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Married Couple, 40s, seek alternative contraception to birth control pills

- - - - Testes
      - Epididymis
      - Epididymis, Vas Deferens, Ejactulatory Duct, Urethra
      - Prostate, Seminal Vesicles, Cowpers Glands
  - - - Cervix
- - - - Testes: Sperm producing male gonads
      - Vas Deferens: tube that connects testes to urethra, for ejactulation of sperm out of penis
      - Epididymis: Site of Sperm Maturation
      - Prostate, Seminal Vesicles, Cowpers Glands: production of Seminal Fluid for sperm motility as well as nourishment
        
        Ejaculatory Duct collects all this seminal fluid and empties into the Urethra--for ejaculation out of body
  - - - Cervix is opening to uterus, through which the baby exits, into the vaginal canal
    - - Menstrual Phase, Day 0-4: Functional layer of endometrium is shed "menstruation"
        Proliferative Phase, Day 5-14: Functional layer of endometrium is being rebuilt
        
        Secretory Phase, Day 15-28: Begins after ovulation, enrichment of blood supply and glandular secretion of nutrients prepare the endometrium to receive embryo.
    - - Follicular Phase: Occurs during Menstraul and Proliferative phases of Uterine Cycle: large vesicular follicles are growing in the ovary during this phase, and a dominate one begins to take over
        
        Ovulation Phase: Occurs on day 14, ovary wall ruptures and expels secondary oocyte into Fallopian tubes
        Luteal Phase: Occurs during Secretory Phase of Uterine Cycle. Corpus Luteum is formed from rupture follicle, supplying high levels of progesterone that cause endometrium to be fluffy. If pregnancy does not occur it begins to degenerate and as it's hormonal output ends, the Endometrium begins to erod and slough off.
    - - Behavioral Methods
        
        Coitus Interruptus
        
        Withdrawl of Penis before ejaculation, is unreliable because control is never ensured. Also pre-ejaculate contains sperm.
        Side Effect: There is a 19% chance of getting pregnant
        
        Rhythm Method
        
        Avoiding Intercourse during period of ovulation or fertility. Ovulation is detected by recording daily basal body temperatures.
        Side effect: 24% chance of pregnancy. This technique is unreliable because it requires accurate record keeping and bodies change due to outside forces.
        
        Abstinence
        
        100% effective. No copulation=No Baby
      - Barrier Methods
        
        Diaphragms
        
        Reusable form of birth control, small dome shaped cup inserted into vagina to block sperm from entering uterus.
        Side Effect: Latex allergies. 20% chance of pregnancy
        
        Cervical Cap
        
        Cervical Cap covers cervix and prevents semen from entering uterus
        Side Effect: 20-40% chance of pregnancy depending on whether female has had previous births or not
        
        Male Condom
        
        Most popular form of birth control. Sheath that covers the penis, blocks sperm from entering vagina
        Side Effect: Latex allergies, 14% chance of pregnancy
      - Hormonal Methods
        
        the Pill
        
        Birth Control Pill is available in various formulations containing estrogens and progestin. Tricks HPG axis by making it appear that a woman is pregnant. Mature Follicles do not develop, ovulation ceases and menstrual flow reduced
        Side Effects: nausea and hypertension due to hormonal imbalance. Cardiovascular effects, increase risk of breast cancer.
        
        IUD
        
        There are 2 types of Intrauterine devices: Copper and Hormonal. Both make it difficult for sperm to reach the egg. The copper one causes an inflammation response in lining of uterus which is toxic to sperm and makes uterus hostile to implantation should fertilzation occur. The hormonal one works the to thin the lining of the uterus to prevent transport of sperm and progestin thickens cervic mucus
        Side Effects: Insertion can be painful, the copper one can cause periods to be heavier with worse menstrual cramps .
        
        Vaginal Ring
        
        The vaginal ring is a small, flexible, plastic ring that you insert into your vagina. It prevents pregnancy by continuously releasing synthetic estrogen and progesterone. prevent your ovaries from releasing eggs to be fertilized. The hormones also thicken your cervical mucus, which helps prevent sperm from reaching the egg.
        Side effects: Increased Risk of Blood Clotting--leads to deep vein thrombosis, stroke, pulmonary embolism and heart attack
      - Sterilization techniques
        
        Tubal Ligation
        
        Cutting or cauterizing of uterine tubes, seals tubes preventing egg from reaching uterus and keeps sperm from reaching egg
        side effects: permanent. Infection and bleeding are rare side effects. Tubes can spontaneously heal after sterilization(which can lead to ectopic pregnancy which is life threatening to both fetus and mom)
        
        Vasectomy
        
        Cutting or cauterizing of Vas Deferens, Prevents sperm from being released during ejaculation.
        Side Effects: although theoretically reversible, reversal doesn't always work. Short term risk: swelling, bruising, bleeding in scrotum, blood in semen, infection. Long term: fluid buildup in testicle, chronic pain.