TRANS_DEVBIO-M8-ART (MODULE 8: Contraception, Infertility, and Assisted Reproductive Technologies) PDF

MODULE 8: CONTRACEPTION, INFERTILITY, AND ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) + Withdrawal is not safe because of Lessons Overview: pre-ejaculation Contraception:...

MODULE 8: CONTRACEPTION, INFERTILITY, AND ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) + Withdrawal is not safe because of Lessons Overview: pre-ejaculation Contraception: Contraceptive Methods: Barrier methods Terminal methods Spacing methods: Infertility: 1. Barrier methods Male & female infertility 2. Intrauterine Devices (IUDs) Assisted Reproductive Technologies (ART): 3. Hormonal methods DefinitionsTypes & examples 4. Emergency contraception Terminal methods: 1. Male fertilization (e.g. Vasectomy) CONTRACEPTION 2. Female fertilization (e.g. Tubal ligation) Contraception: Against conception Contraceptive methods: Preventive Effectiveness of Contraceptive Methods: methods to help women avoid unwanted pregnancies. + Advantage use of contraception: + Reason: Safety sexual transmission (disease: STDs) + Overpopulation (solution: Family planning) Need for Contraception: To avoid unwanted pregnancies. To regulate the timing of pregnancy To regulate the interval between pregnancies. + Timing of the pregnancies: maximum of 3 + Problem: Irregularity cesarian because the uterus lining keeps + Dental pans - not encourage thinner) *nulliparous/parous - not applicable/applicable Ideal Contraceptive: Safe Effective Barrier Methods Acceptable Reversible (not permanent; ex. vasectomy)) Inexpensive (i.e. pills) Long-lasting (BMPA - 2yrs, Copper IUD - 10yrs) Requires little or no medical supervision  Barrier methods: Physical barriers that Prevent pregnancy by stopping sperm from prevent sperm from reaching the egg. meeting an egg. TYPES: Male condoms Female condoms Diaphragm DIAPHRAGM/CAP Spermicides IUD Pills Injectables Patch Rings Withdrawal Calendar Method A circular dome made of thin, soft silicone CONDOMS that's inserted into the vagina before sex. It covers the cervix so sperm cannot get into the womb (uterus) to fertilize an egg. When used correctly with spermicide, a diaphragm or cap is 92-96% effective at preventing pregnancy. + How long: 2 years (wash & wear) + Toxic shock syndrome: hindi natatanggal/tinatanggal yung cap which can MALE CONDOMS lead to infection SPERMICIDES Surface active agents which attach themselves to spermatozoa and kill them. Available in various forms: Most commonly known and used ○ Foams contraceptives. ○ Creams A male condom is worn on the penis. ○ Suppositories (ipapasok then Usually made of latex, a type of rubber. natutunaw) Some are made of materials that are safe for ○ Soluble films people with latex allergies. A condom is a sheath-shaped barrier device HORMONAL CONTRACEPTIVES used during sexual intercourse to reduce the probability of pregnancy or a sexually Combined pill: Combination of estrogen and transmitted infection. Progesterone. Progesterone-only pill (mini pill): Used FEMALE CONDOMS in people above 40 years of age. (side effects of combined pill might lead to palpitation) - hindi kaya side effects + Only for those na kakapanganak pa lang, breastfeeding, and most likely malapit na magkaperiod + Why encourage breastfeeding and why hindi nasusundan? Effect of high prolactin production inhibits FSH and LH A barrier method of contraception is worn + Combine pill is much more effective than inside the vagina. progesterone-only pill (mini pill)  + (hindi pa mabubuntis) HIGH Prolactin - inhibit FSH (follicle dev), LSH + 3-10 years implant + Maintain the thinness of the uterine lining Post coittal contraception: “PLAN B” (hence, no implantation) + not for habitual (bc of the side effects (possible overdose) TYPES: Basic Components: - Non-hormonal: Copper-containing ○ Levonorgestrel IUD ○ Ulipristal - Hormonal: Progestin-releasing IUD ○ Mifepristone HOW IT WORKS: - Depending on the type, it can: ADVERSE EFFECTS: - Thicken cervical mucus to prevent fertilization. - Thin uterine lining to prevent implantation. - Stop ovulation. PROS: - Effectiveness: With proper use, IUD is more than 99% effective. - Convenience: It stays in the body for 5 to 10 years. Upon removal, fertility is - Cardiovascular effects restored right away. - Carcinogenesis - Metabolic effects CONS: - Liver adenomas - No protection from STDs. - Weight gain - May change menstrual patterns. - Breast tenderness - Some women cannot take estrogen or - Nausea are allergic to copper. - Mid-cycle spotting - Headache Initial Side Effects of Using a Kyleena IUD: - Mood swings - Reduced sexual drive in women - Vulvovaginitis - Breast soreness - Stomach and/or pelvic pain - Vaginal thrush or yeast infections - Acne or greasy skin or discomfort - Breast pain Intrauterine Device (IUD) - Ovarian cysts - Increased bleeding - Headaches or migraines - Dysmenorrhea or uterine spasms INJECTABLES Combination of estrogen and progestogen. - Birth Control Shots: While birth control shots are a reliable and convenient contraceptive method, IUD: Small, T-shaped device that is inserted in the uterus to prevent pregnancy.  women planning to get pregnant soon 4th week: No patch is put on, which triggers a should be mindful of their limitations. period. HOW IT WORKS: HOW IT WORKS: - Contains progestin which prevents - Contain estrogen and progestin, which pregnancy by: are absorbed through the skin and into - Preventing ovulation (no menstruation) the bloodstream to: - Thickening cervical mucus. - Prevent ovulation. - Thinning uterine lining. - Stop the sperm from fertilizing the egg. HOW ARE THEY DONE: PROS: - Ideally, shots should be injected every 3 - 91% effectiveness with typical use months (12-13 weeks) - Only 3 applications per month - If done more than 15 weeks apart, a - Do not hinder fertility back-up birth control method is - May improve irregular periods and needed. acne PROS: CONS: - 94% effective with typical use. - Require diligent applications. - Require 4 injections per year. - No protection from STDs. - May make periods lighter. - May increase the risk of blood clots. - May not be used by women with certain CONS: health conditions and other factors. - Don't protect against STDs. - High out-of-pocket cost. Terminal Methods - May take up to 10 months to restore fertility. + Break outs PATCH CONTRACEPTIVE Permanent methods: + Change every week For males: Vasectomy (Non-scalpel + The patch will diffuse from the skin area to the vasectomy). bloodstream and the hormone will circulate For females: Tubectomy (Minilap operation, + Effectivity: 1 week only (3x month) Laparoscopic sterilization, Tubal ligation). + Exclude the 4th week for menstruation + More absorption, faster circulation + Clip blocking (rare) Birth control patch: Used in people above VASECTOMY 40 years of age. Ring contraceptive: Lower back above the glute. Levonorgestrel, Ullipristal, Mifepristone: Control patches may not be a suitable birth control method for all women. Combined pill: They are placed on the body on a 4-week schedule: - First 3 weeks: New patch is put on the same day every week.  + If the ectopic develops, lead to abortion + Types: cauterized, tied and cut, banded (reversible) + For artificial insemination: get the sperms in the vas deferens Male Sterilization or Vasectomy - Simpler, faster, and less expensive procedures are carried out under local anesthesia. Procedure: - To remove a piece of vas at least 1 cm after clamping. The ends are ligated PREPARING FOR LAPAROSCOPY and then folded back on themselves and suture so that the cut ends face away each other, this will reduce the chance of recanalization. During vasectomy sperm production and hormone output is not affected. + Vas deferens (for storage, pathway) TUBAL LIGATION Laparoscopy is a surgical procedure in DO NOT eat, drink (including water), or smoke which a fiber-optic after midnight the evening before your surgery. instrument is inserted Wear low-heeled shoes on the day of surgery. through the You may be drowsy from the anesthesia and abdominal wall to unsteady on your feet. view the organs in the Do not wear jewelry. (Wedding rings may be abdomen or to permit worn). a surgical procedure. Wear loose-fitting clothing. You will have some Sterilization is the abdominal tenderness and cramping after process of rendering surgery an individual Bring a sanitary pad. You may have some incapable of sexual vaginal bleeding after surgery. reproduction, by Remove nail polish prior to surgery castration, vasectomy, salpingectomy, or some other procedure. Infertility Sterilization by laparoscopy is a common procedure used to perform tubal ligation in women. Tubal ligation is a method of sterilization that involves obstruction of the fallopian tubes. + Removal of the fallopian tube: Cause: Cancer Infertility: Failure to conceive within one or and ectopic (it burst so need tanggalin more years of regular unprotected intercourse. fallopian tube) TYPES OF INFERTILITY: + excess fluid in the scrotum and Primary infertility: Couples who have becoming or having glow-in-the-dark never been able to conceive. Infection: Mumps, orchitis damage, Secondary infertility: Difficulty in spermatogenesis conceiving after already having conceived. + mumps - beke (affected: parotid Infertility problems affect 1 in 7 couples. glands) Gonadotropin suppression: Happens in Etiology: malnutrition, heavy smoking, and high alcohol - Conception depends on the fertility consumption. potential of both male and female Endocrine factors: Raised FSH level is seen partners. in idiopathic testicular failure Male Infertility Loss of sperm motility Genetic: Klinefelter syndrome (44 + XXY) + Extra chromosome; undeveloped testes + morphologically women Latrogenic: Cytotoxic drugs, radiation therapy, and antidepressant drugs are likely to obstruct spermatogenesis. Monks infection(???) OBSTRUCTION OF EFFERENT DUCTS + onco = cancer + Torsion = spermatic cord + Varicocele - glow in the dark (there's fluid) MALE FACTORS: Defective spermatogenesis Gonococcal or tubercular infection. Sperm Anomalies (Errors in the seminal fluid) Surgical trauma during vasectomy. + Sperm count of morphological Testicular Factors FAILURE TO DEPOSIT SPERM HIGH IN THE + Testes capable of performing the VAGINA development. Sperm Canal Problems (Obstruction of the efferent duct) Ejaculation Problems (Failure to deposit sperm high in the vagina) + Erectile dysfunction Substance Use Erectile dysfunction Ejaculatory defects such as premature DEFECTIVE SPERMATOGENESIS retrograde or absence of ejaculation Hypospadias Congenital: Due to + Undeveloped penile(?) urethra undescended testes; spermatogenesis is ERRORS IN THE SEMINAL FLUID depressed. Hypospadias + Undeveloped Low fructose content penile(?) urethra High prostaglandin Thermal factor: content Varicocele Unusually low volume of ejaculation  ○ Reduction of weight in obese. MALE INFERTILITY ○ Avoidance of alcohol and heavy Problem with sexual function (e.g. difficulty smoking. with ejaculation, reduced sexual desire) ○ Avoidance of occupation that may Pain and swelling in the testicle area elevate testicular temperature. recurrent respiratory tract infection Decrease facial or body hair Avoiding medications having a low sperm count ○ Medication that interferes with Gynecomastia spermatogenesis such as beta-blockers, Inability to smell antidepressants, cytotoxic drugs, and cimetidine should be avoided. DIAGNOSIS & EXAMINATION (MALE INFERTILITY) Medication to treat specific causes: ○ HCG, HMG for hypogonadism. ○ Dopamine agonists to improve low libido ○ Clomiphene citrate ○ Antibiotics for genital tract infection History collection Specific treatment: Physical examination: General appearance ○ Includes intrauterine insemination, In of external genitalia vitro fertilization, intracytoplasmic Semen analysis test: Semen volume, sperm sperm injection motility, and culture. Genetic test: Sex chromosome and somatic SURGICAL TREATMENT mutation. Endocrine test: Serum testosterone, serum LH, and FSH TREATMENT OF MALE INFERTILITY Vasovasostomy: a surgical procedure in which the effects of a vasectomy are reversed. (vas deferens sewn together) Treatment of the male partner is indicated in A minor surgical procedure to allow men who extreme oligospermia, azospermia, low-volume have had vasectomies to father children again ejaculation, and impotency. Allows men who have had vasectomies to father children again. May consists of Creates an opening between the separated - Improvement of general health ends of the vas deferens. - Avoiding specific medications - Medications to treat specific causes - Specific treatment Female Infertility - Surgical management Improvement of general health:  Causes of female infertility: - Ovulation problems (no ovulation etc.) + anovulation - hindi pa talaga nagkakaroon) - Fallopian tube damage Risk factors: - Genetics: Turner syndrome (44=XO) OVULATION PROBLEMS A hormonal imbalance: FSH or LH secretion. Anovulation Polycystic ovarian disease Eating disorders such as anorexia or bulimia. - Laboratory test: Measurement of + Anorexia is self-starvation. FSH and progesterone. An endometrial (underweight) biopsy is performed to verify ovulation. + Bulimia is a disorder in which a - Hysterosalpingography person eats large amounts of food - Laparoscopy (“bingeing”) and then rids the body of - Pap smear to check for signs of that food before it can be absorbed infection. (“purging”). (normal weight/stable) Stress HYSTEROSALPINGOGRAPHY Alcohol or drug use Intense exercise that causes a loss of body fat. FALLOPIAN TUBE DAMAGE Previous infection due to gonorrhea. (STD) + Pelvic Inflammatory Disease (PID): pain in the lower back region + in male, there's foul odor discharge Fibroids Endometriosis: Appearance of endometrial an X-ray procedure that is used to view the tissue outside the womb. Causes pain. inside of the uterus and fallopian tubes Ectopic pregnancy + x-ray dye - used to see the blockage A congenital effect RISK FACTOR LAPAROSCOPY - Characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of negative outcomes. - Age, poor diet, and being over or underweight. DIAGNOSIS a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. PAP SMEAR  ○ Follicle-stimulating hormones ○ Gonadotrophin-releasing hormone analog ○ Bromocriptine. A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. Pap smear involves collecting cells from your cervix — the lower, narrow end of your uterus that's at the top of your vagina + Start of Pap Smear: 20-21 years old if it's sexually active (required) + more active = lesser year gap Tissue removal: This surgery removes endometrial or pelvic adhesions with lasers or TREATMENT ablation. Tubal surgeries: If fallopian tubes are blocked or filled with fluid, tubal surgery improves changes of becoming pregnant. Laparoscopic surgery: Surgery is performed to remove adhesions and create a new tubal opening. Salpingectomy: Improve chances of pregnancy with in vitro fertilization. Treatment of female infertility consists of fertility restoration drugs, fertility restoration surgeries, and assisted reproductive SALPINGECTOMY technologies (ART). Treatment is usually non-specific. Assisted Reproductive Technology (ART) FERTILITY RESTORATION DRUGS ART: Involves removing eggs from a woman’s body and mixing with sperm in the laboratory. (manipulation of eggs and sperms) Involves: - IUI - IVF - TESA - Zygote intrafallopian transfer (ZIFT) - Gamete intrafallopian transfer (GIFT) To stimulate ovulation. Drugs are: - Intracytoplasmic sperm injection ○ Clomiphene citrate (ICSI) ○ Human menopausal gonadotrophins ASSISTED REPRODUCTIVE: The sperm is placed directly into the uterus using a small catheter. The goal of this treatment is to improve the chances of fertilization by increasing the number of healthy sperm that reach the fallopian tubes when the woman is most fertile. + IUI is still invivo (loob) + IUI can be performed immediately after TESA Advanced techniques which are used to bring IN VITRO FERTILIZATION eggs and sperms together. All fertility treatments in which both eggs and embryos are handled. + Manipulation of the eggs and sperms TESA: Testicular Sperm Aspiration A process by which an egg is fertilized by sperm outside the body. surgical sperm retrieving procedure, In vitro = in glass performed when the male has viable sperm During in vitro fertilization, mature eggs are quality but is unable to ejaculate during sex or collected from ovaries and fertilized by sperm masturbation. in a lab. Then a procedure is done to place one or more of the fertilized eggs, called embryos, in a uterus, which is where babies develop. One full cycle of IVF takes about 2 to 3 weeks. STEPS: 1. Ovarian stimulation (hormone therapy) + In order to ovulate more than normal. Need to fertility up the women to produce than man + Women only produce 1 egg per month. Need more eggs to produce every month which is why more FSH and LH is needed Intrauterine Insemination (IUI) 2. Egg pick up 3. Sperm preparation 4. Egg fertilization + Sperm and egg put in a petri dish + Test tube baby is not advisable + Eggs is washed (to ensure no semen) 5. Embryo development + Ready for implantation 6. Embryo transfer (to uterus) A procedure in which a catheter is inserted + IVF price - ranges 100 - 150k (misc. no through the cervix into the uterus to deposit a included: surrogate mother etc.) sperm sample directly into the uterus. *Louise Joy Brown is an English woman who was the first human to have been born after conception by an In Vitro fertilization experiment. Her birth, following a procedure pioneered in Britain, has been lauded among "the most remarkable medical breakthroughs of the 20th Century". Intracytoplasmic sperm injection (ICSI) Gamete intrafallopian transfer (GIFT) ICSI is the most successful form of treatment for couples who are infertile. ICSI only requires one sperm which is injected directly into the egg and the fertilized egg is transferred to the uterus. Involves transferring eggs and sperm into the + option if IVF is not successful women’s fallopian tubes so fertilization occurs IVF vs ICSI in the woman’s body. Gamete intrafallopian transfer (GIFT) uses multiple eggs collected from the ovaries. The eggs are placed into a thin flexible tube (catheter) along with the sperm to be used. The gametes (both eggs and sperm) are then injected into the fallopian tubes using a surgical procedure called laparoscopy. + hinatid sa mismo sa site of fertilization IVF: Self-employed penetration sperm in Egg after addition process sperm. ICSI: Injection of a sperm into a Egg under microscopic Zygote intrafallopian transfer (ZIFT) ZIFT is an ART designed to transfer the fertilized embryo into the fallopian tube instead of the uterus The zygote is placed in the fallopian tube through which it will reach into the uterus It is similar to IUF + sa pathway, not im the site of fertilization exactly EEEENNNDD!!!! FINALLY!! 💊💊💊