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Sterilization: A Permanent Contraceptive Solution

Learn about the various methods of sterilization, including tubal ligation and vasectomy. Discover the effectiveness, costs, side effects, and complications associated with these procedures. Understand the importance of contraception in preventing unintended pregnancies.

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Sterilization: A Permanent Contraceptive Solution

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  1. Contraception Fall 2015 Potpourri

  2. Contraception • Variety of methods • Categorized by methodology • Barriers • Hormonal methods • Fertility awareness methods • Sterilization • Contraceptive issues vary across countries • Contraceptive methods in the U.S.(Guttmacher Institute, 2010) • Contraceptive methods in the U.S., 1995 vs. 2006-10 (CDC) • Contraceptive prevalence (Excel, pdf map) across the world (United Nations, 2012) • Contraceptive prevalence by method (United Nations, 2011)

  3. Why Does Contraception Matter? • We (taxpayers) pay for many unexpected pregnancies • Rates of unintended pregnancy (Guttmacher Institute) • How much (Guttmacher Institute) • How much, #2 (Guttmacher Institute, published 2/2015)

  4. Sterilization

  5. Sterilization • Sterilization = permanent contraception • Women undergo tubal ligation or implant • Men undergo vasectomy • The second most common contraceptive method used in the United States (men’s and women’s methods combined) • No formalized data collection system exists • Data retrieved from surveys, questionnaires • Female sterilization: 700,000/year (emedicinehealth.com) • Vasectomies: 500,000/year (WebMD)

  6. Sterilization: Tubal Ligation • Surgical technique • Animation (1:35+) • Close fallopian tubes, preventing egg from traveling to uterus, preventing sperm from reaching egg • Neither organs nor glands are removed • Effectiveness: 99%+ • Considered irreversible

  7. Sterilization: Tubal Ligation • Tubal sterilization: • Tubes can be tied and cut (Pomeroy technique) • Tubes can be cauterized • Tubes can be clipped, clamped • These incision methods often performed after childbirth/abortion • Animation (SMART imagebase)

  8. Sterilization: Tubal Ligation • Cost: $0-3000 • Side effects: thought by many to be rare; hormonal imbalance may lead to increased menstrual bleeding, cramping; adhesions • Complications: infection, internal bleeding, ectopic pregnancy • Before/after photos (private Flickr account)

  9. Sterilization: Implants • Non-incision method • No general anesthesia • Under an hour • Coils inserted into fallopian tubes • In following months, coils and tissue grow together, forming barrier to prevent sperm from reaching egg

  10. Sterilization: Implants • Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting • Animation (YouTube) • Thousands of complaints regarding implant complications reported to FDA (NY Times, 2015)

  11. Sterilization: Vasectomy • Vasectomy blocks sperm from traveling through the vas deferens, preventing sperm from mixing into semen • No glands or organs are removed • Effectiveness: 99%+ • Considered irreversible

  12. Sterilization: Vasectomy • Vas deferens must be isolated • Similar to tubal ligation, the vas deferens can be cut and tied, clamped, cauterized, no scalpel technique • Another form of contraception must be used for a few months

  13. Sterilization: Vasectomy • Cost: $350-1000 (plannedparenthood.com) • Not currently covered via Affordable Care Act (arhp, 1/14) • Side effects: bruising, sensitivity/pain, sperm leaking from tubes may lead to small lump (usually clears up on its own), antibodies to sperm may develop, reducing chances of fertility in a reversal • Complications: rare, usually associated with infection (fever, pus/blood from incision site, swelling, pain); ends of tubes may grow back together (very rare); decreased sexual desire (4 out of 1000 cases per Planned Parenthood) - no apparent physical cause

  14. Sterilization: Vasectomy • Animation (BUPA Health via YouTube, 2:36) • Open-ended (no scalpel) vasectomy (medicalvideos.us) • Video (vasectomymedical.com)

  15. Intrauterine Contraceptives (IUC’s) • IUC’s are made of flexible plastic, available only through prescription • Three types (U.S.) • ParaGard (copper) • Mirena (hormone) • Skyla (hormone)

  16. IUC’s: ParaGard • ParaGard contains copper • Copper prevents sperm from fertilizing an ovum • Copper also makes implantation of fertilized ovum difficult • Amount of copper released is less than needed in daily diet • Copper intolerance or insensitivity would preclude use of ParaGard

  17. IUC’s: Paragard • Requires insertion into uterus by healthcare provider • Takes only a few minutes • Insertion may cause cramping, dizziness • Once inserted, may remain in place for ten years • Patient should not feel IUD • Since no hormones present, monthly cycle should remain unchanged • Effectiveness: 99%+ against pregnancy • Requires monthly checking for IUD slippage

  18. IUC’s: ParaGard • Side effects: heavier and longer periods, cramping, spotting in between periods • May lessen after a few months on ParaGard • Complication risks: pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion • Copper may provide protective benefit against endometrial cancer • Cost: $0-1000 (Planned Parenthood)

  19. IUC’s: Mirena • Hormonal method (pregestogen) • Intrauterine device • Lasts for five years • Mirena: • Prevents sperm from fertilizing ovum • Prevents release of egg • Changes uterine lining

  20. IUC’s: Mirena • Insertion: Similar to ParaGard • Effectiveness: 99%+ against pregnancy • Cost: $0-1000 (Planned Parenthood, Bedsider.org) • Side effects: Abdominal cramping (10% of users during first few months), acne, breast tenderness, headache, mood changes, back pain • May lessen after a few months • As use continues, less menstrual bleeding • Complication effects: ovarian cysts, pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion

  21. IUC’s • Internal Birth Control- IUD’s (via Youtube) • Insertion of IUC (Medialvideos.us)

  22. Barrier Contraceptive Methods • Physical barriers • Prevent sperm from entering cervix • Block sperm from fertilizing ovum

  23. Barrier Contraceptive Methods • Historically, pessaries used • Objects or substances inserted into vagina • Pregnancy prevention effectiveness • Infection effectiveness • Current barrier methods: spermicide, male condom, female condom, diaphragm, cervical cap, sponge

  24. Barriers: Spermicide Nonoxynol-9 • Ingredient in spermicides, may be included in condom packaging • Originally thought nonoxynol-9 protected against HIV • In late 1990’s, early 2000’s, nonoxynol-9 was no longer thought to provide that protection • Among commercial sex workers in Africa, Thailand • Frequent use • Nonoxynol-9 may increase risk for disease transmission • Increases vaginal irritation, which can lead to lesions/sores • Lesions typically result in disease transmission vulnerability • 2007: FDA required manufacturers to provide warning • Effect of Coke on Sperm Motility • Mythbusters (1:04-4:00)

  25. Contraception: News, Interesting Info, Future, Past • Silk Parasol (product website) • Caya – new diaphragm, 2015 (0:30-2:35, product website) • RAPE-AXE female condom (YouTube)

  26. Contraception in the Future • Nestorone • Estrogen and progestin • Gel or spray • Population Council Announcement, 2010 • Phase III trials (Antares Pharma) • Eventual availability? • New vaginal ring • 90 days • Progestin + microbicide • Microbicide = drug to reduce HIV, herpes, HPV • Human trials 2014

  27. Contraception: The Future • Vasalgel (human trials in 2016-2017, per Parsemus Foundation) • Similar to India’s RISUG:Reversible Inhibition of Sperm Under Guidance • Contraceptive method for men, not available in U.S. • Injection into vas deferens of male (video, wired.com, :34) • Vasalgel disrupts membranes of sperm so they cannot fertilize • One injection to last 10 years • Marketing challenges

  28. Contraception: The Future • Male pills (5-10 years) • Gendarussa – plant-based, interferes with sperm’s ability to fertilize egg • Anti-Eppin – interferes with sperm motility • “Clean sheets” pill - Inhibit ejaculation but allow orgasm • Short-term (<24 hours) method via pill, or longer-term via implant • If no ejaculate, STI risk may decrease

  29. Contraception: The Past • Male Contraceptive: Heat • Prolonged heat exposure can impair sperm production in testes • Ancient method • Effectiveness? • 116 degree bath • 45 minutes • Every day • Three weeks

  30. Contraception: Impact of Heat on Sperm

  31. Contraception: Impact of Heat on Sperm Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

  32. Contraception: Impact of Heat on Sperm • Upper left: coiled tail • Upper right: bent tail • Lower left: double head • Lower right: triple head Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

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