Comprehensive Fertility, Pregnancy, and Birth Control: Key Concepts and Methods

Odds of conceiving

Low, ovum live 24 hours without insemination, 99% of sperm die 7 days after ejaculation

Causes of infertility

Anatomical abnormalities, age, abnormalities in sperm count, substance use, environmental toxins

Treatment of infertility

Nonmedical (ejaculate less, loose clothing, no hot baths), Medications (clomiphene increases FSH and LH, Pergonal increases FSH)

Gestational carrier

Surrogate mother who volunteers to have artificial insemination or in vitro fertilization

Artificial insemination

Partner or donor semen inserted

In vitro fertilization

Ovaries stimulated to release multiple eggs, inseminated in lab, reinserted (30% success rate)

Early signs of pregnancy

Missed (or slight) period, breast tenderness, nausea

Human chorionic gonadotropin

Over the counter kit which can detect as early as 4 days before period is expected

Spontaneous abortion

Miscarriage

Self-care in pregnancy

Diet (eat 300 more calories), Sex (usually safe), Medications (acetaminophen is safe), Environmental hazards (avoid cat feces, long soaks in tub, and x-rays)

Viability/quickening

Movement within womb at about 20 weeks and when it can survive outside the womb at 24 weeks

First trimester features

Ball of cells forms, Major organs begin to develop

Second trimester features

Lanugo forms, Vernix caseosa forms, Quickening, Viability, Mother has less nausea, more abdominal bulging, feet may swell, forgetfulness, mood swings

Third trimester features

Fetus gains weight, brain growth, fetus drops to be head down for delivery; Mother has more fatigue, constipation, urinary frequency, nesting urge

Importance of folic acid

To prevent spinal chord abnormalities and autism spectrum disorders

Braxton-Hick's contractions

Usually painless tightening of uterus

Prenatal provider choices

OB/GYN, Family practitioner, certified nurse/midwife

Ectopic pregnancy

Implantation outside the uterus

Detection of birth defects

Ultrasound, blood testing, amniotic sac testing (amniocentesis)

Fetal alcohol syndrome

Behavioral/cognitive issues with unusual facial features

Preeclampsia/eclampsia

High blood pressure can lead to seizures

Gestational diabetes

Maternal difficulty metabolizing glucose

Placenta previa

Placenta grows over cervix

Effects of smoking and cannabis use

Prematurity, low birth weight, self-regulation/impulse control issues

Placental abruption

Separation of placenta from uterus which cuts off blood supply and causes maternal blood loss

Risks with multiple births

High rate of preeclampsia, anemia, c-section

Types of twins

Fraternal (2 egg and 2 sperm), identical (same embryo splits), super twins (3 or more)

Approaches to childbirth in Western cultures

medically assisted 1850 to education + relaxation in years after to currently natural childbirth with medical coach

Effacement

Cervix gets thinner

Types of fetal presentations

Normal (head down), Posterior (head up with pressure on moms tail bone), Breech (head wrong way)

Stages of childbirth

Labor, pushing and delivery, delivery of placenta

Forceps

Tongs

Vacuum extraction

Suction cup

Pregnancy after 35

Riskier

Prepared childbirth

When parents learn about childbirth

Episiotomy

Cut in perineum to prevent tearing (not common anymore)

Cesarean section

Cut mom open and get baby

Baby blues

60-80% of mothers

Postpartum depression treatment recommendations

Be screened for depression and treated with therapy or meds

Postpartum psychosis

Suicidal or violent thoughts

Maternal mortality rates

Higher risk for non-white mothers, higher maternal death if stricter abortion restrictions, recommendations for reducing - education and further care

Comstock laws

Anti obscenity and no birth control

Griswold vs. Connecticut

No contraceptives for married couples

Roe vs. Wade

Right to abortion

Dobbs vs. Jacksons

States decide rights to abortion

WHO

World Health Organization

Outercourse

Non penetrative sex

Backup method

A secondary protective measure

Male condom

Penis sheath, 82-85% effective, no side effects, protect against STI

Diaphragm

Ring inserted with spermicide in it, 88% effective, no side effects

Spermicide

Kills sperm, 72% effective, may increase STI risk cause irritation

Female condom

Interior condom, 79% effective, less effective against STI than male condom

Sponge/cervical cap

Block and absorb semen, 88% effective pre giving birth, 71% effective if given birth, leave in after sex and no side effects

Birth control pills

Pills, 91% effective, may reduce menstrual severity

Patch

Patch, 91% effective, need new patch every week for 3 weeks then no patch for 1 week and less effective if overweight

Vaginal ring

Ring inside vagina, 91% effective, wear inside for 3 weeks then out for 1, no side effects but may fall out

Injection

Shot every 3 months, 94% effective, may cause weight gain, irregular bleeding, headache and thinning of bones

Emergency contraception

ELLA, Plan B, copper IUD

IUD copper

(99.2% effective, works for 12 years, risks of cramps, bleeding, uterine perforation and has no sti protection)

IUD hormonal

99.8% effective, 5-7 years, risks of cramps, bleeding, uterine perforation and has no sti protection

Fertility awareness

Tracking calendar, temp, signs of ovulation, cervical mucus to find fertile days and avoid them, 76% effective, no side effects.

Withdrawal

78% effective, no side effects but hard to maintain.

Contraceptive implant

Small rod in arm, 99.95% effective, approved for 3 years and has risks of acne, weight gain, ovarian cysts, mood changes.

Vasectomy

Vas deferens cut through small incision of scrotal sac, nearly 100% effective, no side effects.

Vasovasostomy

Reversal of vasectomy (50% success).

Tubal sterilization

Cut in fallopian tubes, nearly 100% effective, severe gas, pain, bleeding, infection, and anesthesia reaction.

Transcervical sterilization

Coils inserted into tubes causing tissue growth, not available because of high rate of significant complication.

Characteristics of women seeking abortions

Poor, young, women of color.

Position of WHO on abortion

Necessary and a right.

Changes in abortion rates/availability of abortion services

Higher rates, less availability.

LARCS

Long Acting Reversible Contraception.

Medical abortion first trimester at 9 weeks

Women take mifepristone to soften cervix then take misoprostol to cause contractions and expel embryo, 98% effective, 63% of abortions.

Suction curettage first trimester 7-13 weeks

Cervix opened and tissues removed with vacuum, risk of infection, hemorrhage, uterine perforation, common.

Dilation and evacuation second trimester 13-21 weeks

Cervix dilated and fetus removed with suction, forceps, and scraping, includes pain, bleeding, cervical trauma, uncommon.

Intact dilation and evacuation late term abortion

Cervix dilated and fetus removed with skull crushed, used in worst case situation, .2% of abortions and banned.

Mifepristone

No production of progesterone softens cervix.

Misoprostol

Causes uterine contractions and expels embryo.

Psychological effects of abortion

Most have no emotional reactions but may react if there is ambivalence, being forced by others, abortion due to medical issues, strong religious connection, history of psych issues.

Peyronie's disease

Curved erection caused erectile dysfunction.

Sexual double standard

People are judged differently depending on the gender.

Performance anxiety

Nervousness beforehand which causes failure.

Desire discrepancy

Mismatch of desire between partners.

Male hypoactive sexual desire disorder

at least months of lack of interest, 6% of young men and 41% of males over 65, desire declines naturally with age so need to determine how far person is from 'normal'

Erectile disorder

inability to achieve or maintain erection for 75% to 100% of interactions, 15-30 million in US, lifelong is rare and acquired is after a period of normal functioning

Female sexual interest/arousal disorder

lack of interest for several months and lack of genital sensation, 30% of women, may be lifelong in response to stress or a physical issue

Premature ejaculation

orgasm before its wanted, 25% of men, affects older and younger men

Female orgasmic disorder

delay in or absence of orgasm in 75% to 100% of encounters, 25% of women, tied to relationship difficulties, physical issues, and arousal disorder

Delayed ejaculation

delay or absence of ejaculation for 75% to 100% of encounters for 6 months, least common sexual difficulty, increases after 50

Genito-pelvic pain/penetration disorder

pain associated with intercourse for women, 15% of women but 60% report at some time, most common in early adulthood and around menopause

Vaginismus

sudden tightening of vagina when something is inserted, 5-7%, caused by pain and anxiety and worsens as it goes on and women continue being fearful

controversy of sexual addiction

tied to trauma and escalation

Paraphilic disorder

Sexual arousal that causes distress or impairment to the individual or leads to personal harm to them or others.

Fetishism

Sexual behavior linked to object or activity beyond sexual organs.

Transvestic fetishism

Sexually aroused by crossdressing.

Sexual coercion

Involuntary touching.

Affirmative consent

In words, don't have sex if person incoherent, consent can be revoked.

Anatomical Abnormalities

endometriosis, scarring from STI's

age

fertility declines after 30 for women, male fertility declines less

cause of lower sperm quality

abnormalities in sperm count

substance use

alcohol, marijuana, narcotics, tobacco