OB 1 Reproductive health and contraception's

🌸 What’s the Menstrual Cycle?

It’s the process your body goes through every month to get ready for a baby 👶 (even if you don’t end up having one).

It’s usually about 28 days long 📆.

Menstrual Cycle Phases

🩸 Phase 1: Menstrual Phase (Days 1–5)

• The uterus says, “No baby this month!” ❌👶

• The lining of the uterus (endometrium) comes out — that’s your period 🩸.

• Hormones are low 😴.

 

🌱 Phase 2: Follicular Phase (Days 1–13)

• The brain sends a message 🧠➡💌 to the ovaries to start growing eggs 🥚.

• One egg starts getting ready to be released.

• Hormones like FSH (follicle-stimulating hormone) and estrogen rise ⬆ to help the uterus rebuild its lining 🏗.

 

💥 Phase 3: Ovulation (Day 14)

• The egg is released from the ovary 🎯🥚 — this is ovulation!

• It travels down the fallopian tube 🚗.

• This is the best time to get pregnant 🤰 if sperm meets the egg.

 

🌙 Phase 4: Luteal Phase (Days 15–28)

• The spot where the egg came from turns into a “hormone helper” called the corpus luteum 💛

• It makes progesterone 🧴 to keep the uterus lining thick and cozy 🛏

• If no baby comes ❌👶, hormone levels drop and your period starts again 🩸🔁

 

🩸 What Is Menstruation?

• Every month, the uterus 🏠 builds a soft, cozy lining 🧸 to get ready for a baby 👶.

• If there’s no baby, the body gets rid of that lining — it comes out as period blood 🩸.

• This is called menstruation — or your period! 📅

 

⏰ When It Starts & Stops

• Menarche = your first period 🎉 — it usually happens around age 12–14 👧.

• Menopause = when periods stop for good 🚫🩸 — usually between ages 45–55 👩‍🦳.

 

🔁 How Often It Happens

• A full cycle (from one period to the next) is about 28 days 🗓, but can be between 21–36 days — everyone’s a little different! 💁‍♀

⚖ What Can Affect Your Period

• 💊 Birth control or contraceptives

• 😥 Stress

• 🏃‍♀ Too much exercise or not eating enough

• 😷 Illness

• 💻 Sleep or environment changes

• 🩺 Conditions like PCOS (Polycystic Ovary Syndrome)

🤔 What Is Conception?

Conception is when a sperm 🏊‍♂ from a dad meets an egg 🥚 from a mom — that’s the start of a new life! 🌱👶

It’s the very first step of pregnancy. ❤

 

🏠 Step 1: Fertilization

• The sperm swims 🏊‍♂ through the uterus and finds the egg 🥚 in the fallopian tube.

• When they join together 💞, they make a zygote — a tiny baby-in-the-making! 👶✨

 

🩸 Step 2: Implantation

• The zygote travels to the uterus 🏠.

• It settles into the wall of the uterus (like a seed planting in soil 🌱🌸).

• This is called implantation, and it’s where the baby will grow! 🤰

 

🧬 Step 3: Cell Growth

• The baby starts out as one cell ⚪.

• Then it keeps dividing over and over — this is called mitosis 🔁 (making more body cells).

• There’s also meiosis ➗ — this happens in germ cells to make sperm and eggs with half the normal number of chromosomes, so when they meet, the baby gets the right total! 🧩

 Fertilization and Timing steps 

💞 Step 1: The Big Meeting – Conception

• When a sperm 🏊‍♂ from the dad meets an egg (ovum) 🥚 from the mom, they form a zygote — the very first baby cell! 👶

• This is the start of pregnancy ❤

 

🕐 Step 2: Timing Is Everything

• The egg 🥚 stays ready for 12–24 hours after it’s released.

• The sperm 🏊‍♂ can live up to 72 hours inside the body!

• That’s why timing matters — they have to meet while both are still alive! ⏳

 

💦 Step 3: The Sperm’s Big Race

• Each time a man releases sperm, there are about 200–500 million swimmers! 😲

• They race up the fallopian tubes 🏁 to find the egg.

• Only a few hundred actually make it close to the egg — it’s a tough journey! 💪

 

🌟 Step 4: Fertilization

• The sperm and egg finally meet in the ampulla (the wider part of the fallopian tube) 🧪

• 💥 Fertilization happens here!

• The sperm and egg’s DNA mix together 🧬 to form one new cell — a zygote! 🌱

 

🏠 Step 5: Implantation

• The zygote travels down to the uterus 🏡

• Around 7–10 days later, it attaches to the wall of the uterus — this is called implantation 🩸🪴

 

🍼 Step 6: Early Development

• The first 2 weeks are called the pre-embryonic stage 👶🧫

• The baby is just starting to grow and divide into more cells 🔁

 

🧫 What Is the Embryonic Period?

when the baby starts forming all its body parts and organs 🧠💗🫁 — it’s the most important and delicate time of pregnancy! 🤰

 

🕒 When It Happens:

• It lasts from Day 13 to Week 8 after conception 🗓

• By the end of 8 weeks, the tiny baby (embryo) already has:

  • 👐 Arms and legs forming

  • 👀 Eyes and ears starting

  • ❤ A beating heart

  • 🧠 A growing brain and spinal cord

  • 🌬 All the major organs beginning to develop

 

⚠ Why It’s So Important:

This is the most critical time for development ⚠

• The baby’s organs are very sensitive 🧩

• Things like drugs, alcohol, infections, or radiation can cause big problems 🚫💊☢

• That’s why prenatal care and healthy habits are super important 💪🥦💧

 

🧮 How Do They Figure Out “How Far Along Am I?”

They start counting from your LMP (Last Menstrual Period) 🩸 — even though you weren’t pregnant yet!

This helps estimate when the baby was likely conceived. 🧬

• 🌙 Pregnancy = about 280 days or 40 weeks total

• That’s about 9 calendar months (like the ones on your phone calendar 📅)

• Or 10 lunar months (because each “lunar month” = 4 weeks 🌕)

 

🧠 Quick Science Part:

• Doctors assume ovulation and conception happen on Day 14 of a 28-day cycle 🧪

• They use a Pregnancy Wheel 🌀 (like the one in the picture!)
  → You line up your last period date, and it shows your due date and how many weeks you are! 👶✨

🧮 What Is “Gestational Age”?

It’s how doctors measure how far along a pregnancy is — starting from the first day of your last period (LMP) 🩸 even though the baby wasn’t made yet!

It helps them track how the baby grows week by week 👶📆

🌼 Pregnancy Is Divided into 3 Parts (Trimesters):

1⃣ First Trimester: Weeks 1–12

• 🌱 The baby’s organs start forming (like the heart, brain, and spine 🧠❤).

• The mom may feel tired 😴, have morning sickness 🤢, or mood changes 🌧☀.

• This is a very important stage for early development! ⚠

 

2⃣ Second Trimester: Weeks 13–27

• 🌸 The baby starts to grow bigger and move around! 🤰💃

• You might feel kicks 🦶 around week 20!

• The mom’s belly gets rounder 🎈 and energy often returns ⚡

 

3⃣ Third Trimester: Weeks 28–40

• 👶 The baby gains weight and organs finish growing 🫁🧠

• The baby gets ready for birth — turning head down ⬇

• The mom may feel heavier, with more back pain and swelling 😅

 

✏ How Weeks Are Written

You might see something like 15⁴⁄₇ weeks — that just means 15 weeks and 4 days! 📏

 

Contraception 🧠 Nurse’s Role:

• 🩺 Assess the person’s needs, preferences, and goals 💬

• 💕 Support them in choosing what works best for their body and lifestyle

• 🎯 Goal = Prevent pregnancy until the person is ready

🧩 Types of Contraception:

 Natural Methods 🌿

• Tracking ovulation 🩸 and body temperature 🌡

• Abstinence (no sex) 🚫

• “Fertility awareness” = knowing when you’re most likely to get pregnant

2⃣ Barrier Methods 🛡

• Condoms (male or female) 🧤

• Diaphragms or cervical caps 💍

• Spermicides (gel or foam that kills sperm) 💦

3⃣ Hormonal Methods 💊

• Birth control pills 💊

• Patches 🩹

• Shots 💉

• Vaginal ring 🔵

• Implants (tiny rod in the arm) 💪

4⃣ Intrauterine Devices (IUDs) 🌀

• Small T-shaped device in the uterus

• Can be hormonal or non-hormonal (copper)

5⃣ Surgical Methods ✂

• Tubal ligation (“getting tubes tied”) for women ♀

• Vasectomy for men ♂

👶 What Is Family Planning?

Family planning means deciding if and when you want to have children — and how many. 🗓💞

It’s all about choice, timing, and what’s best for you and your family. ❤

 

🧠 Key Ideas:

• 👤 Highly individual — everyone’s plan looks different!

• 💉 Medical factors – some people can’t use certain birth control because of health reasons.

• 🍼 Desire for children – some want a big family 👨‍👩‍👧‍👦, others want one child or none.

• 🙏 Beliefs – religious, cultural, or personal values may guide choices.

• 💰 Finances – babies are expensive! 💵 Families plan based on what they can afford.

• ⚖ Freedom to choose – everyone deserves to make their own decision.

• 🔄 Plans can change – what someone wants now may change later in life.

😕 What Are Unintended Pregnancies?

These are pregnancies that happen by accident — when someone didn’t plan or want to get pregnant right now. 🤰❌

There are over 3 million unintended pregnancies every year in the U.S. 🇺🇸

 

📊 Why They Happen:

1⃣ Didn’t use contraception – 1.3 million 😬

2⃣ Didn’t use contraception correctly or regularly – 1 million 😕

3⃣ Contraception failure (it didn’t work as expected) – 0.4 million ⚠

⚠ Consequences of Unintended Pregnancy:

Unplanned pregnancies can make life harder for moms, babies, and families 💔

They can increase the chances of:

• 🚬 Smoking, 🍷 drinking, or 💊 drug use during pregnancy

• 🍼 Low birth weight (tiny or premature babies)

• 💔 Infant death

• 😢 Child abuse or neglect

• 😞 Childhood depression

• 💸 Poverty for women and children

 

💡 Why It Matters:

Good education, access to birth control, and family planning support can help prevent unintended pregnancies — and lead to healthier families 💕👩‍👧‍👦

🚫💊 What Are Non-Hormonal Methods?

🩸 1⃣️Vaginal Barriers (used before sex)

These are like shields that stop sperm from entering the uterus 🛡:

• Diaphragm ☂ – soft dome that covers the cervix

• Internal condom ♀ – fits inside the vagina

• Sponge 🧽 – has sperm-killing chemicals

• Fem Cap 🧢 – covers cervix like a tiny hat

• Lea Shield 🛑 – reusable barrier that fits the cervix

 

🧍‍♂ 2⃣️Male Condom

• Worn on the penis 🧤

• Stops sperm from entering the vagina

• Also helps protect from STIs (sexually transmitted infections) 🦠

 

🍼 3⃣️ Lactation Amenorrhea Method (LAM)

• Works only for breastfeeding moms 🤱

• Breastfeeding keeps certain hormones low, which prevents ovulation (no egg release) 🌙

• Only works for about 6 months after birth ⏳

 

🧍‍♀ 4⃣️ Coitus Interruptus

• “Pull-out method” 🚫💦

• The man removes the penis before ejaculation — but it’s not very reliable ⚠

 

🌿 5⃣️ Natural Family Planning

• Tracking body temperature, cervical mucus, and cycle days 📅

• Avoiding sex during fertile days (when the egg is ready to meet sperm) 🥚🚫

 

🙅‍♀ 6⃣️ Abstinence

• Choosing not to have sex at all — 100% effective in preventing pregnancy 💯💖

 

✂ 7⃣ Permanent Procedures

Once done, they can’t be undone easily:

• Vasectomy 🧍‍♂✂ – closes off tubes that carry sperm

• Tubal Ligation 🧍‍♀✂ – closes or ties the fallopian tubes

 

🌀 8⃣️IUD (Copper T)

• A tiny T-shaped device placed inside the uterus by a doctor 🩺

• Made of copper, which stops sperm from reaching the egg 🧲🚫

• Can last up to 10 years! ⏰

🚫💞 What Is Abstinence?

means choosing not to have sex.

It’s a way to completely prevent pregnancy 🤰❌ and avoid STIs 🦠.

 

🧠 Why People Choose Abstinence:

• 💖 To wait until they’re ready for sex

• 🙏 For religious or personal reasons

• 💊 To stay healthy and avoid infections

• 🎯 To focus on school, goals, or relationships

 

💪 Key Points:

• Abstinence = 100% effective birth control if practiced correctly ✅

• It’s a personal choice — everyone has the right to decide what’s best for them ❤

• You can choose it anytime, and you can change your mind later 🕊

📅 What Is the Calendar Method?

The Calendar Method is a natural birth control method 🌿

It helps people predict when they’re most likely to get pregnant 🤰 or avoid pregnancy 🚫 by tracking their menstrual cycle 🩸.

 

🧮 How It Works:

1⃣ Track your periods for at least 6 months 🗓

• Write down when each period starts and ends.
  2⃣ Find your average cycle length (usually about 28 days) 🔢
  3⃣️Ovulatio— when the egg is releas 🥚🥚— usually happens s 14 days before your next per ️

• You are most fertile (most likely to get pregnant) on day–16 🌸6 🌸

 

💞 How to Use It:

• If you want a baby 👶 — try during days 12–16!

• If you don’t want a baby 🚫 — avoid sex or use protection during those days 🧤💊

📿 What Is the Standard Days Method?

This is a natural birth control method 🌿 that helps people know which days they can get pregnant 🤰 and which days they can’t 🚫.

It uses colorful beads (called CycleBeads) to keep track of your days 🎨🧮

 

🧠 How It Works:

• Each bead = one day of your menstrual cycle 🗓

• You move a little marker along the beads every day to know where you are in your cycle 🔵🔴🤎

• It’s for women with cycles that are 26–32 days long ⏳

 

🌼 Fertile Days (Can Get Pregnant):

• Days 8–19 are the “fertile window” 🥚💞
  → These are the days when the egg could meet sperm 🏊‍♂ and start a pregnancy.

 

🚫 Non-Fertile Days:

• Days 1–7 and Days 20–32 are usually safe days — when it’s less likely to get pregnant 😌

🌿 What Is Natural Family Planning (NFP)?

NFP (also called Fertility Awareness, Rhythm Method, or Periodic Abstinence) means using your body’s natural signs to know when you can or can’t get pregnant 🤰🚫.

It’s a natural birth control method — no hormones, no devices 💊❌.

 

🧠 How It Works:

• You avoid sex (or use protection) during the days you could get pregnant 🌼.

• Works best if you have regular cycles ⏳ and can track your body carefully 🩺

 

🧾 What You Need to Do:

📅 Track your cycle

🌡 Take your temperature every morning (it goes up slightly after ovulation)

💧 Check your cervical mucus — it becomes clear and stretchy (like egg whites 🥚) when you’re fertile

✍ Record everything daily

 

📊 Efficacy (How Well It Works):

• 💯 Perfect Use: 98% effective

• 🙃 Typical Use: 76% effective (because it’s easy to make tracking mistakes!)

🌡 What Is Basal Body Temperature (BBT)?

means your body’s temperature when you first wake up — before you get out of bed 🛏.

It helps you track when you ovulate (release an egg 🥚) each month.

 

🧠 How It Works:

1⃣ Use a special BBT thermometer 🧪 that can measure tiny changes in temperature (0.1° differences).

2⃣ Take your temperature every morning at the same time ⏰ before doing anything — even talking or sitting up! 😴

3⃣ Write it down or use an app 📱 to make a chart 📈

 

💥 What You’ll Notice:

• 🌬 Just before ovulation, your temperature may drop slightly 🧊

• 🔥 Then it rises by about 0.4–0.8°F when ovulation happens

• 🌼 You are most fertile in the few days before that temperature rise

 

💧 What Is Cervical Mucus?

Cervical mucus (or CM) is the natural fluid made by your cervix — it changes throughout your cycle 🩸 to help (or block) sperm 🏊‍♂ from reaching the egg 🥚.

By watching how it looks and feels, you can tell when you’re fertile (able to get pregnant). 👶

 

🔍 How It Changes During the Cycle:

1⃣ Dry / Tacky / Thick (Not Fertile)

• Looks: Sticky or crumbly 🧼

• Feels: Dry or thick ❌

• Meaning: Not ready for sperm — low chance of pregnancy 😌

2⃣ Creamy / Sticky (Not Fertile)

• Looks: Like lotion or yogurt 🥛

• Feels: Smooth but not stretchy

• Meaning: Body is preparing for ovulation, but not fertile yet ⚠

3⃣ Cloudy / Stretchy (Semi-Fertile)

• Looks: Cloudy or whitish ☁

• Feels: A little stretchy 🧵

• Meaning: Getting close to ovulation — sperm can start surviving longer! 🌱

4⃣ Watery / Clear / Egg White (Most Fertile)

• Looks: Clear, slippery, stretchy like egg whites 🍳

• Feels: Slick and smooth 💦

• Meaning: Perfect for sperm to swim through! 🏊‍♂💞 This is the most fertile time! 🌼

 

🍼 What Is the Lactation Amenorrhea Method (LAM)?

AM is a natural birth control method 🌿 that works after giving birth 🤱.

It uses exclusive breastfeeding to stop the body from releasing eggs 🥚 — which means no ovulation, and no pregnancy! 🚫🤰

 

🧠 How It Works:

• When a mom breastfeeds often and only (no formula or long breaks), her body makes prolactin 🧬 — a hormone that prevents ovulation (egg release).

• This keeps her from getting pregnant right after having a baby 👶.

 

⏰ Rules for LAM to Work:

1⃣ Breastfeed exclusively (no bottles or formula) 🍼

2⃣ Feed every 4 hours in the day and every 6 hours at night ⏳

3⃣ Baby must be under 6 months old 👶

4⃣ Mom’s period has not returned yet 🩸

 

⚠ Important Notes:

• After 6 months postpartum, or once baby starts eating solids 🍎, LAM becomes less effective.

• Using a pump or expressing milk by hand 🤱🖐 doesn’t work as well as direct breastfeeding.

• As time goes on, the chance of ovulating before your first period increases 📈

🧤 What Is an External Condom?

An external condom (sometimes called a male condom) is a thin cover that goes on the penis 🩵 before sex.

It catches sperm 🏊‍♂ so it doesn’t reach the egg 🥚 — preventing pregnancy 🤰🚫

It also helps protect against STIs 🦠💪

⚠ Important Tips:

• Condoms can break or slip off if used incorrectly, but it’s rare (about 2% of the time) 📊

• Always have extra condoms just in case 💼

• Use lubrication (water-based 💦) to reduce friction and tearing

• Do not double up (never wear two condoms at once!) 🚫🧤🧤

🧤 Male Condom: Pros & Cons

✅ Pros (Good Things!)

• 🩺 No doctor visit needed — easy to get at stores or clinics!

• 💵 Cheap — very affordable.

• 🎨 Lots of choices — different sizes, textures, and materials.

• 🦠 Protects against HIV and most STIs (sexually transmitted infections).

• 👶 Prevents unplanned pregnancy when used correctly.

• 🌿 No hormones — great for people who can’t or don’t want to use hormonal birth control.

 

⚠ Cons (Not-So-Good Things)

• 🤝 Needs both partners to cooperate — must be used every time.

• 🩹 Doesn’t fully protect from HPV (human papillomavirus) or HSV (herpes simplex virus).

• 😬 Can break or slip if not used properly (rare but possible).

🌸 The Internal Condom (Female Condom)

This is a barrier method that helps stop sperm 🏊‍♂ from reaching the egg 🥚 to prevent pregnancy 🤰🚫.

It’s a soft pouch (made of polyurethane) that goes inside the vagina before sex.

⚙ Effectiveness:

• 💯 Perfect use → 95% effective

• 🧍 Typical use → 81% effective

 

⚠ Important Rules:

• Use it only once 🗑

• ❌ Do NOT use with a male condom (they can stick and tear!)

• It’s pre-lubricated and available over the counter 🛍

 

💡 Quick Facts:

• Protects from pregnancy + STIs (including HIV) 🦠

• No hormones 🌿

• Gives women more control over protection 🙋‍♀

🌸 Pros and Cons of the Internal (Female) Condom

✅ Pros (Good Things!)

• 🙋‍♀ Female-controlled — gives women more control over protection

• 🌿 Non-hormonal — no effect on mood or cycles

• 🦠 May give extra protection from HPV and HSV

• 🩺 No doctor visit or pelvic exam needed

• 💖 Latex-free — great for people with allergies

• 🔄 Can be used for vaginal, anal, or oral sex (as a dental dam!)

 

⚠ Cons (Not-So-Good Things!)

• 💸 More expensive than male condoms

• 👀 Can stick out a little from the vagina

• 😕 Some partners say it feels “different”

• 🔄 Can slip or move if not inserted correctly

🧴 Spermicide

Chemical Name: Nonoxynol-9 (N-9) ⚗

🧠 How It Works:

Spermicide is a chemical barrier that kills sperm 🏊‍♂ before they can reach the egg 🥚.

It’s inserted into the vagina (using an applicator) before sex.

 

⚙ Effectiveness:

• 💯 Perfect use: ~80%

• 🧍 Typical use: ~70%
  ➡ Works best when combined with other methods (like condoms 🧤).

 

⏱ Timing:

• Must be used every time you have sex.

• Insert it right before — it only lasts about 1 hour ⏳.

 

⚠ Risks & Considerations:

• Using it too often (many times a day) may cause vaginal irritation 😣.

• Irritated tissue can make it easier for HIV or STIs to spread 🦠.

• Not recommended for people at high risk for HIV.

🩷 Diaphragm — Barrier with Spermicide

This is a soft dome-shaped cup made of latex or silicone 🩸 that blocks sperm 🏊‍♂ from reaching the egg 🥚.

It’s a reusable birth control method used with spermicide gel or cream 🧴 to make it more effective.

 

🧠 How It Works:

• 🩷 Placed over the cervix (the opening to the uterus)

• 💪 Held in place by vaginal muscles and pubic bones

• ⏰ Can be inserted up to 2 hours before sex

• 🧴 Must be used with spermicide (kills sperm)

 

⚙ Effectiveness:

• 💯 Perfect use: 98%

• 🧍 Typical use: 80%

 

🕒 After Sex:

• Keep it in place for at least 6 hours after sex ⏳

• If sex happens again before 6 hours, add more spermicide, don’t remove it yet

• ❌ Don’t leave it in for more than 24 hours (can cause Toxic Shock Syndrome 😷)

🌸 Caya Diaphragm — The New Diaphragm!

This is a soft silicone cup 🩷 that fits over the cervix and acts as a barrier to stop sperm 🏊‍♂ from reaching the egg 🥚.

It’s the only diaphragm currently available in the U.S. 🇺🇸

 

🧠 How It Works:

• 🩷 Made of silicone (not latex!)

• 🧴 Must be used with spermicide jelly or cream

• ⏰ Can be inserted up to 2 hours before sex

• 🕒 Must stay in at least 6 hours after sex

• 🚫 Don’t leave in for more than 24 hours (TSS risk 😷)

 

💧 How to Use:

1. Put 1 teaspoon of spermicide 🧴 into the cup and around the rim before inserting.

2. Insert it into the vagina so it covers the cervix completely.

3. Held in place by pubic bones and vaginal muscles 💪.

4. After sex, leave it in for 6 hours, then remove.

5. If having sex again before removal → add more spermicide without removing the Caya.

 

⚙ Effectiveness:

• 💯 Perfect use: 84% effective

• 🧍 Typical use: 83% effective
  (So — not as effective as some hormonal methods, but good with consistent use!)

 

💡 Bonus Facts:

• Fits most women — designed to work for many vaginal and cervical sizes!

• No fitting needed by a doctor for most users 👩‍⚕

• Great for people with latex allergies 🌿

• Can be reused for up to 2 years if cared for properly 🧼

🩷 Cervical Cap — A Mini Barrier!

The cervical cap is a tiny silicone cup that fits snugly over the cervix 🩸 to block sperm 🏊‍♂ from entering the uterus.

It works like a smaller version of a diaphragm — same idea, just mini-sized! 💡

 

🧠 How It Works:

• 🩷 Acts as a barrier — sperm can’t pass the cervix

• 🕒 Insert at least 30 minutes before sex

• ⏰ Can be left in up to 48 hours

• 💧 Must be used with spermicide (for extra sperm-stopping power!)

 

⚙ Effectiveness:

• 💯 Perfect use: 98%

• 🧍 Typical use: 87%

 

⚠ Important Rules:

• ⏳ Leave it in for 6–8 hours after sex

• 🚫 Do not leave in for more than 48 hours — increases risk of Toxic Shock Syndrome (TSS) 😷

• 🩺 Must be fitted by a healthcare provider 👩‍⚕

💊 Oral Contraceptives (The Pill)

These are hormonal pills you take every day to prevent pregnancy 🤰🚫

They contain synthetic versions of the body’s natural hormones:

• 💖 Estrogen + Progestin → “Combination pill”

• 💛 Progestin-only → “Mini pill”

 

🧠 How They Work:

OCPs stop pregnancy in 3 ways 🧩

1. 🚫 Stops ovulation — no egg is released 🥚

2. 🧴 Thickens cervical mucus — sperm can’t swim through 🏊‍♂

3. 🩸 Thins uterine lining — makes it harder for a fertilized egg to attach

 

⚙ Effectiveness:

• 💯 Perfect use: 99.5% effective

• 🧍 Typical use: 98% effective

 

⏰ How to Take It:

• Take one pill every day at the same time 🕒

• If you forget a pill → take it as soon as you remember

• Use backup birth control (like condoms) if you miss more than 1 pill in a row

 

💊 Oral Contraceptives (The Pill) Side effects and Complications

💢 Possible Side Effects (Mild):

😕 Nausea

😣 Breast tenderness

💧 Spotting between periods

😮‍💨 Headache or mood changes

 

🚨 Serious Complications (Call the Doctor!):

💥 Blood clots (legs, lungs)

💥 Stroke

💥 Heart attack — higher risk if smoking 🚭 and over age 35

 

💥 When NOT to Use Estrogen Contraceptives!

🚫 Do NOT Use If You Have:

🩸 Blood Clot Problems

• History of thrombophlebitis (blood clots in veins)

• Stroke (CVA) or heart disease (CV disease) 💔

🎗 Cancer Concerns

• Estrogen-dependent cancer (like breast or uterine)

• Benign or malignant liver tumors

🫀 Circulatory Issues

• Hypertension (high blood pressure)

• Diabetes with vascular damage

• Migraines with aura ⚡ (increases stroke risk)

 

⚠ Other Serious Risks:

• 🚭 Smoking + age >35 (especially heavy smokers)

• 🏥 Major surgery with long bed rest (immobilization)

• 🧠 Impaired liver function

• 🤰 Pregnant or might be pregnant

• 💧 Unexplained vaginal bleeding

⚠ DANGER — When to Stop the Pill & Call the Provider Immediately!

💥 A C H E S:

• A — Abdominal pain (severe): 🩻 May mean liver problem or blood clot in abdomen (thrombosis)

• C — Chest pain or shortness of breath: 💔 Possible pulmonary embolism (PE) or heart attack (MI)

• H — Headaches (severe, dizziness, vision changes): 🧠 Possible stroke (CVA)

• E — Eye problems (vision loss, blurring): 👁 Could be retinal artery thrombosis

• S — Severe leg pain: 🦵 May indicate deep vein thrombosis (DVT)

➡ These are life-threatening emergencies! 🚑

🩸 Venous Thromboembolism (VTE) Risk

Estrogen increases the risk of blood clots — especially with:

• 💊 Higher estrogen doses

• ⏳ Longer duration of use

• 👩‍🦰 Age >35 years

• 🚬 Smoking

• ⚖ Obesity (BMI >30)

• 🤰 Pregnancy & postpartum (risk ↑ 4x–20x)

🔹 Progestin-only pills have minimal clotting risk ✅

💔 Stroke Risk

Estrogen-containing contraceptives can raise the risk of stroke, especially:

• 🚭 Smokers

• 🧠 Migraines with aura

• 🫀 Hypertension (HTN)

• 🍩 Diabetes (DM)

• ⚖ Obesity

🧩 Types of Stroke Risks:

• 🩸 Ischemic stroke: Caused by blood clots — related to estrogen use

• 💥 Hemorrhagic stroke: Caused by bleeding — higher risk with HTN, smoking, alcohol

🧠 Important Teaching for Patients about The Pill

🗓 VTE risk disappears within 30 days of stopping the pill

🚭 Avoid smoking while on the pill

⚖ Use caution if overweight or >35

💬 Report any ACHES symptoms immediately!

🚫 Contraindications to Combined Oral Contraceptive (Estrogen + Progestin)

🤰 Pregnancy or Breastfeeding

• OCPs are not used during pregnancy or the early postpartum period (↑ risk of clotting).

 

💧 Undiagnosed Vaginal Bleeding

• Always rule out cancer or another underlying cause first! 🩸

 

🫀 Cardiovascular & Clotting Disorders

• History of DVT, PE, or Factor V Leiden mutation 🩸

• Uncontrolled hypertension 💢

• Major surgery with prolonged bed rest 🏥

• Smoker over 35 years old 🚭

 

💛 Liver or Gallbladder Disease

• Active liver disease, jaundice, or hepatic tumors 🧠

• Estrogen can worsen liver problems and cause more clotting.

 

🧠 Neurologic & Migraine Issues

• Migraines with aura ⚡

• Vision loss or numbness/tingling in face or hands = stroke warning sign 🚨

 

🎗 Cancer-Related Contraindications

• Estrogen-dependent carcinoma (like breast, uterine, or hepatic cancers) ❌

 

🍭 Metabolic Conditions

• Diabetes with vascular involvement (especially >20 years duration) ⚖

 

😔 Mental Health

• Depression that worsens with OCP use — may require a non-hormonal or progestin-only option 🌙

🩹 Transdermal Patch (Xulane, Zafemy)

⚙ How It Works

• 🚫 Stops ovulation (no egg released)

• 💧 Thickens cervical mucus → sperm can’t get through

• 🌸 Changes uterine lining → harder for fertilized egg to implant

 

📆 How to Use

• Apply 1 patch per week for 3 weeks, then no patch for 1 week (menstrual week)

• Place on:

  • Lower abdomen

  • Upper outer arm

  • Upper torso (not breasts)

  • Buttock 🍑

 

📊 Effectiveness

• Perfect use: 99.7% (0.3% failure) ✅

• Typical use: ~93% effective (7% failure) ⚠

• Less effective if weight >198 lbs (BMI >30) ⚖

 

⚠ Warnings

• 🚭 Smoking + estrogen = DANGER!

  • ↑ risk of blood clots (VTE), heart attack, and stroke

  • FDA warns against use for:

    • Smokers >35 years old

    • Anyone with BMI >30

 

💡 Extra Notes

• 🏊 Swimmers may prefer another method (patch may peel off)

• 🩸 Use new patch each week, never reuse!

• 💬 If patch falls off >24 hrs → use backup contraception for 7 days

• ❌ Do NOT place on broken, oily, or irritated skin

💉 Injectable Progestin: Depo-Provera (Medroxyprogesterone acetate)

⚙ How It Works

• 🩸 Intramuscular (IM) injection of progestin only

• ⏳ Prevents ovulation for 12 weeks (≈3 months)

• 📉 Thickens cervical mucus + thins endometrial lining

• 💊 Failure rate: ~3%

 

🗓 Administration

• Given every 12 weeks (3 months) in the deltoid or gluteal muscle

• 💬 Schedule reminder is key! Missing a dose increases pregnancy risk

• Safe for breastfeeding moms 🤱

 🌿 Other Notes

• 🍼 No effect on breast milk (safe while breastfeeding)

• 🕰 Fertility returns in ~10–18 months after stopping injection

• 👍 Good option for people who:

  • Want privacy

  • Can’t take estrogen

  • Need long-term contraception

 

💡 Nursing Tips

• Give IM using deep injection technique, do not massage site 🩹

• Document injection site and date for next dose

• Teach calcium-rich diet & vitamin D supplementation

💉 Injectable Progestin: Depo-Provera side effects and considerations

⚠ Side Effects (SE)

• 🔴 Irregular menstrual bleeding (spotting → amenorrhea over time)

• ⚖ Weight gain (~4 lbs/year average)

• 😣 Depression, headaches, nervousness, fatigue

• 💔 Decreased libido, breast tenderness

 

🦴 Long-Term Considerations

• ↓ Bone density loss with prolonged use, especially in adolescents
  → Encourage calcium + vitamin D intake ☀🥛
  → Consider alternate method after 2 years if bone loss risk high

⚠ Depo-Provera (DMPA) — Bone Density Warning (FDA Boxed Warning)

🦴 Key Concern: Bone Mineral Density Loss

• Long-term use of Depo-Provera (Depot Medroxyprogesterone Acetate, DMPA) can decrease bone density over time.

• 🧮 The longer you use it, the greater the bone loss risk — and it may not be fully reversible.

• ⚠ Adolescents and young adults are at special risk because their bones are still developing.

 

📉 FDA & ACOG Recommendations

• 🚫 Do NOT use DMPA longer than 2 years unless other birth control methods are inadequate.

• 🧪 Routine DXA scans (bone density tests) are not recommended for teens or young women using DMPA, since DXA isn’t validated for this age group.

• 💊 Do NOT give estrogen supplements while on DMPA—risks outweigh benefits and there’s no proven protection against fractures.

Depo-Provera (DMPA) 🥛 Nursing & Patient Teaching

• Encourage calcium-rich foods (milk, yogurt, cheese, dark leafy greens 🥦).

• Promote vitamin D intake ☀ (diet or supplement).

• Encourage weight-bearing exercise (walking, dancing, resistance training 🏃‍♀).

• Discuss alternative birth control if bone health is a concern (e.g., IUD, implant).

💍 NuvaRing — Hormone-Releasing Vaginal Ring

⚙ What It Is

• A flexible, soft vaginal ring that slowly releases estrogen + progestin 💊

• Prevents pregnancy by:

  • 🚫 Stopping ovulation

  • 💧 Thickening cervical mucus

  • 🌸 Thinning uterine lining

 

🩸 How to Use It

• 👩‍⚕ One-size-fits-all — no fitting required

• 🗓 Insert into vagina and leave in place for 3 weeks

• 🧺 Remove for 1 week (menstrual week)

• 🔁 Insert a new ring every cycle (every 4 weeks)

 

📊 Effectiveness

• Perfect use: 99% effective ✅

• Typical use: ~92% effective ⚠

 

💡 Tips & Teaching

• 📆 If ring is out for >3 hours, use backup contraception (condom) for 7 days

• 💦 Can be removed up to 3 hours for intercourse if desired — rinse with cool water & reinsert

• 💬 May increase vaginal discharge or cause mild irritation/discomfort initially

• 🚭 Avoid if smoking + over 35 years old (↑ risk of blood clots)

• 🩷 Fertility returns quickly after removal

💍 Annovera (Segesterone acetate + Ethinyl Estradiol Ring)

 What It Is

• A reusable hormone-releasing vaginal ring that combines estrogen + progestin

• Works the same way as NuvaRing:

  • 🚫 Prevents ovulation

  • 💧 Thickens cervical mucus

  • 🌸 Thins the uterine lining

 

🗓 How to Use

• Insert ring into vagina for 21 days (3 weeks)

• Remove for 7 days (ring-free week → menstrual period)

• 🧺 Store in its case during ring-free week

• Reinsert the same ring — it’s reusable for 1 full year (≈13 cycles / 365 days)

 

📊 Effectiveness

• Perfect use: 97–99% effective ✅

• Typical use: ~92% ⚠

• Provides 273+ days of active hormones

 

💡 Teaching Points

• 🧴 Clean with mild soap and water before reinserting

• 💬 Can be removed for up to 2 hours (for sex, etc.) — rinse and replace after

• 🚭 Avoid if smoker >35 yrs or history of VTE/clotting disorders

• 🩷 Fertility returns quickly once discontinued

• 🌿 Environmentally friendly (reusable = less waste)

💉 Implantable Progestin — Nexplanon (Implanon)

⚙ What It Is

• A small, flexible plastic rod (size of a matchstick) inserted under the skin of the upper arm 💪

• Slowly releases progestin hormone into the bloodstream

• Prevents pregnancy by:

  • 🚫 Stopping ovulation

  • 💧 Thickening cervical mucus

  • 🌸 Thinning uterine lining

 

⏳ How Long It Works

• 💪 Effective for up to 3 years (sometimes 4 years)

• One of the most effective forms of birth control:

  • Perfect use: 99% effective ✅

  • Typical use: 99% effective 💯

 

⚠ Common Side Effects

• 🔴 Irregular menstrual bleeding (most common)

• 😴 Headache, mood swings, breast tenderness

• ⚖ Possible mild weight gain

 

🚫 What It Does NOT Do

• ❌ No STI protection — use condoms for infection prevention

• ❌ May be contraindicated in:

  • Unexplained vaginal bleeding (VB)

  • Liver disease, breast cancer, or blood clots

 

🩷 Teaching Tips

• 👩‍⚕ Inserted subdermally in upper arm during office visit

• ⏰ Can be removed any time — fertility usually returns quickly

• 💬 Expect spotting or no period at all

• 🧊 Minor swelling/bruising after insertion is normal

💉 Nexplanon (Etonogestrel Implant)

⚙ What It Is

• A thin, flexible plastic rod (about the size of a matchstick) 🔦

• Inserted under the skin of the upper arm 💪 by a healthcare provider

• Contains progestin only (no estrogen!)

• Works for 3 years continuously ⏳

 

🧠 How It Works

• 🚫 Prevents ovulation

• 💧 Thickens cervical mucus (blocks sperm)

• 🌸 Thins uterine lining (makes implantation harder)

 

📊 Effectiveness

• 💯 >99% effective (less than 1 pregnancy per 100 women in a year)

• One of the most reliable long-term methods of birth control

 

⚠ Side Effects

• 🔴 Irregular bleeding or spotting (most common)

• 😴 Headaches

• 😕 Mood changes or mild acne

• 💧 Temporary swelling or redness at the insertion site

 

🚫 What It Does NOT Do

• ❌ No protection against STIs (use condoms for STI prevention!)

• ❌ Contraindicated in:

  • Unexplained vaginal bleeding

  • Liver disease or breast cancer

 

💡 Teaching Points

• 👩‍⚕ Inserted and removed in-office using local anesthesia

• 🧊 Expect mild soreness or bruising after insertion

• 💬 Fertility returns quickly after removal (within weeks!)

• 🩺 Can be used safely while breastfeeding

🩷 Intrauterine Device (IUD)

⚙ What It Is

A small T-shaped device inserted into the uterus by a healthcare provider 🩺

It works long-term and is reversible — one of the most common contraceptives worldwide 🌍

 

💎 Two Main Types

1. Copper IUD (Paragard) ⚡

   • 🕐 Lasts up to 10 years

   • 🧲 Copper creates a toxic environment for sperm → prevents fertilization

   • 💬 May cause heavier bleeding or cramps

2. Hormonal IUDs (release levonorgestrel) 💊

   • 🕐 Duration depends on brand:

     • Mirena: 5 years

     • Kyleena: 5 years

     • Liletta: 3 years

     • Skyla: 3 years

   • 🌸 Thickens cervical mucus → sperm can’t enter

   • 🌿 Thins uterine lining → prevents implantation

   • ❤ Decreases bleeding (BTB) and dysmenorrhea

 

💡 How It Works

• 🚫 Thickens cervical mucus → blocks sperm entry

• 🚫 Inhibits sperm motility/function

• 💢 Foreign body reaction → toxic to sperm

• 🌸 Endometrium changes → prevents implantation

• 📉 Decreases menstrual flow and cramps (especially hormonal IUDs)

 

📊 Effectiveness

• 💯 98–99.9% effective — as effective as sterilization!

• 👶 Fertility returns quickly after removal

 

⚠ Nursing Notes / Teaching

• 🩺 Inserted during office visit; insertion can cause mild cramping

• 🩸 Teach patient to check for IUD string monthly

• 🚫 Does NOT protect against STIs

• 💬 Report pain, fever, or foul discharge (may indicate infection or perforation)

• ⚠ Contraindicated in pregnancy, unexplained bleeding, pelvic infection, or distorted uterus

 

⚠ IUD Side Effects & Complications

🩸 Common Side Effects

• 🔄 Irregular periods — light bleeding or spotting at first

• 🚫 Amenorrhea (no periods) — may occur after months with hormonal IUDs

• 😣 Cramping or pelvic discomfort (usually short-term after insertion)

 

⚠ Possible Complications

1. 🩻 Uterine perforation

   • May occur at the time of insertion (rare)

   • Signs: sudden severe pain, bleeding, faintness

   • Nursing action → stop procedure, monitor, notify provider

2. 🚨 Expulsion

   • Occurs in 2–10% of users, usually within the first few months

   • Teach to check for strings monthly after menses

   • If strings feel longer/shorter → possible expulsion or displacement

3. 💥 Ectopic pregnancy (rare but serious)

   • If pregnancy occurs, increased risk it’s ectopic

   • Symptoms: shoulder pain, pelvic pain, missed period, faintness

4. 🩸 Spontaneous abortion or preterm birth

   • If pregnancy occurs with IUD in place → risk of miscarriage or preterm delivery

5. 🦠 Infection risk

   • Highest within first 20 days after insertion

   • Risk for pelvic inflammatory disease (PID) if STI is present

   • Cultures done prior to insertion to rule out infection

 

🧠 Nurse Teaching

• 🩺 Pre-insertion: screen for STIs & obtain consent

• 💬 Post-insertion: expect mild cramping & spotting

• 🚨 Call provider if:

  • Fever, chills, foul discharge

  • Severe abdominal pain or missed period

 

💢 PAINS — IUD Warning Signs

🔤 P — Period Late / Missed

• Possible pregnancy (including ectopic pregnancy 🚨)

• Watch for abnormal spotting or heavy bleeding

 

🔤 A — Abdominal Pain

• Could indicate infection, perforation, or ectopic pregnancy

• Assess for sharp or severe pain and tenderness

 

🔤 I — Infection

• Signs: foul vaginal discharge, fever, or pain during sex

• May be Pelvic Inflammatory Disease (PID) from ascending infection

 

🔤 N — Not Feeling Well

• General malaise: fever, chills, aches

• Could signal systemic infection or sepsis

 

🔤 S — String Missing / Shorter / Longer

• May indicate IUD expulsion, displacement, or perforation

• Instruct patient to check strings monthly after each period

 

🩺 Nursing Tip

“Teach all IUD users to remember PAINS — it helps them detect serious complications early!”

🚺 Female Sterilization (Tubal Ligation)

• 🔹 Permanent surgical contraception — “getting tubes tied”

• 🔹 Most common form of contraception worldwide

• 🔹 Often performed immediately after childbirth (postpartum)

 

🩺 Procedure

• 🩻 Abdominal surgery: fallopian tubes are cut, tied, or sealed to block sperm from reaching the ovum

• ⏱ Usually done laparoscopically or during C-section recovery

• 💵 Average cost: around $1,200 (varies by insurance and region)

 

📊 Effectiveness

• ✅ Efficacy: 99.6%

• 🚫 No ongoing adherence needed (no daily pill or device check)

• ❌ Does NOT protect against STIs

• very low failure rate

 Pros and Cons of Female Sterilization (Tubal Ligation)

✅ Pros (Advantages)

• 💪 Female-controlled — doesn’t depend on partner cooperation

• 🔒 Permanent — long-term, no maintenance

• 🏥 Can be performed with C-section — convenient if already having abdominal surgery

• 🔁 Highly effective — failure rate < 1%

• 🧘‍♀ No hormonal side effects — good for those who can’t take estrogen

 

⚠ Cons (Disadvantages)

• 🩺 Requires surgery — carries anesthesia and infection risks

• 💵 Expensive — can cost over $1,000 without insurance

• 💢 Visible scar possible with abdominal approach

• 🚫 Difficult to reverse — and if pregnancy occurs, ↑ risk of ectopic pregnancy

• 🦠 No protection from STIs

• 😞 Possible emotional regret — especially if done at a young age or under pressure

• ⚖ Ethical concern: historically linked to forced sterilization / population cleansing in vulnerable groups — patient consent is essential

♂ Male Sterilization (Vasectomy)

🧠 Overview

• ✂ Outpatient surgical procedure — the vas deferens (tubes carrying sperm) are cut and sealed

• 💉 Local anesthesia; quick recovery

• 🚫 Does not affect testosterone level, libido, or ejaculation

 

📈 Effectiveness

• ✅ Efficacy: ~99.8%

• ⏳ Takes ~3 months or 15–20 ejaculations to clear sperm from vas deferens

  • Must confirm zero sperm count before stopping backup contraception

 

💵 Cost

• Average: $250–$400 (less expensive than female sterilization)

 

⚠ Risks / Side Effects

• 🦠 Infection at incision site (mild redness/swelling)

• 💢 Pain or hematoma (bruising in scrotum)

• 🧬 Sperm granuloma — small lump from sperm leakage

• 🔄 Spontaneous reconnection of vas deferens (rare, but possible)

• 😞 Regret if patient changes mind — reversal possible but not guaranteed

🩺 Post-Procedure Teaching

• 🚫 Continue another contraceptive method until sperm count = 0

• ❄ Apply ice packs for 20 min intervals to reduce swelling

• 👖 Wear supportive underwear

• 🚫 Avoid heavy lifting and sex for about 1 week

• 🦠 Report: redness, fever, pus, or severe pain

🚨 Emergency Contraception (EC)

Paragard IUD (Copper) 🧲	Copper	Up to 5 days after sex	⭐ Almost 100%	Must be placed by a provider; can be left in for 10 yrs
Ella (Ulipristal acetate) 💊	Selective progesterone receptor modulator	Within 5 days (120 hrs)	✅ Most effective pill	Requires prescription; less effective if BMI > 35
Plan B One-Step / Levonorgestrel 🌼	Progestin	Within 72 hrs (3 days), but may work up to 5 days	⚡ 85–89% effective	OTC — available without prescription
Mirena / Liletta IUD (LNG-IUD) 🌀 (added in 2021)	Levonorgestrel	Within 5 days	✅ Highly effective	Dual use: EC + long-term contraception

 

📍 Key Points

• 🕒 The sooner, the better — efficacy decreases with time

• 🧍‍♀ Use another contraceptive afterward for ongoing protection

• 🩸 May cause temporary spotting or nausea

• 🚫 Does NOT protect against STIs

• 🩺 No abortion effect — safe even if implantation has already occurred

🚨 Post-Coital Contraception (“Morning-After Pill”)

💊 AKA

• “Emergency Contraception”

• “The Morning-After Pill”

• Oral EC (Emergency Contraceptive Pills)

 

⚙ How It Works

• ⏸ Delays or inhibits ovulation

• 🚫 Prevents fertilization or implantation (if it hasn’t occurred yet)

• ❌ Does NOT terminate an existing pregnancy

 

⏰ Timing

• Most effective within 72 hours (3 days) after unprotected sex

• May work up to 5 days, but effectiveness ↓ with time

• ⏳ “The sooner it’s taken, the better it works!”

 

📊 Common Brands

• Plan B One-Step / Julie / My Way (levonorgestrel 1.5 mg – OTC)

• Ella (ulipristal acetate – prescription only, effective up to 120 hrs)

 

⚠ Side Effects

• 🤕 Cramping or pelvic pain

• 🤢 Nausea / vomiting

• 🩸 Temporary spotting or early/late period

• 💤 Fatigue / dizziness

(If vomiting occurs within 2 hours → may need to repeat dose!)

 

🩺 Patient Teaching

• 💬 Use a backup birth-control method for the rest of the cycle

• 🧍‍♀ Does not protect against STIs

• 🩸 Period may be earlier or later than usual

• 🧠 Repeat if unprotected intercourse occurs again during same cycle

🧬 Essential Fertility Factors

🩸 1. Ovulation Must Occur

• 🥚 An egg must be released from the ovary.

• Occurs about 14 days before the next menstrual period.

• If ovulation doesn’t happen → no egg = no fertilization ❌.

 

🌬 2. Fallopian Tubes Must Be Patent (Open)

• 🚗 The egg travels from the ovary → tube → uterus.

• Blocked tubes (e.g., from PID, endometriosis) can prevent fertilization.

 

🧑‍🤝‍🧑 3. Healthy Sperm in Adequate Numbers

• 💦 Sperm must be motile, normal shape, and numerous.

• Ejaculation must occur near the cervix for sperm to reach the egg.

 

💧 4. Cervical Mucus Must Be Hospitable

• Around ovulation, estrogen makes mucus clear, thin, stretchy, and slippery — like egg white 🥚.

• This helps sperm swim easily into the uterus.

• Thick, acidic mucus (from infection or hormones) can block sperm 🚫.

 

🩸 5. Endometrium Must Be Receptive

• 🏡 The uterine lining must be thick and nutrient-rich to allow the fertilized egg (conceptus) to implant.

 

💊 6. Adequate Hormones Must Support Pregnancy

• 🧠 Hormones from the hypothalamus–pituitary–ovarian axis (especially progesterone) maintain early pregnancy.

• Insufficient progesterone → risk of early miscarriage ⚠.

 

🧠 NCLEX Tip

“Fertility requires both a healthy ovum and healthy sperm in the right environment at the right time.” ⏰💞

🧬 Infertility

💡 Definition

• Not an absolute inability to conceive, but a reduced ability to do so.

• Defined as no conception after 12 months of regular, unprotected intercourse (6 months if age ≥ 35).

• Affects about 13% of women ages 15–35.

 

🌸 Types of Infertility

Type	Description
Primary 🚫	The woman has never conceived.
Secondary 🔁	The woman has conceived before, but is unable to again.

 

⚖ Key Contributing Factors

🧠 Female Factors

• Advanced Maternal Age (AMA) > 35 years 🕰

• Anovulation (no ovulation)

• Tubal blockage (PID, endometriosis)

• Uterine abnormalities (fibroids, scarring)

• Cervical mucus issues

• Hormonal imbalance (thyroid, prolactin disorders)

🧍‍♂ Male Factors

• Low sperm count or motility

• Abnormal sperm shape

• Retrograde ejaculation

• Infections (e.g., STIs)

• Substance use / environmental toxins

🧬 Other / Shared Factors

• Chronic illnesses (e.g., diabetes, autoimmune diseases)

• Obesity or underweight ⚖

• Stress and lifestyle 🧘‍♀

• Unexplained infertility (in ~10–20% of couples)

 

🩺 Evaluation Timing

• <35 years → start evaluation after 12 months

• ≥35 years → start evaluation after 6 months

 Male Factors in Infertility

💦 1. Abnormalities of the Sperm

• Oligospermia 🧮 → Low sperm count

• Asthenospermia 🏊 → Poor sperm motility

• Teratospermia 🧫 → Abnormally shaped sperm

• May result from:

  • Varicocele (dilated scrotal veins)

  • Testicular trauma

  • Infections (e.g., mumps, STI)

  • Hormonal imbalance (↓ testosterone, ↑ FSH/LH)

 

⚙ 2. Abnormal Ejaculation

• Retrograde ejaculation 🔄 — Semen goes backward into the bladder instead of exiting the urethra.

• May be caused by:

  • Diabetes

  • Spinal cord injury

  • Surgery or certain medications (like antidepressants).

 

⚡ 3. Abnormal Erections

• Erectile dysfunction (ED) prevents adequate sperm delivery.

• Causes: vascular disease, diabetes, psychological stress, or medications.

 

🧬 4. Structural or Hormonal Disorders

• Obstruction of vas deferens or epididymis 🚫

• Pituitary or thyroid dysfunction (affecting testosterone and sperm production).

 

⚠ 5. Other Contributing Factors

• 🦠 Mumps after puberty

• 🎗 Cancers or testicular tumors

• 🍔 Poor nutrition or obesity

• 🚬 Smoking / Alcohol / Substance abuse

• 💊 Medications: SSRIs, MAOIs, anabolic steroids

• 🌡 Exposure to high temperatures (sauna, hot tubs, tight clothing)

• ⏳ Age — sperm quality declines after 40

 

🧪 Nursing Fact

With infertility testing, the male is evaluated first because it’s less invasive — starting with a semen analysis (volume, count, motility, and morphology).

 

👩‍🩺 Female Factors in Infertility

🚫 1. Abnormalities of the Fallopian Tubes

• Most common cause of female infertility.

• Tubes may be blocked, scarred, or damaged, preventing sperm from meeting the egg.

• Causes:

  • Pelvic Inflammatory Disease (PID) 🦠 (often from untreated STIs)

  • Endometriosis 🩸 (tissue growth outside uterus causing scarring)

  • Previous pelvic/abdominal surgery ✂ (adhesions)

  • Tubal ligation (intentional surgical blockage)

🧠 NCLEX Tip:

Hx of PID or endometriosis = ↑ risk for tubal infertility and ectopic pregnancy.

 

💧 2. Abnormalities of the Cervix

• The cervical canal or mucus may block or destroy sperm before they reach the uterus.

• Causes:

  • Cervical stenosis (narrow canal)

  • Infections or inflammation

  • Scarring from surgery or trauma

  • Hostile cervical mucus (too thick, acidic, or lacks estrogen influence)

💊 Treatment:

• Estrogen therapy 💧 to thin cervical mucus

• Intrauterine insemination (IUI) to bypass the cervix

 

🥚 3. Disorders of Ovulation

• Ovulation may be absent (anovulation) or irregular (oligo-ovulation).

• Causes:

  • Polycystic Ovary Syndrome (PCOS) 💢

  • Thyroid disorders 🦋

  • Premature ovarian failure

  • Stress, weight changes, or excessive exercise 🏃‍♀

  • Hyperprolactinemia (too much prolactin hormone)

💉 Management:

• Clomiphene citrate (Clomid) or Letrozole to stimulate ovulation

• Lifestyle modification (nutrition, weight management)

 

🧫 Female Diagnostic Tests for Infertility

🩸 1. Ovulation Prediction

• Used to determine if and when ovulation occurs.

• Common methods:

  • Basal body temperature (BBT) 🌡 — a slight 0.5–1°F rise after ovulation.

  • Ovulation predictor kits (LH surge test) 🧪 — detects luteinizing hormone (LH) in urine; a surge indicates ovulation will occur in 24–36 hours.

  • Serum progesterone levels — drawn about day 21 of a 28-day cycle; confirms ovulation.

🧠 Nursing Tip: Educate patient to track temperature and use the same thermometer each morning before getting out of bed.

 

🩻 2. Ultrasonography

• Transvaginal ultrasound monitors:

  • Follicle development and ovulation timing

  • Uterine abnormalities (fibroids, polyps, endometrial lining thickness)

  • Ovarian cysts or PCOS

💡 Used during fertility treatments to guide ovulation induction or insemination timing.

 

💧 3. Post-Coital Test (PCT)

• Evaluates the interaction between sperm and cervical mucus.

• Conducted 10–12 hours after intercourse, near the time of ovulation.

• Normal result: Many motile sperm visible moving through clear, stretchy mucus.

• Abnormal result: No or sluggish sperm movement → suggests hostile mucus or sperm dysfunction.

🧠 Nursing Reminder: Instruct the couple to have intercourse 2–8 hours before the appointment and avoid douching or lubricants before testing.

🌸 Infertility Therapy Overview

❤ 1. Timing of Intercourse

• Intercourse is planned during ovulation (usually day 14 ±2 of a 28-day cycle).

• Basal body temperature and LH surge kits help identify fertile days.
  🧠 Nursing Tip: Encourage intercourse every other day during fertile window to optimize sperm health.

 

 

🧬 3. Surgical Procedures

• Laparoscopy 🔍 — removes endometrial implants, adhesions, or obstructions.

• Hysteroscopy — repairs uterine septum, polyps, or fibroids.

🩺 Nursing Role: Educate about post-op care and importance of infection prevention.

 

💧 4. Therapeutic (Artificial) Insemination (IUI)

• Washed, concentrated sperm are inserted directly into the uterus at ovulation.

• Used for:

  • Low sperm count or motility

  • Cervical mucus issues

  • Unexplained infertility
    🧠 Tip: Procedure is quick, often painless, and done outpatient.

 

🧫 5. Assisted Reproductive Technology (ART)

Includes advanced methods for conception when other treatments fail:

• In Vitro Fertilization (IVF): Egg + sperm combined in lab → embryo placed in uterus.

• Gamete Intrafallopian Transfer (GIFT): Eggs + sperm placed in fallopian tube.

• Zygote Intrafallopian Transfer (ZIFT): Fertilized zygote transferred to tube.

• Intracytoplasmic Sperm Injection (ICSI): Single sperm injected directly into egg.

💡 Note: ART requires hormonal preparation, ultrasound monitoring, and emotional support.

 

🧍‍♀ 6. Donor & Surrogacy Options

• Egg donation: Donor eggs used if ovarian failure or advanced maternal age.

• Sperm donation: Used for male infertility.

• Surrogate parenting: Another woman carries the pregnancy for intended parents.

🧠 Ethical Consideration: Ensure psychological counseling and legal agreements are discussed.

 

🧬 Therapeutic Insemination (IUI)

 A fertility procedure where washed sperm (from partner or donor) is placed directly into the uterus near ovulation to increase the chances of fertilization.

 

💡 Purpose

• To bypass cervical barriers (like thick mucus or scarring).

• To improve sperm delivery to the fallopian tubes.

🥚 Egg Donation (Oocyte Donation)

Definition:

A fertility procedure in which eggs from a donor are retrieved, fertilized with sperm in a lab (usually through IVF), and the resulting embryo is transferred into the recipient’s uterus.

 

💉 Why It’s Done

Used when:

• The woman has premature ovarian failure, diminished ovarian reserve, or genetic disorders.

• Older maternal age (especially >40).

• Recurrent IVF failures with own eggs.

• Same-sex male couples or single men using a gestational carrier.