1. BY
Ms.JYOTI VERMA
M.Sc (N) 1st YEAR

2. OBJECTIVES
• Introduction
• Need of contraception
• Reasons of unintended pregnancies
• Importance
• Currently available methods
1.temporary methods
Natural methods
• Basal body temperature
• Cervical mucus
• Symtothermal method

3. • Ovulation awareness
• Lactation amenorrhea method
• Coitus interrupts
barrier method
• Condoms
• diaphragms
• Cervical caps
• Vaginally inserted spermicidal products
IUD
• Copper T
• Progestasert
• Lippes loop
hormonal method

4. • Oral contraceptive pills
Problems associated with OCP
Advantages of continuous use
• male hormonal contraception
2.permanent method
• Vasectomy
• Tubectomy
3.immunocontraception
Newer targets
Contraceptive vaccine

5. INTRODUCTION
India’s population is increasing very explosive. It
contributes one fifth of the world’s population by
having more than one billion people. Population
explosion is found to be the main reason for
shortages of resources and neutralization of the
impact of progress made in various
developmental sectors.

6. NEED
• World’s population expected to reach 9 billion by
2050.
• India accounts for 17%of worlds population
• 21%of all pregnancies resulting live births are
unplanned.
• Around 2/5th of all pregnancies are unintended.
• If unmet need for contraception was met, we can
avoid
55 million unwanted pregnancies (71%)
22 million fewer abortions
90,000 fewer maternal deaths.

7. REASONS OF UNINTENDED
PREGNANCIES
• Unawareness
• Use of traditional methods
• Side effects
• High cost
• Difficult mode of delivery
• Fear of irreversibility of fertility
• Length of effectiveness(inconvenience to take
pills daily)
• Fear of problems associated with amenorrhoea.

8. IMPORTANCE
• Slow the pace of population growth
• Decrease abortion related complications and
deaths
• Cut down maternal care costs
• Promote better maternal health
• Improve the health of children through
provision of better nutrition and other care.

9. AVAILABLE METHODS
METHODS
TEMPORARY PERMANENT IMMUNOCONTRACEPTION
NATURAL BARRIER IUD’S HORMONAL
METHODS METHODS
• NATURAL-Abstinence and withdrawal
• BARRIER –condoms, diaphragms and cervical caps, vaginally
inserted spermicidal products.

10. • IUD’S-copper-T, Progestasert and lippes loop
• HORMONAL-birth control pills, mirenal (IUD), implants(rod),
injectables (shot), orthoevra (patch), nuva ring(ring)
• MALE HORMONAL CONTRACEPTIVES-oral formulations, depot
injections, implants, transdermal gels and patches

11. TEMPORARY METHODS

12. 1.NATURAL METHOD
• No introduction of chemical of foreign material
into the body.
• Practice may be due to religious belief, “natural”
way is best for them.
• Effectiveness varies greatly, depends on couples
ability to refrain from having sex on fertile days.
• Failure rates about 25%.
• Poses no risk to foetus.

13. TYPES
1. Rhythm (calendar) method.
2.basal body temperature (BBT)
3. Ovulation or cervical mucus (billings method).
4.Sympto thermal method
5.Ovulation awareness
6.Lactation amenorrhea method
7. Coitus interrupts.

14. RHYTHM (CALENDAR) METHOD
• Abstaining from coitus on the days in relation
with menstrual cycle when a woman is most
likely to conceive (3 or 4 days before until 3 or 4
days after ovulation).
• Woman keeps a diary of 6 menstrual cycles.

15. BASAL BODY TEMPERATURE (BBT)
• Identifying fertile and infertile period of a
woman’s cycle by daily taking and recording of
the rise in body temperature during and after
ovulation.
• Just before ovulation, a woman’s BBT falls about
0.5 F.at time of ovulation, her BBT rises a full
degree.
• This higher level is maintained the rest of
menstrual cycle.

16. • How: woman takes her temp each morning
immediately after walking, before she undertake
any activity.
• She has ovulated, slight drip in temp followed by
• Usually combined with calendar method
• Ideal failure rate :9%

17. CERVICAL MUCUS/BILLING/OVULATION
• Use changes in cervical mucus with ovulation.
• Woman: must be conscientious in assessing her
vaginal secretions.
• ideal failure rate :3%
Before ovulation
• thick and does not stretch

18. With ovulation (peak day)
• Copious, thin, watery, transparent, feels slippery
and stretches at least 1 inch before the strand
breaks=property known as “spinnbarkeit”. These
are fertile days.

19. SYMPTOTHERMAL METHOD
• Combines the cervical mucus and BBT methods.
• A watch temp daily and analyzes cervical mucus
daily.
• Couple must abstain from intercourse until 3
days after rise in temp or 4th day after peak of
mucus change.
• more effective than BBT or CM method alone
• ideal failure rate:2%

20. OVULATION AWARENESS
• Use an ovulation detection kit.
• These kits detect the midcycle surge of
luteinizing hormone (LH) that can be detected in
urine 12 to 24 hours before ovulation.
• 98% to 100% accurate in predicting ovulation
• expensive

21. LACTATION AMENORRHEA METHOD
• Temporary introductory postpartum method of
postponing pregnancy based on physiological
infertility experienced by breast feeding women.
• Universally available to all postpartum
breastfeeding women.
• no other FP commodities required
• Contributes to improve maternal and child
health and nutrition.

22. COITUS INTERRUPTUS
• One of oldest known methods of contraception.
• Couple proceeds with coitus until the moment of
ejaculation.
• Then the man withdraws and spermatozoa are
ejaculated.

23. 2.BARRIER METHOD
• Placement of a chemical or other barrier
between the cervix and advancing sperm so that
sperm cannot enter the uterus or fallopian tubes
and fertilize the ovum.
• Major advantage: lack hormonal side effects
associated with COCs.
• Failure rates: higher and sexual enjoyment may
be lessened.

24. A.CONDOMS
MALE CONDOM
• Condom-a latex rubber or synthetic sheath,
placed over the erect penis before coitus begins.
• Spermatozoa are deposited in the tip of condom
• Latex condoms-potential prevention against
spread of STIs, major part of fight to prevent
infection with human immunodeficiency virus
(HIV).

25. FEMALE CONDOMS
• Latex sheaths made of polyurethane and
prelubricated with a spermicide.
• Inner ring (closed end)) = covers cervix; outer
ring (open end) =rests against vaginal opening.
• May be inserted any time before sexual activity
begins: then remove after ejaculation occurs.
• Like male condoms, one time use only. Difficult
to use.
• Offer protection against both conception and
STI.
• More expensive than male condoms

27. B.DIAPHRAGMS
• Circular rubber disk placed over cervix before
intercourse. Usually with spermicidal gel.
• Fitted initially by physician, nurse or midwife.
• Kept in place at least 6hrs after coitus.
• Should not stay for at least 24 hrs-may cause
cervical inflammation (erosion) or urethral
irritation.

28. How to use-
• inserted into the vagina (rim coated with
spermicidal gel) by sliding it along the posterior
wall and pressing it up against the cervix.
• Check with a finger after insertion to be certain
that its fitted well by palpating the cervical as
through diaphragm.
• Remove by inserting a finger through diaphragm
and loosening by pressing against the anterior
rim and then withdrawing it vaginally.

29. • After use, washes in mild soap and water, dries
gently and stores in its protective case. May last
for 2 to 3 years.
Contraindication-
• history of recurrent UTIs
• If uterus is prolapsed, retroflexed, or ante flexed.
• With acute cervicitis.
• Allergy to rubber or spermicidal.
• History of toxic shock syndrome-a
staphylococcal infection introduced through the
vagina.

30. C.CERVICAL CAPS
• Made of soft rubber, shaped like a thimble, and
fit snugly over the uterine cervix.
• Failure rate as high as 32%.
• Readily dislodged.

31. Contraindicated to:
• An abnormally short or long cervix.
• A previous abnormal pap smear.
• A history of TSS.
• An allergy to latex or spermicide.
• A history of PID, cervicitis, or papilloma virus
infection.
• A history of cervical cancer
• Undiagnosed vaginal bleeding

32. D. VAGINALLY INSERTED SPERMICIDAL
PRODUCTS.
• Cause death to spermatozoa before they enter
the cervix.
• Also change the vaginal pH to a strong acid level
(not conducive to sperm survival)
• Purchased w/o prescription
• Increase other methods effectiveness
• Available in various preparations: gels, creams,
sponges, films, foams and suppositories.

33. How to use-
• Gels or creams are inserted into the vagina
before coitus with an applicator.
• To be effective: must be 1 hour before coitus,
should not douche for 6 hours after, to ensure
that the agent has completed its spermicidal
action.
• Contraindicated: with acute cervicitis and
inconveniency.
• Adolescent usually uses: no parental permission
or extensive expense.

34. 3.INTRAUTERINE DEVICES
• A small plastic object inserted into the uterus
through the vagina.
• 1980’s very popular in US but decrease due to
lawsuits with increase incidence of PID
(infection of the pelvic organ).
• IUD prevents fertilization by creating a local
sterile inflammatory condition that prevents
implantation.

35. • Fitted by a physician, nurse, midwife
(ambulatory setting).
• Inserted after menstrual flow or after childbirth.
• Advantages: only one insertion, does not require
daily attention, does not interfere with sexual
enjoyment.
• Check: IUD string is in place and yearly pelvic
exam.

36. TYPES
There are two types of IUD, non-medicated and
medicated.
• First generation IUDs:-include lippes loop,
Margulies spiral, saf-T-coil and Dana super.
• Of these, the lippes loop was widely used in
India since 1965, when it was introduced in the
national family planning program. The non-
medicated IUDs are often referred to as first
generation IUDs.

37. • Second generation IUDs: were introduced in the
1970s. It was found that metallic copper had a
strong antifertility effect (zipper, 1969).the
addition of copper has made it possible to
develop smaller devices, which are easier to fit,
even in nulliparous women. a number of copper
bearing devices are now available:

38. Earlier devices:
• Copper-7.
• Copper-T-200.
Newer devices:
• Variants of the T device:
• Copper T-220C (Cu T-220C)
• Cu T-380A or Ag.
• Nova T.
• Multiload devices:
• Multiload copper-250 (ML cu-250)
• ML Cu-375.

39. 2.MODE OF ACTION:
• IUD
• Medicated IUDs
• Hormone
TIME OF INSERTION
• During menstruation or within 10 days of the
beginning of a menstrual period. During this
period, insertion is technically easy because the
diameter of the cervical canal is greater at this
time.

40. • Postpartum insertion is done 6-8 weeks after
delivery.post puerperal insertion has several
advantages. It can be combined with the follow –
up examination of the woman and her child.
• Post abortion insertion can be taken up
immediately after a legally induced first
trimester abortion.
• Immediate postpartum insertion of IUD can also
be done during the 1st week after delivery before
the woman leaves the hospital.

41. SIDE EFFECTS AND COMPLICATION:
• Bleeding
• Pain
• Pelvic infection
• Uterine perforation
• Pregnancy may occur in 3-5 per hundred users
per year.
• Ectopic pregnancy
• Expulsion
• Fertility after removal
• Cancer or teratogenesis.

42. INDICATIONS FOR REMOVAL OF IUD
• Persistent excessive regular or irregular bleeding
and /or severe cramp-like pain in the lower
abdomen.
• Flaring up of salpingitis.
• Perforation of the uterus with the device in the
peritoneal cavity.
• Downward displacement of the device into the
cervical canal or partly protruding outside into
the vagina.
• Patient desirous of a baby.
• Missing thread.

43. CONTRAINDICATIONS:
• Has or history of PID
• Risk for toxic shock syndrome (TSS: a
staphylococcal infection from the use of
tampons).
• Multiple sexual partners: risk for STIs
• Never been pregnant
• Uterus distorted in shape
• Severe dysmenorrhoea, menorrhagia, history of
ectopic pregnancy.
• Anaemia.

44. COPPER T
The copper T is the T-shaped plastic frame has
copper wire coiled around the stem and two
copper sleeves along the arms that continuously
release copper to bathe the lining of the uterus.

45. FEATURES
• Small device that fits inside the womb.
• Very effective.
• Keeps working up to 10 years depending on type.
• We can remove it for you whenever you want.
• Very safe.
• Might increase menstrual bleeding or cramps.
• No protection against STIs or HIV/AIDS.

46. CONTRAINDICATIONS
• May be pregnant.
• Gave birth recently (more than 2 days).
• At high risk for STIs.
• Unusual vaginal bleeding recently.
• Infection or problem in female organs.

47. SIDE-EFFECTS
After insertion:-
• some cramps for several days.
• Some spotting for a few weeks.
Other common side-effects:-
• longer and heavier periods.
• Bleeding or spotting between periods.
• More cramps or pain during periods.

48. PROGESTASERT
Intrauterine device with progesterone releases
the hormone levonorgestrel. It is used for birth
control, heavy menstrual periods and to prevent
excessive build of the lining of the uterus in
those on estrogens replacement therapy. It is
one of the most effective forms of birth control
with a one – year failure rate around 0.2%.the
device is placed in the uterus and lasts three to
five years.

49. USES
• Birth control
• Heavy menstrual periods
• Endometriosis and chronic pelvic pain
• Dysmenorrhoea

50. ADVANTAGES
• Considered one of most effective forms of
reversible birth control.
• Can be used while breastfeeding.
• No preparations needed before sex, through
routine checking of the device strings by patient
and physician is advised to ensure proper
placement remains intact.
• May experience lighter periods.
• Effective for up to three to five years.

51. DISADVANTAGES
• Irregular periods and spotting between periods
often occurs after insertion.
• Mild to moderate discomfort experienced during
insertion procedure, including cramping or
backache.

52. CONTRAINDICATION
• Are, or think they may be, pregnant.
• Untreated cervical or uterine cancer.
• May have breast cancer.
• Abnormalities of the cervix or uterus.
• Pelvic inflammatory disease within past three
months.
• Liver disease or tumour.
• Have an allergy to levonorgestrel.

53. SIDE EFFECTS
• Weight gain
• Headache
• Irregular menstrual periods
• Cramping and pain
• Pregnancy complication
• Infection
• Ovarian cysts

54. Mental health changes
• nervousness, depressed mood and mood swings.
• Nausea
• Acne
• Lower abdominal or back pain.
• Irregular periods
• Benign ovarian cysts
• Pelvic pain
• Depression

55. LIPPES LOOP
• It is a type of intrauterine contraceptive device
made of inert plastic in a double s-shaped, which
can be inserted for long periods.
• Lippes loop intrauterine device was first
introduced in 1962.it was a plastic double “S”
loop, a trapezoidal shaped IUD that closely fit
the contours of the uterine cavity, thereby
reducing the incidence of expulsion.

56. 4.HORMONAL METHOD
• All hormonal birth control measures act via
same mechanism:
• Stops ovulation
• Prevents uterus lining from build up
• Making the cervical mucus thick to prevent
penetration of sperm.

57. A.ORAL CONTRACEPTIVE PILLS
• Monophasic pills
• Biphasic pills
• Triphasic pills
• Progesterone only pills

58. MONOPHASIC PILLS
TYPE ESTROGEN PROGESTIN
Mala N EE 30ug Norgestrel 300ug
Mala D EE 3oug Levonorgestrel 150ug
Ovral L EE 30ug Levonorgestrel 150ug
Ovral G EE 50ug Levonorgestrel 150ug
Novelon EE 30ug Desogestrel 150ug
Femilon EE 20ug Desogestrel 150ug
Loette EE 20ug Levonorgestrel 100ug
Yasmin EE 30ug Drospirenone 3mg

59. MULTIPHASIC COC
• Comparable in efficacy to monophonic pills.
• It was introduced with an aim of reducing the
total dose of hormones per cycle and to decrease
BTB.
• Better carbohydrate and lipid profile.

60. PROGESTIN ONLY PILLS
• Reducing the dose to the lowest possible without
reducing efficacy (10 fold reduction).
• Norethisterone 350microgram.
• Norgestrel 75microgram.
• Levonorgestrel (LNG) 30microgram

61. Dosing schedule
• Started on 5th day of menstruation normally.
• 21 day of postpartum period.
• Soon after abortion.
• Extra precautions for 2 days to be taken.

62. Benefits of the progestin only pill
• POPs have no oestrogen side effects.
• POPs do not decrease breast milk production.
• A woman’s periods may be lighter, shorter and
have less cramping

63. POPs may be used by women:
• Who are breastfeeding.
• Over 35 years who smoke.
• Have a history of blood clots in the veins.
• Have migraine headaches.
• Have a higher risk of heart attack or stroke,
irregular bleeding, headache, migraine, weight
gain.

64. PROBLEMS ASSOCIATED WITH OCP
• Intermenstrual spotting
• Amenorrhoea
• Lactation suppression
• Decreased libido
• Nausea, vomiting
• Liver adenomas

65. • Gall stones
• Carbohydrate intolerance
• Abnormal lipid profile
• Headache, depression, irritability and lethargy
• Weight gain

66. FOUR PHASIC PILLS
• Estrogen-estradiol valarate along with newer
progestin is used.
• Step down doses of oestrogen and step up doses
of progestin preparation is used.

67. ADVANTAGES
• Fewer spotting days, reducing in mean blood
loss.
• Reduced breakthrough bleeding.
• More increase HDL.
• Stability in carbohydrate metabolism.
• Effective in treatment of heavy menstrual
bleeding.

68. ADVANTAGES OF CONTINUOUS USE
Decreased incidence of
• Pelvic pain
• Headaches
• Breast tenderness for women who experienced
these symptoms during the pill-free interval
• Improved control over symptoms of
endometriosis and polycystic ovary syndrome
• Greater convenience due to fewer withdrawal
bleeds per year.

69. DISADVANTAGES OF CONTINUOUS USE
• Higher cost of medicine.

70. B.INJECTABLES
1.Progrstin-only injectables:-
• Depot-medroxyprogesterone acetate
• 150 mg given IM every three months
• NET-EN: norethindrone (ornorethisterone)
enanthate, noristerat given every 2 months.
2.combined injectable contraceptives (CICs, progestin
plus oestrogen)-given monthly:
• Cyclofem (MPA, 25MG PLUS ESTRADIOL, 5MG)
• Mesigyna (50 mg norethindrone enanthate, plus 5
mg estradiol)

71. DEPO PROVERA
• Injectable sustained released preparation of
DMPA available as uniject.
• Inhibits ovulation, follicular formation, thicken
cervical mucous.
• 150 mg, in 3 months
• Delayed ovulation after discontinuation

72. side-effects
• Amenorrhea
• Weight gain
• Hair loss

73. BENEFITS
• Reliable method of birth control
• Reduced risk of endometrial cancer and pelvic
inflammatory disease (PID).
• Reduced symptoms of endometriosis, PMS and
chronic pelvic pain.
• Decreased incidence of seizures.
• Possible decreased number of sickle cell crisis.
• Periods may disappear after 9 to 12 months on
depo-provera.
• Only need to get injection every 12 weeks.

74. TRANSDERMAL DELIVERY SYSTEM
• Contraceptive patch (orth evra)
• Transdermal gel
• Transdermal spray

75. 1.ORTH EVRA (PATCH)
28 day regimen
• Replaced every week
• No patch free interval if only LNG 40microgram
is in it.
21 day regimen
• Replaced every week
• 7 day patch free interval if EE
30microgram+LNG 100microgram

76. ADVANTAGES
• Once a week dosing good compliance
• Avoid first pass metabolism
• Progestin with minimal androgenicity.

77. DISADVANTAGES
• Patch is noticeable
• High cost
• Minor skin reaction
• Room temperature storage is necessary.

78. 2.TRANSDERMAL GEL
• Nestorone (NES) a progestin is used
• Applied in dose 2.3 mg/day once for 21 days
with 7 free days.
• Antiovulatory mechanism

79. Advantages
• No skin irritation
• Regular bleeding pattern maintained
• No serious adverse effects.

80. 3. TRANSDERMAL SPRAY
• MDTS-metered dose transdermal system
• Spray delivers drug in skin with the aid of safe
enhancer’s forms reservoir in skin.
• Drug slowly absorbed in the circulation over a
period of hours.
• Antiovulatory mechanism.
Side effects-bruising at the site, breast tenderness,
tearfulness, tiredness, headaches, dizziness,
vagueness.

81. NUVA RING
• Effectiveness-92-97%
• Failure rate-1.2-1.5 %
• 21 day/7day
Advantages
• reused for a year
• reduced cost
• Excellent bleeding control.
• Rapid return of fertility
• No changes in weight.

82. Disadvantages
• Feeling of ring on place
• Difficulty in remembering to reinsert

83. 5.MALE HORMONAL CONTRACEPTIVES
• Supra-physiological dose of testosterone
suppresses testicular production of testosterone.
• Halts spermatogenesis
• May include a progestin for faster, complete
suppression
It includes:-
• Oral formulations
• Depot injections
• Implants
• Transdermal gels and patches

84. MALE PILLS
• Less androgenic desogestrel oral pill (75-
300microgm) along with long acting testosterone
injection which releases slowly.
• No effect on HDL levels.
• Maintains male characteristics and sex drive.
• 100% effective
• 1.antiandrogenic progesterone pill
• Anti androgenic progesterone cyproterone acetate in
low doses (12.5mg daily) and injectable testosterone
100mg per week for 16 weeks has known to cause
complete azoospermia in 8-10 weeks with no
biochemical ill effects

85. INJECTABLES
1.testosterone enanthate
• 200 mg weekly injections used in a multicentric
study(1986-1990)
• All men achieved azoospermia and were able to
sustain safe, reversible contraception for atleast
12 months.
• But it required high doses of testosterone,
affecting other organs like prostate, liver, bone
and muscles.

86. 2.testosterone buciclate (TB)
• Long acting testosterone ester
• Effective for 12 weeks
• Used alone or in combination with progesterone.

87. 3.testosterone undecanoate (TU)
• One of the newest and most successful
testosterone preparations.
• Longer action-bimonthly of monthly injections
• 1000mg initial dose f/b 500 mg monthly dose
were used in Chinese trials found effective for 2
years.

88. 4.progestrone+testosterone
• Oral progesterone inhibits spermatogenesis by
inhibiting gonadotrophins and physiological
replacement of testosterone is required for
sexual functions.
• Levonorgestrol pill+testosterone inj.-they are
rapid and effective to inhibit spermatogenesis
but decreased HDL levels and increased risk of
coronary heart disease.

89. IMPLANTS
• Depo-Provera 300mg 3monthly +testosterone
implants/pellets 800 mg 4 monthly

90. SIDE EFFECTS
• Mild weight gain, increase in lean muscle mass
• Acne
• Drop in HDL cholesterol level with some
androgens (so desogestrol like progesterone
should be used)
• Oligospermia (less than 1 million per ml) in all
men on trial.

91. 2.PERMANENT METHOD
(STERILIZATION)
Voluntary sterilization is a well-established
contraceptive procedure for couples desiring no
more children. Currently female sterilizations
accounts for 85% and male sterilizations for 10-
15% of all sterilizations in India .voluntary
sterilization is a surgical method whereby the
reproductive function of an individual male is
vasectomy and that on female is tubal ligation or
tubal occlusion.

92. ADVANTAGES
• It is one-time method.
• It does not require sustained motivation of the
user for its effectiveness.
• It provides the most effective protection against.
• The risk of complications is small if the
procedure is performed according to accepted
medical standards.
• It is most effective.

93. GUIDELINES
• The age of husband should not ordinarily be less
than 25 years or more than 45 years.
• The age of the wife should not be less than 20 years
or more than 45 years.
• The motivated couples must have two living children
at the time of operation.
• If the couple has three or more living children, the
lower limit of the age of the husband or wife may be
relaxed at the discretion of the operating surgeon.
• The couple knows that for all practical purposes, the
operation is reversible.

94. 1.VASECTOMY OR MALE STERLIZATION
• Vasectomy is a permanent sterilization
operation done in the male, where a segment of
vas deferens of both sides is resected and cut
ends are ligated.
• The ligated ends are then folded back on them
and sutured into position, so that the cut ends
face away from each other. It does not affect the
sperm and hormone production.

95. ADVANTAGES
• Procedure is simple and can be performed as an
outpatient or outdoor procedure.
• Complications are few.
• Failure rate is about 0.15%.
• The expenditure is minimal.

96. DRAWBACKS
• Additional contraception is needed for about 2-3
months following operation, i.e., until the semen
becomes free of sperm.
• Frigidity or impotency when occurs is mostly
psychological.
SELECTION OF CANDIDATES
• Sexually active and psychologically adjusted
husband having desired number of children is an
ideal candidate

97. POSTOPERATIVE ADVICES
• Antibiotic injection is administered as a routine and
an analgesic is prescribed.
• Weight lifting, heavy work and cycling are restricted
for about 2 weeks while usual activities can be
performed forthwith.
• To wear a scrotal support.
• The patient should report for check-up after 1 week
or earlier, if any complication arises.
• To have the stitches removed on the 5th day.
• Additional contraceptive should be used for 3
months.

98. COMPLICATIONS
Immediate :-
• Wound sepsis, which may lead to scrotal
cellulites or abscess.
• Scrotal hematoma.
Remote:-
• Frigidity or impotency
• Sperm granuloma or sperm granules caused by
accumulation of sperm.
• Autoimmune response
• Spontaneous recanalization

99. 2.FEMALE STERLIZATION
• Occlusion of the fallopian tubes in some form is
the underlying principle to achieve female
sterilization. Female sterilization also known as
tubal ligation or tubectomy is a surgical
procedure in which the fallopian tubes are
severed and sealed or ‘pinched shut’ in order to
prevent fertilization

100. METHODS OF LIGATION
• 1.occlusion method-it is for tubal ligation are
typically carried out on the isthmic position of
the fallopian tube that is the thin portion of the
tube closest to the uterus:-

101. 1. Partial salpingectomy-pomeroy technique (tying
a small loop of the tube by suture and cutting off
the top segment.
Laparoscopy and laparotomy
2.Clips-filshie clip (titanium)
hulka clip or wolf clip (steel)
• Falope rings: yoon ring (silicone)
• Electro coagulation and
cauterization

102. 2.METHOD OF TUBAL LIGATION BY
ENTRY SITES OR ROUTES
1.Laparotomy method
• Pomeroy method
• Irving tubal ligation
• Uchida method
2.Laparoscopic tubal ligation
3.Minilaparotomy
4. Vaginal tubal ligation (colpotomy)

103. TIMING OF TUBAL LIGATION
• Postpartum or puerperal tubal ligation
• Caesarean ligation
• Interval tubal ligation
• Concurrent with metatarsophalangeal (MTP)

104. ADVANTAGES
• Very effective as a method of contraception.
• Gives permanent or lifelong protection.
• Nothing to remember, no supplies needed and
no repeated clinic visits required.
• No interference with sex.
• No known long-term side effects or health risks.

105. DISADVANTAGES
• Pain for few days after surgery.
• Infection or bleeding at the incision site.
• Injury to internal organs.
Anaesthetic risks:-
• Allergic reaction or overdose of local anaesthesia
or sedation.
• Delayed recovery and side effects of general
anaesthesia.
• Reversal surgery is difficult and expensive.

106. 3.IMMUNOCONTRACEPTION

107. INTRODUCTION
• The use of the body’s natural immune defence
mechanisms to provide protection against an
unplanned pregnancy.
• It requires the production of a controlled, time-
limited and non-pathogenic immune response to
components of the reproductive process.

108. ANTI-DISEASE VACCINES
• designed to provide long-term, ideally life-long,
protection against life-threatening or
debilitating diseases;
• often the only method of protection against such
diseases;
• directed against an immunologically foreign
pathogen;
• Vaccine-induced immunity often boosted by
sub-clinical infection or exposure to the
pathogen.

109. IMMUNOCONTRACEPTIVES
• designed to provide long-term but not
permanent protection against unplanned
pregnancy;
• other methods of birth control available;
• directed against a non pathogenic cell or
hormone;
• Vaccine-induced immunity not boosted by re-
exposure to the target antigen or by pregnancy.

110. USES
• Intended for use by women and men,
throughout their reproductive lives, for them to
Delay or postpone first pregnancies;
• Space pregnancies at intervals beneficial to the
health of the mother and her infants;
• provide comparatively long-lasting but not
permanent protection on the attainment of the
desired family size

111. REASON FOR DEVELOPMENT
• To provide an additional option to current or
potential users of family planning methods and
services
• To address an unmet need in reproductive
health.

112. ADVANTAGES
• Lack of endocrine or metabolic side-effects.
• Do not require insertion of an implant or device.
• Provide long term but not permanent protection.
• Do not require storage or disposal by the user.
• Use is independent of coitus.
• Permit confidentiality of use.
• low annual cost to users and services

113. DISADVANTAGES
• Delay between administration and attainment of
effective immunity.
• Need for periodic injections.
• Individual variations in immune responses and,
therefore, in level and duration of effectiveness.
• Cannot be ‘turned off’ on demand.
• Not a barrier to sexually-transmitted
infections/HIV.
• Alleged abuse potential and other socio-political
issues

114. POSSIBLE POINTS OF INTERVENTION
• Hypothalamus-GnRH
• Pituitary-FSH and LH
• Gonads-progesterone, oestrogen and
testosterone
• Gametes-ovum and sperm
• Pre-embryo-structural and endocrine
component

115. GnRH IMMUNOCONTRACEPTIVE
• Various veterinary trials to control feral animal
populations and for immunological castration
• Clinical trial conducted in postpartum women to
prolong anovulation
• Clinical trial conducted in men with prostatic
cancer.
• Clinical trial in healthy men

116. FSH IMMUNOCONTRACEPTIVE
• Phase I clinical trial conducted in normal men to
assess immunogenicity and to assess effect on
spermatogenesis
• Prototype preparation found to be only weakly
immunogenic, some reduction in sperm
numbers and motility but no significant effect on
semen parameters

117. STEROID IMMUNOCONTRACEPTIVES
• Several studies carried out in laboratory animals
but no known clinical trials conducted to date.

118. GAMETE IMMUNOCONTRACEPTIVES
• Some cell surface antigens are unique, tissue-
specific, immunogenic and accessible to
antibodies:
• Zona pellucid antigens: used in animal control
• Sperm antigens: naturally-occurring antibodies
lead to infertility
• No known clinical trials conducted to date

119. HCG IMMUNOCONTRACEPTIVE
• Several types and formulations of hCG-based
immunocontraceptives have been studied
extensively in preclinical studies and clinical
trials sponsored by:
• National Institute of Immunology, Delhi, India
Population Council, New York, USA World
Health Organization, Geneva, Switzerland

120. NEWER TARGETS

121. HORMONAL APPROACHES
• Testosterone enanthate, testosterone undecanoate weekly
injections.
• Testosterone+progestin
• TE gel +inj DMPA
• TEinj/week+LNG oral daily
• TU inj/8week+LNG implant
• TE pellet (implant)+DMPA
• GNRH antagonist s./day +TE inj/week
Side effect-weight gain, HDL suppression, prostatic
hypertrophy
• SARM-MEN (7alpha methyl-19-norgesterone) implants
• 10 fold greater potency than testosterone
• Additional 5 alpha inhibition property (minimize prostatic
problems)

122. NON HORMONAL
• Target sertoli cell-indenopyridines (CDB4022) with
GNRH antagonist
• Spermatid sertoli cell interaction-adjudin
• HE6 epididymal duct specific protein receptor
• CRISP-1 preventing initiation of capacitation during
sperm transit and maturation
• CATSPERS-allow Ca++ entry in sperm tail
• CAMP-necessary for capacitation
• IZUMO-sperm specific membrane protein
responsible for sperm egg fusion
• RISUG-a clear gel injected in vas blocks it

123. CONTRACEPTIVE VACCINE
• Safe, effective and acceptable contraceptive vaccines may
be an attractive addition to the currently available range
of family planning methods in that they would:-
• Confer long-term (but not permanent) protection
following a single course of immunization.
• Be free of overt pharmacological activity and the
metabolic and endocrine disturbances that often
accompany other methods of birth control.
• Not require insertion of a device or implant.
• Remain effective without continuous conscious action by
the user
• Be inexpensive to manufacture.

124. ANTI-SPERM VACCINES
• Research has focused on two types of sperm
antigens:-
• Functional antigens as the enzymes known to be
required for sperm metabolism (lactic
dehydrogenase-X), involved in sperm-egg
interactions and the processes leading to
fertilization (acrosin and hyaluronidase).
• Structural antigens such as the molecules expressed
on the sperm cell membrane and which may be
involved in gamete interaction and fusion.

125. ANTI-OVUM VACCINES
• Antigen-focused on the surface antigen zona
pellucida (ZP), the jelly like glycoprotein coat
surrounding the egg.
• To date, however, no convincing data have been
presented to indicate that it can inhibit fertility
without causing an inflammatory reaction in the
ovary which might be indicative of a risk of acute
ovarian disturbances or long-term
immunopathology.

126. ANTI-CONCEPTUS VACCINES
• Placenta-specific antigens
• Structural antigens, forming part of the trophoblast cell
membrane.
• Pregnancy-specific beta1 glycoprotein (SP-1) an
antifertility effect was observed when female baboons
and cynomolgus monkeys were actively immunized with
human SP-1, in the majority of cases (50-80%), this
effect was manifested as a late abortion.
• Another placental antigen PP-5, when animal is actively
immunized with human PP-5 and a substantial reduction
in fertility was shown.
• Functional antigens, such as placental hormones, have
been evaluated.

127. HORMONAL PLACENTAL ANTIGENS
• Human chronic gonadotrophin (hCG)-
production or function of hCG can be inhibited
immunologically, the corpus luteum would
regress.
• One type of anti-hCG vaccine, developed by the
population council in new York and by the
national institute of immunology (NII) in new
Delhi, is based on the whole beta subunit of the
hormone (beta-hCG) (21,22).the other type of
anti-hCG vaccine, developed

128. with support from the WHO task force on
vaccines for fertility regulation, based on a
portion (the carboxyterminal peptide or CTP) of
the beta subunit of the hormone (beta-hCG-
CTP)
• All of these anti-hCG vaccines require multiple
injections to achieve and maintain levels of
immunity that are considered effective.