CONTROL OF PREGNANCY

Many methods are used to prevent pregnancy, either by preventing fertilization or by preventing
implantation of the developing embryo. Many of these techniques are quite effective when used
perfectly and consistently. But most of these methods also have disadvantages, and the use of some of
them is controversial.

Behavorial Methods

Abstinence, or refraining from sexual intercourse, is 100% effective in preventing pregnancy when
practiced consistently. It is not an effective method when used only occasionally.

Coitus (kō′i-tŭs) interruptus, or withdrawal, is removal of the penis from the vagina just before
ejaculation. This is a very unreliable method of preventing pregnancy because it requires perfect
awareness and willingness to withdraw the penis at the correct time. It also ignores the fact that some
sperm cells are present in preejaculatory emissions. Statistically, about 23 women out of 100 become
pregnant while relying on this method.

The calendar method, also called natural family planning or rhythm method, requires abstaining from
sexual intercourse near the time of ovulation. Although the calendar method provides some protection
against becoming pregnant, it has a relatively high failure rate because of both the inability to predict
the time of ovulation and the failure to abstain around that time. About 9 women out of 100 become
pregnant while using the calendar method.

Barrier Methods

A male condom is a sheath made of animal membrane, rubber, or latex. When placed over the erect
penis, a condom acts as a barrier by collecting semen instead of allowing it to be released into the
vagina. Condoms also provide protection against sexually transmitted diseases. Male condoms alone are
98% effective; when used with spermicide, they are 99% effective. A vaginal condom, or female
condom, also acts as a barrier. A woman can place the vaginal condom into the vagina before sexual
intercourse. Female condoms are 95% effective; using spermicide further increases their effectiveness.

Methods to prevent sperm cells from reaching the oocyte once they are in the vagina include a
diaphragm, a cervical cap, spermicidal agents, and a vaginal sponge. The diaphragm and cervical cap
are flexible latex domes that are placed over the cervix within the vagina, where they prevent sperm
cells from passing from the vagina through the cervical canal of the uterus. The diaphragm is a larger,
shallow latex cup, and the cervical cap is a smaller, thimble-shaped cup. Diaphragms are 94% effective,
whereas cervical cap effectiveness ranges from 71% in a women who has previously been pregnant to
86% in a woman who has never been pregnant. The most commonly used spermicidal agents are foams,
creams, and gels that kill the sperm cells. They are inserted into the vagina before sexual intercourse,
often in conjunction with diaphragm or condom use. Alone, spermicidal agents are only about 85%
effective.
Intrauterine devices (IUDs) are inserted into the uterus through the cervix. The two types of IUDs now
available in the United States are the copper containing ParaGard and the progestin hormone–coated
Mirena. The ParaGard may be left in place for 12 years, whereas the Mirena may be left in place for 5
years. Both types of IUDs thicken cervical mucus, which bars sperm cells from entering the uterus. Some
women stop ovulating when they have an IUD implanted. IUDs also alter the endometrium, which in
theory may prevent implantation of an embryo. IUDs are 99.99% effective in preventing pregnancy.

Chemical Methods

Synthetic estrogen and progesterone in oral contraceptives (birth control pills) are among the most
effective contraceptives, providing 99.9% effectiveness. The synthetic hormones may have more than
one action, but they reduce LH and FSH release from the anterior pituitary. Estrogen and progesterone
are present in high enough concentrations to have a negative feedback effect on the pituitary gland,
which prevents the large increase in LH and FSH secretion that triggers ovulation. Over the years, the
dose of estrogen and progesterone in birth control pills has been reduced. The current lower dose has
fewer side effects than earlier doses. For most women, the pill is effective and has a minimum frequency
of complications, until at least age 35. However, the risk for heart attack or stroke increases in women
who smoke or have a history of hypertension or coagulation disorders.

The mini-pill is an oral contraceptive that contains only synthetic progesterone. It reduces and thickens
the mucus of the cervix, which prevents sperm cells from reaching the oocyte. It also prevents
blastocysts from implanting in the uterus.

Surgical Methods

Vasectomy (va-sektō-mē) is a common method of rendering males permanently infertile without

affecting the performance of the sex act. Vasectomy is a surgical procedure in which the ductus
deferens from each testis is cut and tied off within the scrotal sac. This procedure prevents sperm cells
from passing through the ductus deferens and becoming part of the ejaculate. Because such a small
volume of ejaculate comes from the testis and epididymis, vasectomy has little effect on the volume of
the ejaculated semen. The sequestered sperm cells are reabsorbed in the epididymis. Only 1–4 in 1000
surgeries of this type fail.

A common method of permanent birth control in females is tubal ligation (lī-gāshŭn), in which the
uterine tubes are tied and cut or clamped by means of an incision through the wall of the abdomen. This
procedure closes off the pathway between the sperm cells and the oocyte. Commonly, tubal ligation is
performed by laparoscopy (lap-ă-roskŏ-pē), in which an instrument is inserted into the abdomen
through a small incision, so that only small openings need to be made to perform the operation.

Source: Seeley, R., VanPutte, C., Regan, J. and Russo, A. (2014). Seeley’s Anatomy & Physiology.
McGraw-Hill. New York, New York. 10th Ed. Pp. 1052 – 1053.