Reproductive Health

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 Key Takeaways

Population 1

Overpopulation
2 Contraception

Contraceptive methods 3

Natural methods Medical termination of

4
pregnancy
Barrier methods
Misuse
Chemical methods

Intrauterine devices
5 Female foeticide
Surgical methods

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 Amniocentesis 6

Sexually transmitted
7
infections

Infertility 8

In males Assisted reproductive

9
technologies
In females
In vitro fertilisation

In vivo fertilisation

Summary

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 Reproductive Health

Reproductive health is physical, emotional, behavioural and

social well-being in aspects of reproduction.

Two major concerns are associated with

reproductivity and awareness around it

Population Health

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 Population

Population growth rate is indicated by

Annual average growth rate Doubling time

Growth rate depends on

Natality rate Age/Sex ratio Mortality rate Migration

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 Population
Birth/Fertility/Natality rate Mortality rate

 Fertility is the ability of the reproductively  Mortality rate is the number of

active individual to produce offspring. deaths per thousand individuals.
 Natality rate is the number of births per  It has fallen in most countries.
thousand individuals.
○ This is due to modern medicines
 Birth rate can never be negative as and improved hygiene and sanitation.
opposed to population growth rate.
○ Infants below 1 year of age and senescent
people have a higher mortality rate.

Migration Age/Sex ratio

 Immigration rate - Number of people  It is the ratio of individuals in different age

entering the country per thousand people. groups/gender groups.
 Emigration rate - Number of people  Higher percentage of females in
leaving the country per thousand people. active reproductive age increases
birth rate.

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 Population
Total fertility rate Crude death rate
 The average number of children that would  Number of deaths per thousand
be born to a woman during her reproductive individuals in the middle of a given year
years.
 Total fertility rate varies from region to region Rate of natural increase

 Developed countries - lower fertility rate  Difference in the number of

deaths and births
 Replacement level (RL) - number of children
a couple must produce to maintain
population growth rate at zero Demographic transition
 RL = 2.1 in developed countries  Demographic transition theory assumes
 RL = 2.7 in developing countries that size and complexity of households
decreasing as societies industrialise.
Crude birth rate  State of zero population growth rate
 Number of live births per thousand  Witnessed by most developed countries
individuals in the middle of a given year

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 Overpopulation

India’s population
 World population 134 Crs
exploded from around 2021
2 billion in 1900 to about
6 billion in 2000 and
100 Crs 1999
then to 7.2 billion in 2011.

 Population of India as
well rocketed from 350 60 Crs
million in 1947 to a
billion in 2000 and then 1960
to 1.2 billion in 2011. 30 Crs
1930

1804

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 Overpopulation - Reasons

Low mortality and 1 Child marriage 2

higher life span

Preference for
Illiteracy 3 4
male kids

Aversion to family Non availability of

5 6
planning contraceptives

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 Overpopulation
Educating through
Scarcity of resources
media, posters, etc.

Raising the minimum

Shortage of funds
age of marriage

Problems Measures

Over consumption Incentives to couples

of resources with small families

Ecological Imbalance Family planning

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 Methods to Tackle Overpopulation
Birth control/Contraception

 Birth control or contraceptive methods are the acts or methods which

prevent conception.

 The word contraception comes from

○ Contra = against
○ Conception = process of fertilization and subsequent pregnancy

Checkpoints for contraception

Fertilisation Release of gametes Implantation

Ovulation Release of sperms

Each of these steps can be inhibited which would eventually

lead to contraception or birth control.
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 Contraception
Ideal contraceptive
Seven characteristics of an ideal
contraceptive

No side effects Easily available Highly effective Reversible

Shouldn’t interfere Shouldn’t interfere with

User friendly
with sexual act sexual desire

 User friendly infers that the user should be able to use it without the help of a doctor.
 Easily available infers that the contraceptive should be low cost and should be available at
all places.
 Highly effective infers it should reduce the chances of pregnancy in a very high
percentage of cases.

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 Contraception
Contraceptive methods

Reversible Irreversible

Natural Barrier Chemical IUD Surgical

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 Contraceptive Methods
Natural contraceptive methods

Periodic abstinence Coitus interruptus Lactational amenorrhea

(Rhythm method) (Withdrawal method) (Absence of menstruation)

Description Description Description

Involves avoiding coitus during Involves withdrawing penis from It is a temporary period of infertility in
fertile period i.e. from day 10-17 of vagina before ejaculation. women post-parturition. Release of
the menstrual cycle. GnRH , LH and FSH is reduced
How it works resulting in no ovulation and thus
How it works  Insemination is avoided by
amenorrhea.
 Ovulation occurs on 14th day withdrawal of penis in time.
 Sperms survive for 3 days  Sperms don’t reach egg and How it works
 Ovum survives for 1 day fertilisation is averted.  Since the female is infertile during
 Hence, days 10-17 of menstrual this period, no ovulation occurs
cycle have high probability of Drawback  As a result, coitus can't result in
fertilisation (fertile period)  Some sperms can enter vagina
fertilisation since the sperms don’t
 Abstaining from coitus during find an egg to fertilise.
before ejaculation
this period will prevent  Withdrawal of penis may not
conception. occur in time. Drawback
 Effective only up to 6 months from
Drawback parturition.
 Actual time of ovulation cannot
be predicted.
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 Contraceptive Methods
Natural contraceptive methods

Ideal contraceptive Periodic Coitus Lactational

characteristics abstinence interruptus amenorrhea

Side effects No No No

Easily available Yes Yes Yes

Reversible Yes Yes Yes

User friendly Yes Yes Yes

Interferes with Yes Yes Yes

sexual act

Interferes with No No No
sexual desire

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 Contraceptive Methods
Barrier contraceptive methods

Condom Femshield Diaphragm Vault Cervical cap

 Thin tubular  Polyurethane  Tubular rubber  Hemispherical  Rubber nipple

latex/rubber pouch with rings sheath with a dome-like rubber  Fitted over the
sheath to cover on either end flexible metal or plastic cap cervix
penis during  Covers external ring with a thick rim  Remains there
coitus genitalia as well  Fitted inside the  Fits over the by virtue of
 Traps the semen, as lines the vagina vaginal vault over suction
thus preventing vagina  Doesn’t protect the cervix
 Prevents the
entry of sperms  Protects against against STDs entry of sperm
in female STDs into uterus
reproductive
tract
 Protects against
STDs

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 Contraceptive Methods
Barrier contraceptive methods

Ideal Condoms/ Femidoms/ Diaphragms Cervical caps Vaults

contraceptive Male Female
characteristics condoms Condoms

Side effects No No Risk of UTI No No

Easily available Yes Yes Yes Yes Yes

Reversible Yes Yes Yes Yes Yes

User friendly Yes Yes Yes Yes Yes

Interferes with Yes Yes Yes Yes Yes

sexual act

Interferes with No No No No No
sexual desire

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 Contraceptive Methods
Chemical contraceptives

Chemical contraceptives
Chemical
constituents are
used to prevent
fertilisation or avoid Hormonal
implantation
Steroidal

Pills Implants Vaginal rings

Injections Skin patches

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 Hormonal Chemical Contraceptives
 Small doses of
Progestogen Estrogen
o Progestogen alone
o Progestogen-estrogen
combinations given to Acts like progesterone Compensates and
women maintain normal
thickening of uterine wall
 Releases hormones in Inhibits GnRH release from
bloodstream and acts on Hypothalamus
endocrine system. Prevents irregular
 Progestogen produces menstrual bleeding
No GnRH No LH and FSH
effect similar to
progesterone
o Inhibits ovulation and No Estrogen from ovary
implantation thus No progesterone
prevents pregnancy

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 Hormonal Chemical Contraceptives

Contraceptive pills How contraceptive pills work?

 Have to be taken daily for a period of 21  Inhibit ovulation and implantation

days starting preferably within the first five
 Alter the quality of cervical mucus to
days of menstrual cycle
prevent/retard entry of sperms
 After a gap of 7 days (during which
 Inhibit motility and secretory activity of
menstruation occurs) it must be repeated in
fallopian tubes
the same pattern till the female desires to
prevent conception. S M T W T F S
 Oral pills are of two types:
o Combined pills
o Minipills

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 Hormonal Chemical Contraceptives

Combined pills Minipills

 Contain both estrogen and progestin  Progestin only pills

o Most commonly used progestin is  Taken daily without break
levonorgestrel or desogestrel  Ex - POP
o Most commonly used estrogen is
ethinyl estradiol or menstranol
Saheli
 Monophasic combined pill contains
estrogen and progestin in same amount  Saheli is an oral contraceptive for females
o Ex - Mala D and Mala L which contains a non-steroidal preparation.
 It is a ‘once a week’ pill with very few side
 Multiphasic combined pills maintain
effects and high contraceptive value.
estrogen at same level through
the 21-day course.
o Level of progestin are
increased gradually
o Ex-triquilar, Ortho-novum

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 Hormonal Chemical Contraceptives

Contraceptive injections Implants

 Contain progestogen-estrogen  Hormone containing devices

combination implanted sub-dermally for
long term contraception
 Ex - depot-medroxyprogesterone acetate
injection’s effect sustains for approximately  Ex-norplant - progestin only
3 months device with six small silicone
capsules having
 Ex - norethisterone enanthate's effect
levonorgestrel
sustains for 2 months.
 Remains effective for 5 years
 Ex - Cyclofem and mesigyna
o Injected as a combination  Ex-implanon - single rod like
device which is implanted
o Given once every month
through a wide-bored needle
o Contains progestin and oestradiol

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 Hormonal Chemical Contraceptives
Skin patches Vaginal rings
 Hormonal transdermal patch  Small, flexible, soft plastic ring
applied to the skin  Releases continuous dose of
 Contains estrogen – progestogen estrogen – progestogen combination
combination
 Short-term and reversible

Spermicidal formulations
 Non - steroidal chemical formulation for topical application
 Contains chemicals which prevent pregnancy by
o Killing, blocking or slowing the sperms
 Spermicidal creams (ex- delfen) are applied deep in the vagina and
cervix just 10-60 minutes before sexual intercourse
 Best effective with other barrier method
 It also comes in the form of jellies, ex - perceptin, volpar paste
 It also comes in the form of tablets, ex - aerosol foam, chloramine - T or contab
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 Emergency Contraceptive Methods

 It is a method of contraception that can be used to

prevent pregnancy after sexual intercourse.

 They are also called morning-after pills.

 Pill/s should be taken within 5 days of sexual intercourse.

 They are more effective when taken as early as possible

especially within 3 days or 3 x 24 = 72 hours.

 Two Ovral tablets to start and two tablets after 12 hours

helps in prevention of pregnancy.

 Other options are noral, norigynon and ovidon.

 Mifepristone is a single pill treatment.

 They are used after unprotected sex and in case of rape.

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 Contraceptive Methods
Intrauterine devices or IUDs

 Small birth-control devices placed in the uterus to prevent pregnancy

 Long-acting reversible contraception

IUDs

Non-medicated IUDs Copper releasing IUDs Hormonal IUDs

(e.g., Lippes loop) (CuT, Cu7, Multiload 375) (Progestasert, LNG-20)

 IUDs are ideal contraceptives for females who want to

delay pregnancy and/or space children.
 It is one of most widely accepted methods of contraception in India.

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 Intrauterine Devices or IUDs

CuT Cu7 Multiload 375

How IUDs act?

 Increase phagocytosis of sperms within the uterus

 Cu ions released suppress sperm motility and
the fertilising capacity of sperms
 The hormone releasing IUDs, in addition, make the
uterus unsuitable for implantation and the cervix
hostile to the sperms.

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 Intrauterine Devices or IUDs
Copper T features

 Copper T has ionised copper.

 It causes release of toxic cytokines.
○ They suppress sperm motility and their ability to fertilize ovum.
 Such devices need to be replaced 3-5 years.

 Cu T380A has a replacement period of 7-10 years.

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 Contraceptive Methods
Surgical methods of contraception

Vasectomy Tubectomy

 It is a surgical method of male sterilisation.  It is a surgical method of female sterilisation.

 It prevents the transportation of sperms.  It prevents the transportation of ova.
 Vas - Vas deferens, ectomy - surgical removal.  Tub - Fallopian tube, ectomy - surgical removal.

Cut and tied

vas deferens

Male sterilisation Sealed fallopian tube Female sterilisation

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 Vasectomy
Method of sterilisation

 A small part of the vas deferens is removed or tied up through a

small incision on the scrotum.

 This blocks sperm from entering the ejaculate and thereby

prevents conception.

Two small incisions, one on each Then the cuts are sealed. Thus, the sperms
side of vas deferens, are done. cannot pass through the vas deferens.

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 Vasectomy

Techniques Efficiency

 Conventional vasectomy - 1 cm incision Vasectomy is 99% effective.

is made over the area of vasa deferens
with the help of scalpel.
99%
○ Each vas deferens is cut and exposed
Drawbacks
and tied.
○ A gap of 1-4 cm is a must between the  Cannot be easily reversed, even
two ends. if couples want to conceive later.
 No scalpel vasectomy - Dissecting and  There is a reversal technique,
ringed forceps are used instead of scalpel. but it is usually not successful.
○ 1-2 cm of vas deferens is removed.
○ Each end is occluded by heat and clips.

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 Tubectomy
Method of sterilisation
 A small part of the fallopian tube is removed or tied up through a
small incision in the abdomen or through vagina.
 It is also called tubal ligation.

Two small incisions on both the The ends are sealed.

fallopian tubes are made. It prevents the transportation of ova.

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 Tubectomy

Techniques Efficiency
 Conventional transabdominal Tubectomy is 99% effective.
surgery - Fallopian tubes are cut and
loose ends are tied to prevent reunion
99%
 Conventional laparotomy or Mini Drawbacks
laparotomy - In these two procedures,  It cannot be easily reversed. The
loop development and constriction of female cannot conceive even if she
the basal region of the loop with the wants to.
help of a silastic ring is used to achieve  Reversal technique is usually not
sterilisation. successful.

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 Medical Termination of Pregnancy
 Voluntary termination of pregnancy before its complete term
 20% of total pregnancies (45-50 million annually) are aborted
 Can be safely performed up to 12 weeks (within first trimester)
of pregnancy
○ Risky in the second trimester
 Misoprostol and Mifepristone is an effective combination for MTP
 Vacuum aspiration and surgical operations are taken up thereafter
 Helps in containment of population
 Used to end unwanted pregnancies arising due to
unprotected sex or rape
 Medical Termination of Pregnancy Act, 1971 was bought in by
Government of India to prevent unnatural maternal deaths due to unsafe
abortions

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 Misuse of MTP
 Illegally done by unqualified quacks  Foetal sex determination followed by MTP
(fraudulent or ignorant pretender to ○ Female foeticide
medical skill)
 Could be fatal for mothers

 Sex-determination methods such as

amniocentesis and sex determination
through ultrasound scanning are
carried out.

 If the foetus is found to be female,

then MTP is undertaken by couple
which is totally against the law.

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 Female Foeticide
Male favoured for
successful lineage
 It is the process of selective
abortion of female foetuses.

 It is an illegal practice. Dowry system

 There are strict laws against it Reasons
and penalties are imposed on for female
violators.
foeticide
Girls are not safe

Lack of education

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 Amniocentesis
 It is a prenatal test.
 It is based on the genetic makeup of
the cells from the amniotic fluid.
 It is used in sex determination test
and foetal disorder test (Down
syndrome, Haemophilia, sickle
cell anaemia).
 It is performed between 15th-20th
weeks of pregnancy.
 Amniotic fluid sample is taken from
mother and tested.
Safe period for performing
 When it is performed, it carries a
amniocentesis
minor risk factor (1%) of causing a
miscarriage.

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 Sexually Transmitted Infections

 These are the diseases which can transmit through sexual intercourse
or through the body fluid interaction.
 They are also called-
○ Sexually transmitted diseases (STDs)
○ Venereal disease (VD)
○ Reproductive tract infections (RTIs)

 Below are eight common STDs:

Gonorrhoea Syphilis Hepatitis B AIDS

Genital Herpes Chlamydiasis Trichomoniasis Genital Warts

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 Sexually Transmitted Infections
Sexually transmitted Causative agent Type of causative agent
disease

Gonorrhoea Neisseria gonorrhoeae Bacteria

Syphilis Treponema pallidum Bacteria

Genital herpes Human simplex virus type -2 Virus

(HSV-II)

Genital warts Human papillomavirus Virus

Hepatitis B Hepatitis B virus Virus

Trichomoniasis Trichomonas vaginalis Protozoa

Chlamydiasis Chlamydia trachomatis Bacteria

Acquired immunodeficiency Human immunodeficiency Virus

syndrome virus

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 Sexually Transmitted Infections
Social stigmas of STDs

Negative attitude towards sex Myths regarding STDs is that it

with multiple partners and can only spread through sex
outside of marriage with multiple partners

Consequently, individuals with STDs are looked down by the society.

Consequences of social stigmas associated with STDs

People avoid getting tested to Affected individuals are isolated

avoid social isolation, leading to leading to depression and
increase in severity of disease. aggravation of disease in them.

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 Sexually Transmitted Infections
Complications of STDs

Abortion Stillbirths Infertility Cancer

Pelvic inflammatory disease Ectopic pregnancies

Prevention of STDs

Use fresh syringe

Use condoms Consult a Use fresh blade
for injection
during sex qualified doctor every time
every time

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 Infertility

It is the inability to conceive or produce children even after 2 years of

regular, unprotected sexual cohabitation.

Its causes:

Immunological 1 Physical 2

Disease 3 Congenital 4

Psychological 5 Drugs 6

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 Infertility

Primary infertility Secondary infertility

Found in patients who have Found in patients who have

never conceived conceived previously

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 Infertility
Infertility in males

Failure of testes to
Low sperm
Oligospermia descend into Cryptorchidism
count
scrotum

Near absence of Absence or

Azoospermia Vasa efferentia
sperms blockage

Due to disorder or
Low sperm
Asthenozoospermia environmental Hyperthermia
motility
factors

Mumps,
Defective sperm
Teratozoospermia bronchiectasis, Infections
morphology
chlamydiasis etc.
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 Infertility
Infertility in females

 Inadequate growth and functioning

 Impaired motility, loss of cilia and
of corpus luteum resulting in
blocked lumen in fallopian tube
reduced progesterone secretion and
resulting in it being unable to pick
deficient secretory changes in
up the ovum.
endometrium.
 It is caused by infection or
 It is called luteal phase and inhibits
endometriosis
implantation.

 Anovulation (non-ovulation) or
oligo-ovulation (deficient  Ovum is not liberated and remains
ovulation) caused by deficient trapped inside the follicle due to
functioning of hypothalamop- hyperprolactinemia (higher than
ituitary complex normal levels of prolactin in blood).

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 Assisted Reproductive Technologies (ART)

A set of medical procedures aimed at treating infertility.

Types of ART

In Vitro Fertilisation In Vivo Fertilisation

 Fertilisation performed outside  Fertilisation performed within

the body of the female. the body of the female.
 Test Tube Baby Programme  Requires donor for
ovum or sperm.

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 In Vitro Fertilisation

Fertilisation performed outside the body of the female.

Steps of in vitro fertilisation :

Superovulation

Gamete retrieval

Intra cytoplasmic sperm injection

Embryo transfer

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 In Vitro Fertilisation

Superovulation Gamete retrieval

Hormone treatment to produce Extraction of sperm and ova from

several mature ova instead of just one donors
 Extraction of ova - Transvaginal
The two hormones are - Luteinizing oocyte retrieval
hormone (LH) and follicle
stimulating hormone (FSH)  Extraction of sperm -
○ Collection condom
 LH helps in the release of an ○ Surgical method
egg from the ovary
 FSH stimulates the growth
of ovarian follicles

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 In Vitro Fertilisation
Intra Cytoplasmic Sperm Injection Embryo Transfer

 The sperm is directly The embryo is implanted in the female

injected into the ovum. genital tract for further development.
 It is done in case of low sperm  Zygote Intra Fallopian Transfer
count, high concentration of (ZIFT) - The zygote or early embryos
deformed sperm and low with up to 8 blastomeres is
sperm motility. transferred into the fallopian tube.
 Intra Uterine Transfer (IUT) -
Embryos with more than 8
blastomeres are transferred into the
uterus.
 Surrogacy - It is an arrangement,
often supported by a legal
agreement, whereby a woman (the
surrogate mother) agrees to bear a
child for a couple.
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 Did You Know?

Freezing gametes

Sperms can be preserved in

sperm bank through a
process called
cryopreservation.

Cryopreservation

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 In Vivo Fertilisation
Fertilisation performed within the body of the female.

Techniques of in vivo fertilisation :

Types of procedures

Gamete intrafallopian Artificial Intra uterine

transfer (GIFT) insemination (AI) insemination (IUI)

● Performed if the ● Performed in cases of ● Performed if vagina

female is unable to inability of the male is too acidic or pH of
produce an egg partner to inseminate the semen is not
female or very low alkaline enough
sperm count
● Sperms are directly
● Sperms are artificially placed in uterus
introduced in vagina artificially

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 In Vivo Fertilisation

Techniques of in vivo fertilisation :

 Gamete Intra Fallopian Transfer (GIFT) – Transfer of an
ovum collected from a donor into the fallopian tube of
another female.
 Artificial Insemination (AI) - The semen collected either
from the husband or a healthy donor is artificially
introduced into the female reproductive tract.
 Intra Uterine Insemination (IUI) - The sperms are
directly introduced in the uterus.

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 Drawbacks of ART

Requires extremely high

Maybe invasive 1 2
precision handling

Can be done only by

3 Expensive 4
specialized professionals

Emotional, religious and

Very few ART clinics 5 6
social factors

Adoption
It is a legal process which fully transfers parental responsibility from a child's
biological parents to the adoptive parents.

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 Summary
Contraceptive methods

Natural Surgical Chemical Implants Barrier

Periodic abstinence
Condoms
(Rhythm method)

Coitus interruptus Male Female

(Withdrawal method)

Lactational amenorrhea Diaphragms,

(Absence of cervical caps
menstruation) and vaults
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 Summary
Contraceptive methods

Hormonal

Steroidal

Pills Implants Vaginal rings

Injections Skin patches

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 Summary
IUDs

Non-medicated IUDs Copper releasing IUDs Hormonal IUDs

(e.g., Lippes loop) (CuT, Cu7, Multiload 375) (Progestasert, LNG-20)

Surgical methods of
contraception

Tubectomy Vasectomy

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 Summary
Sexually Transmitted Diseases

Sexually transmitted disease Causative agent

Gonorrhoea Neisseria gonorrhoeae

Syphilis Treponema pallidum

Genital herpes Human simplex virus type -2 (HSV-II)

Genital warts Human papillomavirus

Hepatitis B Hepatitis B virus

Trichomoniasis Trichomonas vaginalis

Chlamydiasis Chlamydia trachomatis

Acquired immunodeficiency syndrome Human immunodeficiency virus

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 Summary
Sexually Transmitted Diseases

Social stigma Complications of STDs Prevention of STDs

Negative attitude Stillbirths Avoid unprotected sex

towards sex
Infertility Use condoms during sex
Discrimination due
to myths Abortion
Consult with a
doctor
Pelvic inflammatory
Isolation disease
Use fresh syringe for
Ectopic pregnancies injection ever time
Avoid getting
tested
Cancer

© 2022, Aakash BYJU'S. All rights reserved

 Summary
It is the inability to conceive or produce children even
Infertility after 2 years of unprotected sexual cohabitation

Assisted reproductive A set of medical procedures aimed at treating infertility.

technology (ART)

In vitro fertilisation (IVF) Fertilisation performed outside the body of the female.

In vivo fertilisation Fertilisation performed within the body of the female.

ARTs could be invasive, few ART clinics, performed only

Drawbacks of ART by professionals, high precision handling, expensive,
emotional, religious and social factors
It is a legal process which fully transfers parental
Adoption responsibility from a child's biological parents to the
adoptive parents.

© 2022, Aakash BYJU'S. All rights reserved