Elmaz Korimbocus
Control of Fertility
Some methods of contraception do not depend on remembering to take or use contraception. Once someone has been given one of these methods they do not have to think about contraception for as long as the method lasts. They are:
* Contraceptive injection
* Implant
* IUS
* IUD
* Female and male sterilisation
The Combined Pill
The combined pill is usually just called the pill. It contains two hormones - oestrogen and progestogen. These are similar to the natural hormones women produce in their ovaries. There are a variety of types of combined pill.
How does the pill work?
The main way the pill works is:
* It stops the ovaries releasing an egg each month (ovulation).
* It thickens the mucus from the cervix. This makes it difficult for sperm to move through it and reach an egg.
* It also makes the lining of the womb thinner so it is less likely to accept a fertilised egg.
What are the advantages of the pill?
Some of the advantages of the pill are, it:
* Does not interfere with sex
* usually makes a woman's period shorter, lighter and less painful
* can help with pre-menstrual symptoms
* protects against two types of cancer - cancer of the ovary and cancer of the womb
* protects against some pelvic infections
* reduces the risk of fibroids (tumours in the womb that are not cancer), ovarian cysts and breast disease that is not cancer
What are the disadvantages of the pill?
Women may get temporary side-effects when they first start the pill. These side-effects include:
* headaches
* weight gain or loss
* nausea
* breast tenderness
* bleeding between periods
* mood changes
* The pill may increase their blood pressure
* The pill does not protect against sexually transmitted infections so they may need to use condoms as well.
Contraceptive Injections
Progestogen-only injections are very effective, long-term hormonal methods of contraception. One advantage these contraceptives have over other hormonal methods of contraception, such as the pill, is that women do not have to remember to take them every day. Once they have an injection, they should be protected from pregnancy for as long as they are in place.
How do contraceptive injections work?
Exactly like the way in which the combined pill works, this is described above.
What are the advantages of contraceptive injections?
* Women do not have to think about contraception for as long as the injection lasts.
* They do not interfere with sex.
* They can be used if they are breastfeeding.
* They give some protection against cancer of the womb.
* They give some protection against pelvic inflammatory disease.
* They are useful if they cannot take oestrogen, like those in the combined pill.
What are the disadvantages of contraceptive injections?
* Their periods will probably change. At first, bleeding can be irregular and may last for longer than usual, or periods may stop altogether. A few women have frequent light bleeding, but is not harmful.
* Irregular bleeding may continue for some months after injections are stopped.
* Other possible side-effects include headaches, acne, tender breasts, mood swings and bloating.
* The injection works for 12 or 8 weeks, depending on the type. It cannot be removed from the body, so if there are any side-effects, they may continue during this time and for some time afterwards.
* Periods, and fertility, can return immediately.
* Contraceptive injections do not protect against sexually transmitted infections, so, again, a condom may have to use as well.
The Intrauterine Device (IUD)
An IUD is a small plastic and copper device that is fitted into the womb. It has one or two soft threads on the end. These thin threads come through the opening at the neck of the womb (cervix) into the top of the vagina. IUDs should only be fitted by a trained doctor or nurse. An IUD can stay in for three to ten years, depending on type. An IUD ...
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* Contraceptive injections do not protect against sexually transmitted infections, so, again, a condom may have to use as well.
The Intrauterine Device (IUD)
An IUD is a small plastic and copper device that is fitted into the womb. It has one or two soft threads on the end. These thin threads come through the opening at the neck of the womb (cervix) into the top of the vagina. IUDs should only be fitted by a trained doctor or nurse. An IUD can stay in for three to ten years, depending on type. An IUD used to be called a 'coil'.
How does an IUD work?
The main way an IUD works is to stop sperm reaching an egg. It may also do the following:
* Make the egg move more slowly along the fallopian tube.
* Stop the egg from settling in the womb.
What are the advantages of an IUD?
* It works as soon as it is put in.
* Contraception does not have to be an issue for as long as it is in place.
* It works for three to ten years depending on type.
* It does not interfere with sex.
What are the disadvantages of an IUD?
* Periods may be heavier, or longer or more painful.
* There is a very small chance of getting an infection during the first 20 days after an IUD is put in.
* The IUD can be pushed out by the womb, expulsion, or it can move, displacement.
* Rarely, an IUD might go through, perforate, the womb or cervix when it is fitted. If this happens, the IUD may have to be removed by surgery.
* There is a small risk of having an ectopic pregnancy. This is when the pregnancy develops outside your womb, usually in a fallopian tube. Although this is rare, it is dangerous.
* An IUD does not protect against sexually transmitted infections, so a condom may be necessary.
Male and Female Condoms
Male and female condoms are barrier methods of contraception. They stop sperm meeting an egg. A male condom fits over a man's erect penis and is made of very thin latex (rubber) or polyurethane (plastic). A female condom is made of very thin polyurethane. It is put into the vagina and lines it.
What are the advantages of condoms?
* Only needed when having sex.
* They may give some protection to both partners from some sexually transmitted infections, including HIV.
* There are no side-effects from using condoms.
* Male condoms are easily available.
* A female condom can be put in any time before sex.
What are the disadvantages of condoms?
* A male condom can sometimes slip off or split.
* Some people are allergic to latex, though this is rare.
* When using a male condom, the man has to pull out with the condom still on as soon as he has ejaculated. He must be careful not to spill any semen.
* When using a female condom, you need to make sure the man's penis enters the condom and not between the vagina and the condom. Also, the open end must stay outside the vagina during sex.
* Female condoms are not widely available free of charge and are expensive to buy.
The Progestogen-only Pill (POP)
This pill contains a progestogen hormone which is similar to the natural progesterone women produce in their ovaries. Progestogen-only pills are different to combined pills because they do not contain any oestrogen.
How does the POP work?
Again, this works in the exact same way as the combined pill, and the contraceptive injection.
What are the advantages of the POP?
* There are no serious side-effects with the POP.
* It does not interfere with sex.
* Can be used if breastfeeding.
* It is useful if you cannot take oestrogen, like those found in the combined pill.
* It may help with pre-menstrual tension and painful periods.
What are the disadvantages of the POP?
* Periods may stop altogether or be irregular, light, or more frequent.
* Temporary side-effects such as acne and tender breasts may occur.
* Some women may develop small fluid-filled cysts on their ovaries. These are not dangerous and do not usually need to be treated. Often there are no symptoms, but some women may have pelvic pain. These cysts usually disappear without treatment.
* If pregnancy does happen while you are taking the POP, there is a small risk of having an ectopic pregnancy. This is when the pregnancy develops outside your womb, usually in a fallopian tube.
* Again, the POP does not protect against sexually transmitted infections.
Contraceptive Implant
An implant is a small flexible tube(s) which is placed just under the skin. It releases a progestogen hormone over a number of years.
How does an implant work?
Once again, it works very similarly to the other contraception above: the combined pill, the contraceptive injection and the POP.
What are the advantages of an implant?
Again, similar to the above contraception:-
* There is no worry of contraception, for as long as it is in place.
* It does not interfere with sex.
* Normal level of fertility will return as soon as the implant is taken out.
* It offers some protection against pelvic inflammatory disease.
What are the disadvantages of an implant?
* The menstrual cycle changes. In the first year of using an implant, most women have irregular bleeding.
* Other possible side-effects include headaches, acne, putting on weight, tender breasts and bloating.
* Very rarely, having the implant put in can cause an infection in the arm.
* It can sometimes be difficult to remove the implant.
* Some women may develop small fluid-filled cysts on their ovaries. The cysts are not dangerous and do not usually need to be treated. Often there are no symptoms, but some women may have pelvic pain.
The Intrauterine System (IUS)
An IUS is a small T-shaped plastic device which contains the hormone progestogen. It is inserted into the womb. The IUS slowly releases the progestogen hormone.
How does an IUS work?
In the same way as the combined pill, details on page 1.
What are the advantages of an IUS?
* It is a highly effective method.
* It works for five years.
* It does not interfere with sex.
* An IUS usually reduces or gets rid of period pain.
* Usual fertility returns quickly when the IUS is removed.
What are the disadvantages of an IUS?
They are similar to the IUD, details on page 3:-
* Most women have slight irregular bleeding between their periods, for the first three months or so.
* Some women may have cysts on their ovaries in the first few months.
* The womb can push the IUS out (expulsion) or it can move (displacement).
* Rarely, the IUS might go through (perforate) the womb or cervix when it is fitted.
Diaphragms and Caps
Diaphragms and caps are barrier methods of contraception. They fit inside the vagina and cover your cervix. Vaginal diaphragms are circular domes made of thin, soft rubber with a flexible rim. Cervical caps are smaller. To be effective, diaphragms and caps need to be used with a spermicide. Spermicides are chemicals which destroy sperm.
How does a diaphragm or cap work?
A diaphragm or cap stops sperm reaching an egg. It covers the cervix while the spermicide kills any sperm.
What are the different types of diaphragm and cap?
There are three types of vaginal diaphragm: flat, coil, or arcing spring. There are also three types of cervical cap: vault, cervical and vimule.
What are the advantages of a diaphragm or cap?
* They only have to be used when having sex.
* It has no serious health risks.
* There is control of contraception.
* It may give some protection against cervical cancer and some sexually transmitted infections.
What are the disadvantages of a diaphragm or cap?
* Cystitis can be a problem for some women who use a diaphragm.
* The rubber or spermicide can cause an irritation in some women and their partners.
Female and Male Sterilisation (vasectomy)
Sterilisation works by stopping the egg and the sperm meeting. This is done by blocking the fallopian tubes, which carry an egg from the ovary to the womb, in women or the vas deferens, the tube that carries sperm from the testicles to the penis, in men. Sterilisation is only for people who are sure they never want children or do not want more children. Sterilisation is a permanent method of contraception. There is an operation to reverse sterilisation, but it is complicated, expensive and may not work.
What is a vasectomy? The tubes, vas deferens, that carry sperm from your testicles to your penis are cut or blocked.
What is female sterilisation? Your fallopian tubes are cut, sealed or blocked by an operation. This stops the egg and sperm meeting.
What are the advantages of sterilisation?
* It is a permanent method of contraception.
* Male sterilisation is a simple operation and takes about 10-15 minutes. It is more effective than female sterilisation.
What are the disadvantages of sterilisation?
* After a vasectomy it usually takes a few months for all the sperm to disappear from your semen.
* Female sterilisation involves a small operation and usually a general anaesthetic.
For both male and female sterilisation:
* The tubes may rejoin and you will be fertile again. This is not common.
* Sterilisation cannot be easily reversed.
* Sterilisation does not protect you against sexually transmitted infections.
All of the above are methods of contraception, which prevents a women becoming pregnant. In effect, it renders her from her fertility, her ability to become pregnant. Using such techniques is medically safe and above board, however, the use of contraception is sometimes not agreeable. It may not comply with religious views, 'stopping the way god works', 'not letting things take there natural course'.
IVF
Around 6,000 babies a year are born in the UK to otherwise infertile couples as a result of in vitro fertilisation. But the 'techniques used often arouse huge controversy and some say the process can falsely raise would-be parents' hopes since it only has a success rate of around 15%'. There have also been cases of fertilised eggs being mixed up in the laboratory and the wrong embryo being implanted in the woman, leading to fears about how the process is carried out.
IVF was developed in the 1970s. The first British test tube baby was Louise Brown, who was born in 1977 and recently celebrated her 21st birthday. Some 30,000 test tube babies have been born in the UK since then.
Invitro fertilisation involves being given fertility drugs to stimulate the ovaries to develop several mature eggs for fertilisation. Normally, only one egg is released a month. A variety of drugs are used.
By monitoring the blood hormone levels, a doctor can detect when the eggs are mature; an ultrasound confirms that the eggs are ready to be retrieved. Shortly after, a local anaesthetic is given, and the doctor will remove the eggs using a fine, hollow needle. The partner's sperm is then combined with the eggs in a dish containing a nutrient medium, which is then cultured in an incubator.
Two days later, any fertilised eggs will each have become a ball of cells called an embryo. Usually, two or three embryos are transferred into the uterus through the cervix with a thin catheter. To avoid the risk of a multiple pregnancy, no more than three embryos can be legally transferred. Extra embryos, if there are any, may be frozen for future use in case this cycle does not succeed.
In a successful cycle, one or more embryos will implant in the uterine wall and continue to grow. The risk of a multiple birth, which brings added risks for the health of the babies, is relatively high. Around 25% of couples who have had successful IVF treatment will have twins, compared to approximately one in 90% of the general population. Almost half of all IVF babies come from a multiple birth.
This treatment option gives women with blocked, damaged, or missing fallopian tubes a chance at having a baby.
Success rate
Outcomes vary, depending on your particular fertility problem and on your age -younger women usually have healthier eggs and higher success rates. The national average success rate is around 17%.
Disadvantages of IVF
As the procedure often places more than one embryo in a woman's uterus, they have a higher than usual chance of having twins or triplets. Though many couples consider this a blessing, multiple pregnancies do increase the risk of miscarriage and other complications. The fertility drugs used to stimulate egg production can have severe side effects. Cancer may be another concern. IVF treatments also increase a woman's risk of ectopic pregnancy, where an embryo implants in a fallopian tube or a woman's abdominal cavity.
The politics of IVF
* Only 18% of IVF treatment is funded by the NHS and waiting times can differ greatly.
* It can cost up to £2,000 per cycle for a couple to go private.
* Most couples have three cycles at an average cost of £3,420.
* One way of getting free treatment is for women to donate their eggs to other infertile couples.
* Opponents of IVF argue that it 'falsely raises would-be parents' hopes that they will be able to have a baby when the chances are not that high.'
* They also argue that it can be a 'traumatic experience to go through repeated IVF attempts, only to find that the woman does not get pregnant'.
* Another possible drawback is the fact that IVF treatment increases the chance of having multiple births which the couple may not have planned for.
* Some believe fertility drugs could cause ovarian cancer.
Bibliography
* Various leaflets from a Family Planning clinic
* BBC news articles on IVF treatment
* Family Planning Association website
* Various contraception websites
