by inflammatory cells
-it decreases tubal motility therefore inhibiting sperm and blastocyst
transport.
It doesn’t affect ovulation
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Intrauterine devices
Tcu-380A
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Copper in paragard
will stop sperms
motility and
capitation
Therefore sperms
rarely reach fallopian
tubes and no
fertilization occurs.
Intrauterine
devices
Mirina
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Progesterone in mirina thickens
cervical mucous and atrophies
endometrium to prevent implantation
Also labeled to treat menorrhagia
and dysmenorrhea
Used in postmenopausal women
receiving estrogen therapy
Used in young women who didn’t
complete child bearing age,nullipara
women
Used to treat endometriosis and
endometrial hypertrophy and have
decreased risk of PID due to
protection of progesterone induced
cervical mucous thickness
Intrauterine devices
Effectiveness:
-failure 0.8% in paragard
-failure 0.1% in mirena
 Side effects:
-Pain and bleeding
-pregnancy
-expulsion
-perforation
-infection
-may lead to insertion related PID if inserted into woman with
cervical infection
Note: pelvic infection rarely seen beyond 20 days after insertion
most women need tube screened for gonorrhea and
chlamydia prior to insertion of IUD
-even though pregnancy rate is low but if happened
spontaneous abortion increase to 50%
Note : IUDs not associated with increased risk of congenital
abnormalities
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Intrauterine devices
Advantages:
-paragard IUD used for 10 years but maybe
effective for 14 years
-mirena used for 5 years ….7 years
-IUDs can be immediately inserted after
spontaneous abortion in 1st trim
-less risk of ectopic pregnancy. It is an
acceptable form of contraception for women
with prior history of ectopic pregnancy.
Disadvantages:
-Paragard have increased rate of expulsion
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Intrauterine devices
Absolute
contraindications
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Known pregnancy
Undiagnosed abnormal
vaginal bleeding
Acute cervical , uterine
,infection
Copper allergy or wilson
disease (paragard )
Current breast cancer
(mirena)
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Relative
contraindications
Prior ectopic
pregnancy
History of STI in the
past 3 months
Uterine anomaly or
fibroid distorting the
cavity
Current menorrhagia
or dysmenorrhea
(paragard only )
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