Dr.
Konthoujam Shyam Kumar
Former DBT-Post Doctoral Fellow
MSc (GU), SRF (C.I.F.R.I), Ph.D (G.U), SLET
Chapter 3: REPRODUCTIVE HEALTH
REPRODUCTIVE HEALTH:
It is defined as the total well being in all aspects of reproduction i,e physical, emotional,
behavioral and social.
Needs for reproductive health: Due to the following reasons
i) Uncontrolled population growth / overpopulation
ii) Health of mother – Early marriage leads to several disease in mother
iii) Deformities – common in children of early marriage
iv) Believing in myths and misconception about sex related aspects that exist in the
society
v) Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) – These are high
in early marriage.
Strategies:
i) Family planning programme (invented in 1951)
ii) Awareness about reproduction
iii) Sex education
iv) Birth control devices
v) Improved medical facilities
vi) Knowledge of reproductive organs and STD
Sexually Transmitted Diseases (STD’s) / Venereal Diseases / Reproductive Tract
Infections (RTI):
Diseases or infections which are transmitted through sexual intercourse with the
infected persons are collectively called STD.
Eg: Syphilis, Gonorrhoea, Chlamydiasis, Genital wart, Trichomoniasis, Hepatitis B,
AIDS, Genital herpes etc. (Hepatitis B, AIDS, Genital herpes can’t be cured)
Common symptoms: Itching, Fluid discharge, Slight pain and swelling in genital region.
Prevention:
i) Avoid sex with unknown or multiple partners
ii) Use of condoms during coitus
iii) Seeking medical help in case of doubts and its treatment till it is cured
1
Dr. Konthoujam Shyam Kumar
Former DBT-Post Doctoral Fellow
MSc (GU), SRF (C.I.F.R.I), Ph.D (G.U), SLET
BIRTH CONTROL – NEEDS and METHODS
Birth control: The voluntary limiting of human reproduction by means of sexual
abstinence, contraception, induced abortion and surgical sterilization.
Or, The voluntary limiting of human reproduction by preventing sperm transport to
the ovum, ovulation and implantation of the early embryo in the uterus.
Methods:
A) Spacing / Temporary methods of Birth Control:
Commonly used to postpone or to space birth. They are
1. Natural methods:
a) Periodic abstinence / Rhythm method (temporary avoidance of sex): Couples avoid
or abstain from coitus during 10-17 days of the menstrual cycle because ovulation is
most expected i,e fertile period.
b) Coitus interrupts / withdrawal: Male withdraws his copulatory organ from vagina
just before ejaculation to avoid insemination.
2. Barrier methods:
a) Condoms / cervical caps / Diaphragus / vaults: Block the entry of sperm through
cervix during coitus thereby preventing conception.
3. Chemical methods (Spermicides):
These chemical substances apply in the female reproductive tract (vagina) which
kills the spermatozoa.
4. Intrauterine Devices (IUD):
It is the most widely accepted methods of birth control in India. These devices are
available as –
a) Non-mediated IUDs (e.g Lippes loop)
b) Copper releasing IUDs (eg. CuT, Cu7, Multiload 375)
c) Hormone releasing IUDs (Progestasert, LNG-20)
IUD functions as an increase in the phagocytosis of sperms within the uterus. Cu ions
released also suppress sperm motility and the fertilizing capacity of sperms and the
hormone releasing IUD makes the uterus unsuitable for implantation and also makes the
cervix hostile to the sperms.
2
Dr. Konthoujam Shyam Kumar
Former DBT-Post Doctoral Fellow
MSc (GU), SRF (C.I.F.R.I), Ph.D (G.U), SLET
5. Oral Contraceptive Pills (Oral Pills): Taken in the form of tablets
Types of oral contraceptive pills: Depending upon the presence of progestin
(progestogen / progesterone) alone or a combination of progestin and oestrogen.
They are of two types –
i) Mini Pills:- They contain progestin only.
Eg. Saheli (developed at Central Drug Research Institute, CDRI, Lucknow)
ii) Combined Pills:- Most commonly used oral contraceptive pills. They contain both
synthetic progestin and oestrogen to check ovulation.
Eg. Mala D and Mala N (taken daily without breaks)
≠ Not recommended for women with history of blood clotting disorder, cerebral
blood vessel damage, hypertension, liver malfunction, heart disease, breast cancer or
reproductive system.
6. Subcutaneous Implants (Norplant):
Implantation of the synthetic progesterone under the skin, it acts similarly as oral
contraceptives by blocking ovulation and thickening the cervical mucus to prevent
sperm transport. It is effective for five years once implanted.
7. Hormone Injection (Depo-Provera):
These are progesterone derivatives injection, given once in every 3 months releasing the
hormone slowly, preventing the ovulation.
B) Termination / Permanent method of Birth Control:
1. Surgical method:
It is an irreversible or terminal sterilization method used to prevent pregnancy by
blocking gamete transport into the gamete carrying duct.
Vasectomy – In this surgical method, a small part of the male gamete carrying duct
called vas deferens is cut and tied up.
Tubectomy – In this method, a small part of the gamete carrying duct called
fallopian tube/oviduct in female is cut or removed.
CONTRACEPTION:
It is a method of birth control through the deliberate prevention of conception or
impregnation.
3
Dr. Konthoujam Shyam Kumar
Former DBT-Post Doctoral Fellow
MSc (GU), SRF (C.I.F.R.I), Ph.D (G.U), SLET
Characteristics of an ideal contraceptive:
i) User friendly
ii) Easily available
iii) Effective and reversible
iv) No or less side-effects
v) Should not interfere with the sexual drive, desire and sexual act of the user.
Side-effects of contraceptives:
i) Nausea
ii) Abdominal pain
iii) Breakthrough bleeding
iv) Irregular menstrual cycle
v) Breast cancer
MEDICAL TERMINATION OF PREGNANCY (MTP) / INDUCED ABORTION:
- It is the international and voluntary termination of pregnancy before full term of
young one.
- In India, it is legalized in 1971.
Reasons for MTP:
- It is performed in order to get rid of unwanted pregnancies either due to
unprotected intercourse or in rape case or during failure of contraceptive
- MTP is also performed where continuation of pregnancy would cause harm or even
fatal to either mother or child or even both. At present, it is allowed upto 28 th weeks
of pregnancy, however, it is considered relatively safe when done within 12 th weeks
of pregnancy.
AMNIOCENTESIS:
- It is a fetal sex determination and disorder test based on the chromosomal pattern in
the amniotic fluid surrounding the developing embryo.
- The amniotic fluid contains cells from the skin of the fetus and other sources.
Therefore, these cells can be used to determine the sex of the fetus, identify
abnormalities and if it is incurable congenital defect, the fetus should get aborted.
INFERTILITY and ASSISTED REPRODUCTIVE TECHNOLOGIES:
Infertility: It refers to the inability to produce children inspite of unprotected sexual co-
habitation. It can happen due to physical reasons, congenital diseases, drugs,
immunological or psychological reasons.
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Dr. Konthoujam Shyam Kumar
Former DBT-Post Doctoral Fellow
MSc (GU), SRF (C.I.F.R.I), Ph.D (G.U), SLET
Assisted Reproductive Technologies: These are the applications of reproductive
technology to solve infertility problems. Some important techniques are as follows –
IVF / Test Tube Baby:
- Fertilization which occurs outside the body in almost similar condition as that in
the human body followed by embryo transfer into the uterus for implantation, it
is called In vitro fertilization.
- In this method, ova from the donor female and sperms from the donor male are
induced to form zygote in the laboratory.
- The zygote is then allowed to divide into blastomeres, if the division is upto 8
blastomeres, then the zygote is transferred into the fallopian tube and known as
Zygote Intra Fallopian Tube (ZIFT) whereas if the embryo is with more than 8
blastomeres, it is transferred into the uterus, then it is called Intra Uterine
Transfer (IUT).
- The success rate of this technique of producing test tube babies is less than 20%
- The 1st test tube baby Louise Joy Brown was born to Lesley and Gilbert Brown on
July 25, 1978 in Lancashire, England (Dr Patrick Steptoe and Dr Robert Edwards)
consequently, Dr Robert got 2010 Noble Prize for developing a technique for
production of test tube baby
- India’s 1st test tube baby, Kum Harsha was born on August 6, 1986 at K.E.M
Hospital, Mumbai (Dr Indra Hinduja)
Gamete Intra Fallopian Tube (GIFT):
- In this technique, both the sperm and ova are transferred into the fallopian tube.
Therefore, fertilization occur inside the female body i,e in vivo fertilization.
- It is more expensive and invasive procedure than IVF but its results are better
than IVF (27% - 30%).
Causes:
i) Female not able to ovulate.
Intra Uterine Insemination (Artificial Insemination):
- Sperm collected from the donor is artificial introduced into the vagina / uterus of
the female.
Causes:
i) Due to inability of the male individual to inseminate.
ii) Due to low sperm count
Intra cytoplasmic sperm Injection (ICSI):
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Dr. Konthoujam Shyam Kumar
Former DBT-Post Doctoral Fellow
MSc (GU), SRF (C.I.F.R.I), Ph.D (G.U), SLET
- IN THIS technique, sperm is injected into the ovum to form embryo in the
laboratory.
Cuses
Low sperm count.
Extra Notes
- Vitamin E maintains normal functioning of reproductive organs, hence vitamin E
is also called antisterility vitamin
- Manganese is important for normal reproduction. Its deficiency cause infertility.
- 11th July World population Day – since 5th billion baby was born on this day.
- December 1: World AIDS day
- Decrease in death rate: Is a single factor for causing population explosion in
India.