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    What Reproductive Health Means ?

    Reproductive Health Means

     Reproductive health means a total well being in all aspects of reproduction i,e, physical , emotional ,behavioural and social

    A typical angiosperm flower consists of whorls of floral appendages attached on the receptacle:

    1.  Family planning

        -Proper gap should be maintain

        -Depends upon the family income

    1.  Mother and child care
    2. Knowledge of STDs ( sexually transmitted disease)
    3. Sex education
    4. Appropriate medical facilities for reproduction – related problems

     Problems

    1. There is little knowledge of personal hygiene of reproductive organs . this cause sexually transmitted diseases .
    2. Early marriage lead to high maternal and infant mortality rates .
    3. Due to lack of awareness , there has been a rapid increase in population size .
    4. People encourage beliefs in myths and misconceptions about sex-related issues .

     

    Stratergies

    •  Family planning programmes were initiated as early as 1951 
    •        Reproductive and child health care ( RCH) programmes were launched in 
    •         1997 for :-
    • Creating awareness among people about the various reproduction related aspects . 
    • Providing facilities and support  for building up a reproductively healthy society
    • With the help of audio visual aids and print media , both government agencies are engaged in creating awareness among people about reproduction related aspects .
    • Proper information about the reproductive organs , adolescence and related changes , safe and hygienic sexual practices and sexually transmitted disease (STDs) should be given . 
    • Educating people about available birth controls option , care for pregnant mothers , post natal care of the mother and child , importance of the 
    • mother and child , importance of breast feeding , equal opportunities for male and female child .

     

    • Awareness of problems due to uncontrolled . population growth and social evils like sex abuse and sex related crimes etc. 



    • Statutory ban on amniocentesis ( A foetal sex – determination test based on the chromosomes pattern in the developing embryo ) for sex – determination to legally check increasing female foepicide .

    STEPS TO CURD POPULATION GROWTH :-

    1.  Raising marriageable age of girls to 15 years and of boys to 21 years.
    2.  Incentives should be given to souples with small families.

    3. BARRIER METHOD :- These methods prevent the content of sperm and ovum with the help of barriers. Such methods are available for both male and female .

       

      1. CONDOMS :- They are barriers made of thin rubber / latex sheath used 

         To cover the penis in the made or vagina and cervix in females. It prevents the deposition of ejaculated semen into the vagina of the female.

      1. DIAPHRAGM , CERVICAL CAPS $ VAULTS :-  Cervical caps and vaults Are barriers made of rubber that are inserted into the female reproductive tract to cover the 

              Cervix during coitus. They prevent the entry of sperms through cervix.

      1. SPERMICIDAL CREAMS , JELLIES $ FOAMS :- Spermicides immobilize 

             And kill the sperm before they are able to swim into the uterus. 

      To be effective , the spermicide must be placed deep in the vagina , close to the cervix. creams , gels , and foams are squirted into the vagina using an appl.

    BIRTH CONTROL :-

    The most important step to control population growth is to motivate smaller families by using various contraceptives methods an ideal contraceptive should  Be :-

    1. User-friendly 
    2. Easily available 
    3. Effective and reversible with no or least side effects. 

    METHODS OF BIRTH CONTROL :-  The contraceptive methods are divided into following categories :- 

    1. Natural categories 
    2. Barrier method 
    3. Intra uterine devices (IUDs).
    4. Oral contraceptives 
    5. Injectables and implants 
    6. Surgical method 
    1. Naural methods :- These are natural methods that work on the principal of Avoiding the meeting of ovum and sperm .

    > Periodic abstinence :- It is a method in which a couple avoids or abstains from Day 10-17 of the menstrual cycle , when ovulaton is   Expected occur. Not having sexual intercouse on the Days of a womans menstrual cycle when she could  Become pregnant .

    > coitius interrupts : –   The withdrawal method of contraception , also known as  Coitus interrupts , is the practice of withdrawing the penis   From withdrawal method is to prevent sperm from  Entering the vagina .

    The withdrawal method isnot an especially effective form of birth control. Sperm may enter the vagina if withdrawal isnot properly timed or if pre-ejaculation fluid contains sperm .

    >  Lactational amenorrhea :- It is a method which is based on the principle that during the period of lactation , after parturition , ovulation does not occur . 

    This is a temporary contraceptive method that relies on exclusive breast feeding . 

    It can be used from birth up to six months afterwards . producing milk is called lactating and not having a period is called amenorrhea , hence this method of birth control is called lactational amenorrhea (or LAM).

    BARRIER METHOD :-

    These methods prevent the content of sperm and ovum with the help of Barriers. Such methods are available for both male and female.

    1. CONDOMS :-  they are barriers made of thin rubber / latex sheath used to Cover the penis in the male or vagina and cervix in females. It prevents the deposition of ejaculated semen into the vagina Of the female.
    1. DIAPHRAGMS , CERVICAL CAPS $ VAULTS :-  Cervical caps and vaults are barriers made of rubber that are inserted into the female reproductive 

    Tract to cover the cervix during coitus . they prevent the entry of sperms 

    Through cervix. SPERMICIDAL CREAMS , JELLIES $ FOAMS :- Spermicides immobilize And kill the spers before  They are able to swim into the uterus to be effective , the spermicide must be placed deep in the vagina , close to the cervix. Gels and foams are squirted into the vagina using an appl. 

    INTRA UTERINE DEVICES (IUDs):-

    These devices are inserted by doctors in the uterus through vagina. 

    There are three types of (IUDs) available . 

    1. Non mediated (IUDs) :- these increase phagocytosis  of sperm within the uterus 

    For example – the lippes consists of a thin plastip (or polyethylene ) wire bent in a series of S- shapes . it needs to be straightened when it is being inserted into the uterus but resumes its shape once inside it .

    1. Copper releasing ( IUDs) :-  along with phagocytosis of sperm , the copper ions released suttress sperm notility and fertilizing capacity of sperms .

    For example :- cu T , cu7 , multiload 375 

    1. Hormone releasing ( IUDs) :- these make the uterus unsuitable for iamplantation and the servix hostile to sperms . 

    For example – progestassert , LNG – 20 .

    Advantages of IUDs

    • . They are a cheap and practical means of contraception once the woman becomes     tolerant to the device
    • . They can be removed easily by a medical personnel.
    • . Fertility is easily restored after removal and the woman can become pregnant within a few months. Chances of infertility is not much. 
    • . Provides long term protection against pregnancy. 
    • . Hormone based IUDs are also effective against other conditions like menorrhagia and menstrual cramps. 
    • . Some studies hava shown that the IUDs may be effective in preventing uterine and cervical cancers. 
    •    Disadvantages of IUDs
    • . They have to be introduced by medical personnel.
    • . They can cause some pain during the first few episodes of menstruation following 
    •   The insertion.
    • . Intermenstrual spotting and increased bleeding during menstruation can occur.
    • . Injury to the cervix and/ or uterus is rare but can occur.
    • .There is a slightly higher risk of ectopic pregnancy in women with using IUDs. 
    • . The IUDs provide no protection against sexually transmitted diseases.
    • . Some men have reported feeling the strings of the IUD during sexual intercouse ,    
    •   But this problem can be managed by cutting the strings shorter.    

    Oral contraceptive

    A birth control pill taken by mouth. Most oral contraceptives include both estrogen and progest erone. When given in certain amounts and at certain times in the menstrual cycle, these hormones prevent the ovary from releasing an egg for fertilization.

    They inhibit ovulation and implantation as well as alter the quality of cervical mucus to prevent entry of sperms.

    Saheli an oval contraceptive for females containing a non – steroidal preparation was developed by scientists at central drug research institute (CDRI) in lucknow.

    Pills have high contraceptive value and few side effects. 

    It usually makes periods shorter, lighter and more regular. It can improve symptoms that can come with periods such as pain, mood swings and headaches. It nessens the risk of cancer of the ovaries and uterus. 

    CONTRACEPTIVE INJECTIONS

    The contraceptive injections, is a long – acting method of contraception. It contains only one hormone, which is a synthetic form of progesterone, a hormone that is made naturally by the body. 

    The contraceptive injection stops ovulation and makes the fluid at the opening to the uterus thicker, stopping sperm from getting through. It can also be used to treat women with menstrual problems. 

    Advantages of the contraceptive injection include: 

    1. It is very effective and convenient. 
    2. About 50 par cent of women who the contraceptive injection do not have periods, which some women see as advantage.
    3. There is no medication that stops it from working. 
    4. No one can know you are using it unless you tell them. 

    Disadvantages of the contraceptive injection include

    > It cannot be reversed or withdrawn, which meanes its main effect and any side effects can last for 12 to 14 weeks 

    > It can make periods irregular, with some women bleeding more often or at unusual times. 

    > It can take some time for periods and the chance of getting pregnant to go back to normal after stopping the method, sometimes 6 to 12 months.

    > It can cause thinning of the bones, where a small amount of bone density is lost , but this should go back to normal after stopping the method.

    > Some women put on weight or have headaches or mood changes. 

      Contraceptive implant 

    The contraceptive implant is a hormonal implant the size of a matchstick. It is inserted under the skin at the inner side of upper arn. This contains a progesterone – like hormone that stops ovulation. 

    This hormone also makes the fluid at the opening to the uterus (womb) thicker, stopping spern from getting through. 

    The implant is put in and taken out under local anaesthetic by a especially trained doctor or nurse. 

    They work for 3 or 5 years depending on the kind of implant you have. You can choose to have them taken out whenever you want. 

    Advantages of the contraceptive implant include

    . It is close to 100 per cent effective.

    . It lasts for three years.

    . it is safe to use when breastfeeding.

    , About 20 per cent of women who use the contraceptive implant do not have periods, which some women see as an advantage. 

    . It usually makes periods less painful.

    . It can inprove acne.

    . Women usually start ovulating again within three weeks of having the implant taken out. 

    Disadvantages of the contraceptive implant include :

    1. There may be some bruising and tenderness around the implant that can last for up to a week 
    2. It can make periods irregular, with some women bleeding more often or at unusual times 
    3. It can cause headaches, acne, breast tederness and increased appetite. 
    4. Rarely, the implant can move from its original position under the skin. This may affect how easy it is to remove it.
    5. There is a small risk of infection and bleeding around the implant.
    6. Some medications, such as the one used to treat epilepsy, and the natural remedy St John’s wort, can stop it from working

    SURGICAL METHOD OF CONTRACEPTION

    > It is also known as sterilization. 

    > Sterilization is considered a permanent method of contraception.

    > Sterilization can be reversed, but the success of this procedure is not guaranteed.

    > Sterilization is meant for men and women who do not intend to have children in the future.

      VASECTOMY: Surgical  Contraception done in men 

    It is type of sterilization of a man. A vasectomy guarantees that no sperm will exit from his penis when he discharges during sex. Amid a vasectomy the tubes that take sperm from the testicles are cut, which keeps the sperm from getting into the discharge. It’s also important to remember that tha man will continue to produce sperm ; it just won’t be in the ejaculate. This implies in the event that he at any point needed to have more kids it be acc omplished reasonably effortlessly.

    Vasectomy reversals are possible, but they thnd to be expensive and are not guaranteed to be effective.A vasectomy should be sonsidered a permanent form of birth control. 

    A vasectomy dose not protect a man or his partner from sexually transmitted infections.

    TUBECTOMY (tubal ligation): Surgical Contraception in women 

    The fallopian tubes are cut each side, and a little plece is taken out, making it impossible for the egg and sperm to meet. This is done in theater and is more confounded that a vasectomy.

    It is very difficult to reverse, and if it is reversed it can lead to an increased risk of ectopic pregnancies, which is when pregnency occurs out side the uterus. 

    Tubal ligation should not have any impact on a lady’s menstrual cycle or hormone generation.

    Medical Termination of Pregnancy

    MTP is medical Termination of pregnancy. It also called abortion. It is the medical way of getting rid of unwanted pregnancy. Any qualified gynecologist (MD/DGO) can perform MTP. Any MBBS Doctor, who has obtained in MTP, is allowed to perform this procedure. However, MTP should always be performed at a place recognized by authorities.

    Following are the Indications for Medical Termination of Pregnacy

    > Failure of contraception.

    > Possible hazards on physical/mental health of the mother.

    > Pregnancy caused by rape.

    > Possible hazard to the health of growing fetus 

    Medical Termination of pregnancy is legally permitted up to 20 weeks of gestation. Pregnancy termination performed in first trimester is safer than in second trimester since it has fewer complications. It is illegal to perform MTP after determining sex of the child as Government of India has banned sex determination.

    Sexually transmitted diseases

    Sexually transmitted diseases (STDs) are infections that are passed from one person to another through sexual contact. 

    The causes of STDs are bacteria, parasites, yeast, and viruses. There are more than 20 types of STDs, 

    > Genital herpes

    > Gonorrher 

    HIV/AIDS

    Syphilis

    Trichomoniasis

    Most STDs affect both men and women, but in many cases the health problems  They cause can be more severe for women. It a pragnant woman has an STD, it can serious health problems for the baby. 

    Antibiotics can treat STDs caused by bacteria, yeast, or parasites. There is no cure for STDs caused by a virus, but medicines can often help with the symptoms and keep the disease under control.

    Correct usage of latex condoms greatly reduces, but does not complately eliminate, the risk of catching or spreading STDs. the most reliable way to avoid infection is to not have anal , vaginal or oral sex.

    Modes of Transmisson

    Modes of transmission include :

    . Sexual transmission (genital-anal, genital-genital, oral-genital/anal)

    . Skin-to-skin contact (i.e., kissing, non-pennetrative sex, body rubbing)

    . Mixture of infectious body fluids (blood, semen, vaginal secretions)

    . Shareing of needles and other drug parahernalia and needle stick injuries

    . Form a pregnant woman her unborn fetus, or to to infants during vaginal delivery or through breast milk

    . Infestations (scabies and pubic lice) can also be transmitted through shared clothing, bedding, linens etc.

    Assisted Reproductive Technologies.

    The couples could be assisted to have their own child through certain special techniques called as assisted reproductive technologies.

    Assisted reproductive technologies-

    1. Artificial insemination 
    2. Intra cytoplasmic sperm injection 
    3. Gamete intra fallopaian tube 
    4. In vitro fertilization ( IVF ) 

    Artificial Insemination

    Artificial insemination or inter uterine insemination – Here the semen collected either from the husband or a healthy donor is artificially introduced either into the uterus ofthe female 

    In artificial insemination. A doctor inserts sperm directly into a woman’s cervix, fallopian tubes, or uterus. The most common method is called ’’intrauterine insemination (IUI),’’when a doctor places the sperm in the uterus.

    It makes the trip shorter for the sperm and gets around any obstructions. Your doctor may suggest this method first as a treatment for infertility.

    What type of Infertility Can Artificial Insemination Treat?

    In cases involving  male Infertility :-

    When there’s very low sperm count or when sperm aren’t strong enough to swim through the cervix and up into the fallopian tubes 

    In cases invoicing female infertility :-

    If you have something called an “unreceptive cervical mucus. “That means the surrounds the cervix prevents sperm from getting into your uterus and fallopian tubes. Artificial insemination lets the sperm skip the cervical mucus entirely.

     

    In vitro fertilization (IVF)

    IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryos form, they are then placed in the uterus. IVF is a complax and expensive procedure; only about 5% of couples with infertility seek it out.

    it was a mysterious procedure for infertility that produced what were then known as “test-tube babies.”

    What causes of Infertility Can IVF Treat? 

    . Endometriosis

    . Low sperm counts

    . Problems with the uterus or fallopian tubes\

    . Problems with ovulation 

    . Antibody problems that harm sperm or eggs 

    . The inability of sperm to penetrate or survive in the cervical mucus 

    . An unexplained fertility problem



    Gamete intra fallopian transfer (GIFT)

    GIFT is an assisted reproductive procedure which involves removing a woman’s eggs, mixing them with sperm, and immediately placing them into a fallopion tube. 

    One of the main differences between this procedure and in vitro fertilization (IVF) and zygote intrafallonpian transfer (ZIFT) procedures is that with GIFT the fertilization process takes place inside tube rather than in a laboratory . However, healthy tubes are necessary for GIFT to work

    The good news is that GIFT does not require you  to be hoospitalized. After the procedure, patients typically stay in recovery for about eighth hours.

    Who can be treated with GIFT?

    GIFT has been used with following patients:

    . Couples with unexplainable infertility 

    . Couples who have not had success with IVF 

    . Couples who have a religious or moral reluctance touse IVF

    . Women who have at least one healthy fallopian tube 

    . Couples in which thehusband has a low sperm count or other problems with his sperm 

    What are the differences between GIFT and in vitro fertilization (IVF)?

    . With IVF, the eggs are fertilized in a laboratory rather than in the fallopian tubes as with GIFT.

    . IVF can be used with couples in which the female does not have fallopian or has blocked fallopian tubes.

    . IVF allows for ferilization confirmation and assessment of embryo quality.

    . GIFT does not involve fertilization outside of the bode, so couples do not have to deal with the ethical concems with choosing which embryos to transfer.

    Intra cytoplasmic sperm injection (ICSI)

    Intracytoplamic sperm injection (ICSI) involves the direct injection of sperm into eggs obtained from in vitro fertilization (IVF) 

    The ICSI procedure directly introduce an individual sperm cell into each of the eggs obtained during the IVF ( in vitro fertilization) process. The resulting embryo is then transferred to the uterusv to initiate pregnancy. ICSI has proven to be a truly revolutionary technology, giving new hope to many couples who had been unble to conceive. 

    Intracytoplasmic sperm injection can beused in most types of male infertility, including:

     

    1. Low sperm count 
    2. Absence of sperm in the ejaculate
    3. Impaired sperm motility (ablility to move) 
    4. Abnormal sperm morphology (shape of the sperm)