Birth control or contraceptives - refers to restricting the number of children by various methods

designed to control fertility and prevent conception.

1. Surgical Sterilization
● Sterilization - procedure that renders an individual incapable of further reproduction.
● Vasectomy - sterilization of males in which each portion of ductus deferens is removed.
Sperms degenerate and are destroyed by phagocytosis.
○ Conventional procedure - incision made with scalpel
○ Non-scalpel vasectomy - puncture
● Tubal ligation - both uterine tubes are tied closed and then cut. Secondary oocytes can't
pass through uterine tubes and sperm cannot reach the oocyte.
○ Clips
○ clamps
2. Non-Incisional Sterilization
● Essure - alternative for tubal ligation; a soft micro-insert coil made of polyester fibers and
metals (nickel-titanium and stainless steel) is inserted with a catheter into vagina, through the
uterus and into each uterine tube. After 3 months, the insert stimulates tissue growth (scar
tissue) around itself, blocking uterine tubes.
3. Hormonal Methods
● Oral contraceptives (the pill) - contain hormones designed to prevent pregnancy.
● Combined Oral Contraceptives (COC) *contain progestin (similar to progesterone) and
estrogens - to inhibit ovulation by suppressing the gonadotropins FSH and LH and may also
block implantation in the uterus. *low levels of FSH and LH prevent development of dominant
follicle.
○ Progestins - thicken cervical mucus and make it more difficult for sperm to enter
uterus
○ Progestin-only pills - thicken cervical mucus and may block implantation in the uterus,
but not inhibit ovulation.
ORAL
● Combined Pill - contains progestin and estrogen; once a day for 3 weeks to prevent
pregnancy and regulate menstrual cycle. The pills taken during 4th week are inactive. Ex.
Yasmin.
● Extended cycle birth control pill - contains progestin and estrogen; once a day in 3-month
cycles of 12 weeks of hormone-containing followed by 1 week inactive pills. Ex. Seasonale.
● Minipill - contains low dose progestin only and is taken everyday of the month. Ex. micronar.
NON-ORAL
● Contraceptive skin patch - contains progestin and estrogen. Placed on upper arm, back,
lower abdomen or buttocks once a week for 3 weeks. After 1 week, the patch is removed from
one location and a new one is placed. No patch during 4th week. Ex. Ortho Evra.
● Vaginal Contraceptive ring - contains progestin and estrogen; flexible doughnut-shaped ring
about 5cm (2in) diameter. Inserted in vagina and left for 3 weeks to prevent conception and
then removed for one week for menstruation.Ex. NuvaRing.
● Emergency contraception (EC) or Morning after pill - consist of progestin and estrogen or
progestin alone to prevent pregnancy following unprotected intercourse. High levels of
progestin and estrogens provide inhibition of FSH and LH secretion causes ovaries to cease
secretion of their own estrogen and progesterone. Declining levels of estrogen and
progesterone induce shedding of uterine lining, thereby blocking implantation. Pill should be
taken within 72 hours of unprotected sex and second pill must be taken 12 hours afetr first
pill.
● Hormone injections - injectable progestins through IM once every 3 months. Ex. Depo-
provera.
Intrauterine Device (IUD) - small object made of plastic, copper, or stainless steel that is inserted by
a health-care professional into the cavity of the uterus; prevent fertilization by blocking sperm from
entering uterine tubes. Most common is Copper T 380A that is approved for 10 years and has long
term effectiveness compared to tubal ligation.

Spermicides - various foams, creams, jellies, suppositories and douches that contain sperm- killing
agents that make vagina and cervix unfavorable for sperm survival that are placed in vagina. Ex.
nonoxynol-9. Kills sperm by disrupting their plasma membranes.

Barrier Methods - use of physical barriers and are designed to prevent sperm from gaining access
to the uterine cavity and uterine tubes. Aside from preventing pregnancy, it provides protection
against STDs such as AIDS.
● Male Condom - latex covering placed over the penis that prevents deposition of sperm in
female reproductive tract.
● Vaginal Pouch (Female Condom) - designed to prevent sperm from entering the uterus;
made of 2 flexible rings connected by polyurethane sheath.
● Diaphragm - rubber, dome-shaped structure that fits over the cervix and is used in
conjunction with spermicide. Can be inserted for 6 hours before intercourse. Does not fully
protect from HIV because vagina is still exposed.
● Cervical cap - resembles diaphragm but is smaller and rigid. Fits snugly over the cervix and
must be fitted by a health-care professional. Spermicides should be used with cervical cap.

Periodic Abstinence - must use knowledge of physiological changes occurring during the female
reproductive cycle. Either abstain from intercourse on days pregnancy is likely to result or to plan
intercourse to which they wish to conceive child.
● Rhythm Method - abstaining inetrcourse on days that ovulation is likely to occur. (3 days
before ovulation, day of ovulation and 3 days after ovulation). It is a poor method due to
irregularity of reproductive cycle.
● Sympto-thermal method (STM) - natural, fertility awareness-based method of family
planning to either avoid or achieve pregnancy. Uses physiological markers to determine
ovulation (increased basal body temp and production of cervical mucus)- these changes
govern female fertility.

ABORTION - refers to premature expulsion of the products of conception from the uterus, usually
before 20th week of pregnancy,
● Spontaneous - miscarriage
● Induced - intentionally performed
1. Mifepristone (RU 486) - hormone approved only for pregnancies 9 weeks or less
when taken with misoprostol (stimulates uterine contractions). An anti-progestin that
blocks the action of progesterone by binding to and blocking progesterone receptors.
Menstruation will occur.
2. Vacuum Aspiration (suction) - can be performed up to 16th week of pregnancy. A
small, flexible tube attached to a vacuum is inserted into the uterus through vagina.
Embryo or fetus, placenta and lining of the uterus are removed.
3. Dilation and Evacuation - pregnancies between 13th and 16th week. Cervix is
dilated and suction and forceps are used to remove fetus, placenta and uterine lining.
4. Late-stage abortion - can be through sugical or non-surgical method (using saline
solution or induced medication.
DEVELOPMENT of REPRODUCTIVE SYSTEMS
Sex determination - determination of genetic sex by sex chromosomes.
Female - somatic cells contain XX
Male - somatic cells contain Xy
❏ If X bearing sperm fertilizes = genetic female XX
 ❏ If Y bearing sperm fertilizes - genetic male Xy
Bipotential - early embryo that has ability to form either male or female reproductive organs.
❏ If the embryo is genetically male, testes develop and secrete androgens which cause to
develop male reproductive tract and male external genitalia.
❏ If the embryo is genetically female, ovaries develop and the absence of androgens causes
the female reproductive tract and external genitalia to develop by default.
Sex diffrentiation - process by which reproductive organs develop along male or female lines.
● GONADS (from gonodal ridges arise from intermediate mesoderm)
● REPRODUCTIVE SYSTEM IN MALES (from mesonephric ducts or Wolffian ducts)
● REPRODUCTIVE SYSTEM IN FEMALES (from paramesonephric ducts or Mullerian ducts)

MALE
SRY (sex-determining region of Y chromosomes) - “master switch” which initiated the male pattern
development.
● Its protein product causes primitive sustentacular cells to begin to differentiate in the testes
during 7th week.
● Mullerian-inhibiting substance (MIS) - hormone secreted by developing sustentacular cells
which causes apoptosis of cells within the Mullerian ducts.
Testosterone - secreted by primitive interstitial cells in testes stimulated by the (hCG)
● Stimulates development of mesonephric duct on each side into epididymis, ductus (vas)
deferens, ejaculatory duct and seminal vesicle.
● Testes connect to mesonephric ducts that become the SEMINIFEROUS TUBULES.
● SEX GLANDS are endodermal outgrowths of urethra.
●
FEMALE
● SRY is absent = gonodal ridges develop into OVARIES.
● MIS not produced = paramesonephric ducts flourish.
○ formation of VAGINA and UTERUS - distal ends of paramesonephric ducts fuse.
○ Formation of FALLOPIAN TUBES - from unfused proximal portions
○ GREATER and LESSER VESTIBULAR GLANDS - from endodermal outgrowths of
the vestibule.

EXTERNAL GENITALS (BOTH) remain undifferentiated until about eight week.

Before differentiation, all embryos have ff external structures

Dihydrotestosterone (DHT) - In male embryos, some testosterone are converted that stimulates
development of the urethra, prostate and external genitals.
● PENIS - development of genital tubercle
● SPONGY (PENILE) URETHRAL and EXTERNAL URETHRAL ORIFICE - fusion of urethral
folds
● SCROTUM - labioscrotal swellings
Absence of DHT
● CLITORIS - development of genital tubercle.
● LABIA MINORA - urethral folds remain open.
● LABIA MAJORA - from labioscrotal swellings.
● VESTIBULE - urethral groove.
BENIGN PROSTATIC HYPERPLASIA (BPH) - decreases the size of prostatic urethra and is
characterized by frequent urination, nocturia, hesitancy in urination, decreased forced of urinary
stream, and sensation of incomplete emptying.