Fertility and fertility management

• Fertility and fertility management are important contemporary health issues.

Take Home Messages

• Parenting requires a huge, lifelong commitment.
• Contraception is smart when someone is not ready to be a parent.
• The best type of contraception is effective, convenient, safe, cost-effective, and logical for the individual.
• More information on sexual health and reproduction can be found on the SFU website.

Conception Review

• Sperm travels from the testes to the epididymis, then to the vas deferens, then the urethra, then the vagina, then the cervix, then the uterus, and finally to the uterine tubes.
• The ovum travels from the ovaries to the uterine tubes.
• One ovum is released each menstrual cycle, usually around day 14.
• Fertilization occurs in the uterine tube.
• The zygote divides to form a mass of cells that implants into the endometrium.
• After several divisions, the mass becomes an embryo.
• After about 8 weeks, the embryo is known as a fetus.

Natural Birth Control Methods

• Abstinence involves refraining from sexual activity.
• Outercourse includes hugging, kissing, touching, and manual stimulation.
• Coitus interruptus, or withdrawal, is not recommended as a reliable birth control method.
• Fertility awareness involves abstinence for about 9-13 days per cycle.
• Other methods include tracking cervical mucus, the calendar/rhythm method, and monitoring basal body temperature.

Fertility Awareness: Calendar Method

• This involves avoiding intercourse during the fertile days of the menstrual cycle.

Non-prescription: Male Condoms

• Male condoms provide the best protection against STIs and have no side effects.
• Male condoms can interrupt activity, and some people are allergic to latex.
• Male condoms may diminish sensation, and can break
• The effectiveness varies; with perfect use, the failure rate is about 2%, but the average failure rate is 17%.

Non-prescription: Female Condom

• Female condoms can be inserted up to 8 hours before intercourse and protect against STIs.
• Female condoms can be noisy, move, or be uncomfortable, and slippage often occurs.
• Effectiveness varies; with perfect use, the failure rate is about 5%, but the average is 27%, which is higher in new relationships.

Nonprescription: Other Female

• Spermicides are inexpensive and readily available.
• Spermicides must be inserted 10-20 minutes before intercourse and do not protect against STIs.
• Contraceptive sponges can be inserted right before or up to several hours before intercourse.
• Contraceptive sponges doesn't protect against STIs and may increase HIV risk.

Emergency Contraception

• Emergency contraception, such as 'Plan B,' no longer requires a prescription, is available at most drugstores, and contains progestin-only pills.
• Emergency contraception can be used up to 5 days after unprotected sex, but it is ideal to use it within 72 hours.
• The sooner emergency contraception is used, the more effective it is.
• Emergency contraception reduces the risk of pregnancy by 75% (not 100%).
• Side effects include nausea/vomiting, irregular bleeding, fatigue, headache, dizziness, and tender breasts.
• Emergency contraception should not be used as a primary means of contraception.

Prescription Contraceptives

• Hormonal contraceptives like "The Pill", rings, patches, implants, and intrauterine devices (IUDs) mimic pregnancy hormones, tricking the body into thinking it is pregnant, and preventing ovulation.
• Hormonal contraceptives can thin the endometrium and thicken cervical mucus.
• HRT does not cause breast cancer during menopause
• Barrier methods include diaphragms and cervical caps, which need to be fitted.
• BC PharmaCare may cover the cost of many prescription contraceptives.

Prescription Birth Control

• Injectable contraceptives provide 3 months of protection, are effective, and are discrete.
• Injectable contraceptives don't protect against STIs and can cause menstrual irregularities.
• Contraceptive patches are effective and discrete.
• Contraceptive patches don't protect against STIs and have side effects.

Prescription Contraceptives: Hormonal Ring (NuvaRing)

• NuvaRing provides 3 weeks of protection at a time and may result in shorter, lighter periods.
• NuvaRing doesn't protect against STIs and may have side effects.

Prescription Contraceptives: Diaphragm

• A diaphragm can be inserted up to 6 hours before intercourse and protects for 6 hours.
• A diaphragm needs to be fitted, is more expensive, can be moved out of place, and must be left in place for 6 hours after sex.

Implanted Contraceptives: IUDs

• IUDs are typically hormonal and prevent fertilization or implantation.
• IUDs last approximately 3-5 years, may stop menstruation, are effective immediately, and reduce the risk of some cancers.
• IUDs provide no protection against STIs, are expensive ($100/300+), need to be inserted, and can cause cramps and expulsion.

Effectiveness Chart

• No method has a 15% theoretical and actual effectiveness.
• Abstinence has a 100% theoretical and actual (if actually abstinent) effectiveness.
• Withdrawal has a 96% theoretical and 73% actual effectiveness.
• Predicting fertility has a 91-99% theoretical and variable actual effectiveness.
• Spermicides have an 82% theoretical and 71% actual effectiveness.
• Male condoms alone have a 98% theoretical and 85% actual effectiveness.
• Female condoms alone have a 95% theoretical and 79% actual effectiveness.
• Diaphragms and spermicide have a 94% theoretical and 84% actual effectiveness.

Permanent Contraception: Female Sterilization (Tubal Ligation)

• This involves cutting or blocking the fallopian tubes.

Permanent Contraception: Male Sterilization (Vasectomy)

• This involves cutting or blocking the vas deferens.

Choosing a Contraceptive

• Consider how well it fits into the individual's lifestyle.
• Consider how convenient it is.
• Consider how effective it is.
• Consider how safe it is.
• Consider how affordable it is.
• Consider how reversible it is.
• Consider if it protects against STIs.

Abortion: Termination of Pregnancy

• Medical abortion involves dilation and curettage or vacuum aspiration to empty the uterus.
• Abortion is not normally performed after 24 weeks.
• Abortion is legal and covered by MSP in BC.
• Abortion remains a social controversy, with strong views from both 'pro-choice' and 'pro-life' advocates.
• A majority of Canadians identify as pro-choice.

Pregnancy Trimesters

• The first trimester is characterized by morning sickness and a higher risk of spontaneous abortion.
• The second trimester is characterized by the abdomen starting to noticeably swell and movement of the baby being first evidenced.
• The third trimester is characterized by rapid fetal growth.

Keys to a Healthy Pregnancy

• Eat sensibly; in the second and third trimesters, females should eat a bit more.
• Avoid gaining too much weight.
• High pregnancy weight gain increases the risk of future health problems (obesity, diabetes II, etc.) in offspring.
• Pregnant women are at increased risk of infection; ensure proper food safety and minimize exposure to infectious agents.
• Avoid sodium nitrite and nitrates, as they are potentially carcinogenic.
• Ensure adequate intake of folic acid, which prevents neural tube defects and is required for DNA replication.
• Avoid alcohol, tobacco, and limit caffeine, as alcohol promotes fetal alcohol syndrome.
• Engage in moderate levels of physical activity, as PA promotes mental health and wellness.
• Sexual intercourse is safe.
• Avoid drugs, toxins, and heavy metals.
• Some prescription drugs are okay, but always consult a physician.
• Breathe clean air and drink clean water.

Childbirth

• Vaginal delivery is the optimal way for a baby to be born.
• When the placenta comes out it stimulates milk to be made
• Tilting the head back is better because it's more flexible so the baby should face down

Breastfeeding

• Breastfeeding decreases the newborn's risk of cardiovascular disease, obesity, diabetes, autoimmune diseases, and allergies.
• Breastfeeding increases the immune system and bonding.
• Breastfeeding is a natural birth control and helps the mother heal.
• Health Canada recommends exclusively breastfeeding for the first six months, if you can.

Fertility Options

• Fertility options are considered when an individual/couple cannot conceive on their own.
• Options include Assisted Reproductive Technology, sperm donor or surrogate, intrauterine insemination, hormone therapy, In Vitro Fertilization, and adoption.