Intrauterine devices and contraceptive implants

1. Avoiding coitus with unknown/multiple partners.
2. Use of condoms during coitus.

Amniocentesis is generally performed in a pregnant woman between the 15th and 20th weeks of pregnancy by inserting a long, thin needle through the abdomen into the amniotic sac to withdraw a small sample of amniotic fluid. The amniotic fluid contains cells shed from the foetus.

ICSI stands for Intra-Cytoplasmic Sperm Injection. In this method, a sperm is carefully injected into the cytoplasm of the egg and the zygote formed is allowed to divide till 8 celled stages and transferred to uterus. Fertilization occurs in 75-85% of eggs injected with sperm

The transfer of an embryo with more than 8 blastomeres stage into uterus is called embryo transfer technique.

(i) Copper releasing IUD - Multiload 375 CuT 380.
(ii) Hormone - releasing IUD - LNG-20.
(iii) Non-medicated IUD - Lippes loop.

Menstrual cycles resume as early as 6 to 8 weeks from parturition. However, the reappearance of normal ovarian cycles may be delayed for six months during breastfeeding. This delay in ovarian cycles is called lactational amenorrhoea. It serves as a natural but an unreliable form of birth control.

Regeneration is regrowth in the injured region. Regeneration was first studied in Hydra by Abraham Trembley in 1740. Regeneration is of two types, morphallaxis and epimorphosis. In morphallaxis the whole body grows from a small fragment e.g. Hydra and Planaria. When Hydra is accidentally cut into several pieces, each piece can regenerate the lost parts and develop into a whole new individual. The parts usually retain their original polarity, with oral ends, by developing tentacles and aboral ends, by producing basal discs. Epimorphosis is the replacement of lost body parts. It is of two types, namely reparative and restorative regeneration. In reparative regeneration, only certain damaged tissue can be regenerated, e.g. human beings (liver tissue) whereas in restorative regeneration severed body parts can develop. e.g. star fish, tail of wall lizard.

1. Directly gametes cannot be transferred into the uterus, because the uterine environment is not suited for the survival of the gametes.
2. If the gametes directly transferred into the uterus, gametes will undergo degeneration (or) could be phagocytosed and viable zygotes will not be formed.
3. In this method, the own collected from a donor female is transferred to the fallopian tube of another woman.
4. The ovum has to be fertilized by the sperm of the woman's husband; the fallopian tube is the site for fertilization in a human female.
5. The gamete (ovum) if introduced into the uterus cannot move to the fallopian tube, the site of fertilization.

(a) Transfer of an ovum collected from donor into the fallopian tube is called GIFT (Gamete Intra-fallopian transfer)
(b) Transferring of an embryo with more than 8 blastomeres into uterus is called IUT (Intra uterine transfer)
(c) Multi load 375 is a copper releasing IUD

A - Barrier methods
B - Lactational amenorrhoea
C - Tubectomz
D - CuT

Coitus interruptus is a oldest family planning method, where the male partner withdraws his penis before ejaculation, there by preventing the deposition of semen into vagina.

1. Genital herpes
2. Hepatitis -B
3. Genital warts
4. AIDS

All women are born with ovaries, but some do not have functional uterus. This condition is called Mayer- Rokitansky syndrome.

Syphilis and Gonorrhoea

IUD - Intra-Uterine Device. They increase of phagocytosis of sperm within the uterus and prevent meeting of gametes there by acting as birth control measure.

Government of India has taken various steps like PCPNDT Act (Preconception and Prenatal diagnostic technique act-1994) enacted to ban the identification of sex and to prevent the use of prenatal diagnostic techniques for selective abortion.

IVF is used to treat women with blocked, damaged or absent fallopian tubes.

Causes for male infertility:
(i) Undescended tests and swollen veins in scrotum
(ii) Underdeveloped testes
(iii) Tight clothing increases the temperature in scrotum and affect sperm production.
(iv) Autoimmune response against own sperm.
(v) Usage of alcohol, tobacco, marijuana drugs etc.
Causes for female infertility:
(i) Malformation of cervix or fallopian tubes.
(ii) Inadequate nutrition at puberty.
(iii) Low body fat (anorexia = psychological eating disorder due to fear of gaining weight) .
(iv) Pelvic Inflammatory Disease (PID), uterine disorders, endometriosis.
(v) underdeveloped ovaries.
(vi) Developing antibodies against sperm.
Common Causes for both the sexes:
(i) Tumours in pituitary or sex organs
(ii) Inherited mutation of hormone synthesizing genes
(iii) Long term stress
(iv) Ingestion of toxins (Cadmium) & drugs
(v) Injuries to gonads
(vi) Ageing

Natural method is used to prevent meeting of sperm with ovum. i.e., Rhythm method (safe period), coitus interruptus, continuous abstinence and lactational amenorrhoea.
a. Periodic abstinence/rhythm method: Ovulation occurs at about the 14th day of the menstrual cycle. Ovum survives for about two days and sperm remains alive for about 72 hours in the female reproductive tract. Coitus is to be avoided during this time.
b. Continuous abstinence is the simplest and most reliable way to avoid pregnancy is not to have coitus for a defined period that facilitates conception.
c. Coitus interruptus is the oldest family planning method. The male partner withdraws his penis before ejaculation, thereby preventing deposition of semen into the vagina.
d. Lactational amenorrhoea : Menstrual cycles resume as early as 6 to 8 weeks from parturition. However, the reappearance of normal ovarian cycles may be delayed for six months during breast-feeding. This delay in ovarian cycles is called lactational amenorrhoea. It serves as a natural, but an unreliable form of birth control. Suckling by the baby during breast-feeding stimulates the pituitary to secrete increased prolactin hormone in order to increase milk production. This high prolactin concentration in the mother's blood may prevent menstrual cycle by suppressing the release of GnRH (Gonadotropin Releasing Hormone) from hypothalamus .and gonadotropin secretion from the pituitary.

A collection of procedures, which includes the handling of gametes and/or embryos outside the body to achieve a pregnancy as known as Assisted Reproductive Technology. It increases the chance of pregnancy in infertile couples. ART includes intra-uterin insemination (IUI), in vitro fertilization, (IVF) Embryo transfer, (ET), Zygote intra-fallopian transfer (ZIPT), Gamete intrafallopian transfer (GIFT), Intra-cytoplasmic, sperm Injection (ICSI), .Preimplantation genetic diagnosis, oocyte and sperm donation and surrogacy.
(i) Intra-cytoplasmic sperm injection (ICSI): In this method only one sperm is injected into the focal point of the egg to fertilize. The sperm is carefully injected into the cytoplasm of the egg. Fertilization , occurs in 75 - 85% of eggs injected with the sperms. The zrgote is allowed to divide to form an 8 celled blastomere and then transferred to the uterus to develop a productive pregnancy.
(ii) Surrogacy: Surrogacy is a method of assisted reproduction or agreement whereby a woman agrees to carry a Pregnancy for another person, who will become the newborn child's parent after birth. Through in vitro fertilization (IVF), embryesz are created in a lab and are transferred into the surrogate mother's uterus.

A collection of procedures which includes the handling of gametes and/or embryos outside the body to achieve a pregnancy is known as Assisted Reproductive Technology. ART includes
(i) Intra - uterine insemination : This is a procedure to treat infertile men with low sperm count. The semen is collected either from the husband or from a healthy donor and is introduced into the uterus through the vagina by a catheter after stimulating the ovaries to produce more ova. The sperms swim towards the fallopian tubes to fertilize the egg, resulting normal pregnancy.
(ii) Zygote intra - fallopian transfer(ZIFT)
The zygote is allowed to divide to form 8 celled blastomere and transferred to the fallopian tube by laparoscopy. The zygote continues its natural divisions and migrates towards the uterus where it gets implanted.
(iii) Intra uterine transfer (iUT)
Embryo with more than 8 blastomeres is inserted into uterus to complete its further development.
(iv) Gamete Intra-falloplan transfer(GIFT)
Transfer of an ovum collected from a donor into the fallopian tube. In this, the eggs are collected from the ovaries and placed with the sperms in one of the fallopian tubes. The zygote travels toward the uterus and gets implanted in the inner lining of the uterus.
(v) Intra-cytoplasmic sperm injection (ICS):
In this method, only one sperm is injected into the focal point of the egg to fertilize. The sperm is carefully injected into the
cytoplasm of the egg. Fertilization occursin 75% -  85% of eggs injected with the sperms. The zygote is allowed to divide to form an 8 celled blastomere and then transferred to the uterus to develop a protective pregnancy.

1. Reproductive health refers not only to healthy reproductive functions, but to the total well being of physical mental emotional, behavioural and social aspects of reproduction.
2. People having physically and functionally normal reproductive organs and exhibit normal behavioural and emotional interactions among themselves in all reproduction-related aspects are considered reproductively healthy.
3. 214 million women of reproductive age in developing countries who wants to avoid pregnancy are not using a modern contraceptive method.
4. Some family planning methods, such as condoms help prevent the transmission of HIV and other sexual transmitted infections.
5. Family planning contraception reduces the need for abortion, especially unsafe abortion.
6. Family planning reinforces people's rights to determine the number and spacing of their children.
7. By preventing unintended pregnancy, family planning/contraception prevents deaths of mothers and children.
8. Family planning is the key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment and National and Regional development efforts.

Sexually transmitted diseases (STD) or veneral diseases(VD) or Reproductive tract infections (RTI) are called as Sexually transmitted infections (STI).
Transmissions:
1. Normally STI are transmitted from person to person during intimate sexual contact with an infected partner.
2. Infections like Hepatitis-B and HIV are transmitted sexually as well as by sharing of infusion needles, surgical instruments, etc with infected people, blood transfusion (or) from infected mother to baby.
3. People in the age of 15 to 24years are prone to these infections.
4. The bacterial STI are gonorrhoea syphilis, chancroid, chlamydiasis and lymphogranuloma venereum.
5. The viral STI are genital herpes, genital warts Hepatitis-B and AIDS.
6. Trichomoniasis is a protozoan STI, and candidiasis is a fungal STI.

The major sexually transmitted diseases are
(i) Gonorrhoea
1. Causative agent: Neisseria gonorrhoeae
2. Symptoms: Affects the urethra, rectum and throat and in females the cervix also get affected
3. Pain and pus discharge in the genital tract and burning sensation during urination.
4. Incubation period: 2 to 5 days
(ii) Syphilis
Causative agent : Treponema pallidum
Symptoms:
1. Primary stage: Formation of painless ulcer on the external genitalia.
2. Secondary stage : Skin lesions, rashes, swollen joints and fever and hair loss.
3. Tertiary stage : Appearance of chronic ulcers on nose. Lower legs and palate, loss of movement mental disorder visual impairment, heart problems, gummas (soft non-cancerous growths) etc.
(iii) Hepatitis B
1. Causative agent: Hepatitis B virus (HBV) with DNA.
2. Symptoms: Fatigue, jaundice, fever, rash and stomach pain.
3. Liver cirrhosis and liver failure occur in the later stage.
4. Incubation period: 30-80 days
(iv) AIDS:
1. Causative agent: Human immuno deficiency Virus (HIV) .
2. Symptoms: Enlarged lymph nodes, prolonged fever, prolonged diarrhoea, weight reduction, night sweating.
3. Incubation periods: 2 to 6 weeks even more than 10 years