Healthy couple in early 40's seeking advice on contraceptive strategies. Woman wants to stop taking birth control pills. Have two kids in high school and do not want more.

Downstream effects

Upstream causes

Background information

Anatomy of Female Reproductive system

Anatomy of Male Reproductive system

Prostate

Scrotum

Seminal Vesicle

Testicle

Urethra

Penis

Vas Deferens

Contains the urethra

Produces & stores sperm

Where the testicles are located (held), regulates the temperature of the testicles

Produce liquid that form part of semen

Produces liquid that form part of semen

Sperm travels throughout the urethra to the outside of the body; expels urine

Sperm travels through two tubes named Vas Deferentia, to the seminal vesicles

Uterus

Fallopian Tubes

Ovaries

Vagina

Produce cells called ova

The baby grows here

Connects the ovaries to the uterus

Connects the uterus to the outside of the body

Contraception Methods

Rhythm method: avoid sex during ovulation time

Abstinence: only 100% way to prevent pregnancy

Withdrawal method: pull out before ejaculation; high failure rate

Barrier methods: prevent sperm from reaching uterine tubes; condoms, spermicidal gels, diaphragms

Intrauterine devices (IUD): flexible plastic structures inserted into uterus; copper or synthetic progesterone to help prevent implantation

Oral contraceptive or Estrogen/progestin patches: prevent LH spike and ovulation

Morning after pills: inhibit ovulation; take within 72 hours of unprotected intercourse

Tubal ligation: Surgically cutting uterine tubes and tying off ends; prevents sperm from reaching uterus

Vasectomy: Outpatient procedure; ductus deferens cut, segment removed, ends tied; sperm unable to leave testis

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Events of uterine/ovarian cycles

Uterine cycle: cyclical changes in endometrial lining; Influenced by estrogen and progesterone; Timeline based on 28-day uterine cycle, but varies (21-35 day)

Menstrual phase: Days 1-5 of cycle; Sloughing off of the functional layer; Lasts through period of menstrual bleeding

Proliferative phase: Days 6-14 of cycle; Development of new functional layer of endometrium; Overlaps time of follicle growth and ovary estrogen secretion

Secretory Phase: Days 15-28 of cycle; Increased progesterone secretion from corpus luteum; Increases vascularization and uterine gland development; If fertilization does not occur, Degeneration of corpus luteum and dramatic drop of progesterone, without progesterone, sloughs off functional layer

Ovarian cycle and uterine cycle phases: Menstrual phase during ovarian follicular phase; Proliferative phase during ovarian follicular phase and ovulation; Secretory phase during ovarian luteal phase

Factors for this couple not seen in others

Older woman

Higher chance of still birth

Limited methods due to age

3 best options

3 worst options

Morning after pills, dependent on sexual activity this could result in a lot of pills

Withdrawal method, high failure rate

Oral contraceptive, do not want to take pills

Tubal ligation, Surgically cutting uterine tubes and tying off, prevents sperm from reaching uterus

Barrier methods, condoms, spermicidal gels along with withdrawal and rhythm methods would be safe if surgery is out of question

Vasectomy, Outpatient procedure, sperm unable to leave testis