NFPA) Natural Methods
B) Contraceptive Methods
b) chemical methods Theoretical Effectiveness of Different Methods of Fertility Control
Group I - Most effective
methods: - tubal sterilisation - vasectomy
- oral contraceptives - contraceptive injections - periodic abstinence
based on strict application of the symptothermal method (NFP Group II - Highly
effective methods: - intrauterine devices (IUD)
- diaphragm used with jelly or cream - condom - mini-pill Group III - Less effective
methods: - spermicidal agents used
alone (foams, creams or jellies) - periodic abstinence based on probability
calculations (calendar or rhythm method) - coitus interruptus (withdrawal) Group IV - Least effective
methods: - vaginal douche
We will start our discussion
with a short overview of human reproduction after which we will take a
look at the different family planning methods. Everyone who practices birth
regulation should fully understand the mechanisms of fertility. This knowledge
will help to ensure that when a specific FP method is chosen, the decision
will be an informed and a responsible one. In a man, as we all know,
sperm is produced in the testicles beginning at puberty and is continued
throughout his life. A single sperm can live an average of three days,
sometimes less, sometimes longer. Approximately 300 to 800 million sperm
are ejaculated at one time, but whether or not any one particular sperm
can reach and fertilise an egg, depends on many factors: - First of all, whether the
sperm is strong enough to survive the trip up the female reproductive
tract, A woman is born with @ 40,000
sex cells. They are stored in the ovaries and at puberty a few start to
develop in each menstrual cycle. A woman's ability to produce an egg and
become pregnant varies from day to day in a cyclical manner. The first
day of menstruation is counted as day one of such a cycle. During the
first part of the cycle, that is between menstruation and ovulation, the
follicles begin to develop in the woman's ovaries. Oestrogen levels rise
causing glands in the cervix, which is the lower part of the uterus that
comes down into the vagina, to secrete a wet, stretchy and clear mucus,
much like raw egg white. This causes a wet feeling at the vulva - which
is the entrance into the vagina - and is one of the important signs of
fertility. As the oestrogen level peaks,
one or sometimes more follicles rupture and release an egg. The lifespan
of an egg is very short: about 12 to 24 hours. The egg then enters one
of the woman's tubes. If there are healthy sperm in the tube when the
egg passes through it, the egg may be fertilised by one of them, otherwise,
after 12 to 24 hours, the egg will die. The higher oestrogen level at
the time of ovulation causes the cervix to become soft, to move higher
up in the vagina, to become wet and to open, which is another sign of
fertility. At this stage, a woman may experience some lower abdominal
pain. Again, a sign of fertility. If an egg is fertilised, it travels
into the womb and implants itself into the wall of the uterus on the 6th
to 7th day after ovulation. The follicle that releases the egg develops
into the so-called "corpus luteum" which secretes progesterone and oestrogen.
If fertilisation has occurred, these hormones help to maintain the endometrium
in which the fertilised egg is implanted. The endometrium is the innermost
part of the wall of the uterus. Progesterone causes the cervical mucus
to change from being wet and stretchy to thick and sticky. A woman may
feel dry rather than wet in the area of the vulva. Increasing levels of
progesterone also induce a rise in a woman's basal body temperature of
@ 0.2 to 0.6 degrees C, which is 0.5 to 1 degree F. If the egg is not
fertilised, the levels of oestrogen and progesterone remain high for @
14 days before declining. This decline in hormone levels causes menstruation.
The first day of menstruation is day 1 of a new menstrual cycle, which
usually lasts 28 to 30 days, but can vary considerably. A woman's menstrual cycle
thus has three phases that we can distinguish: a) A relatively infertile,
or early infertile period, which begins with the first day of menstruation. b) A fertile phase, which
includes the day of ovulation and the days immediately before and after
ovulation, during which intercourse may result in pregnancy. The fertile
phase begins at the time the wet mucus appears, and the third day after
the peak of wet mucus marks the end of the fertile phase. After ovulation,
the body temperature increases and remains at a higher level until the
next menstruation. The infertile phase after ovulation is deemed to begin
on the evening of the third day after the shift in temperature is observed.
Ovulation occurs about two weeks before menstruation, regardless of the
length of a woman's cycle. c) A post-ovulatory, or late
infertile phase, which begins when the fertile phase ends and lasts until
the first day of menstruation. These are in short the basic
elements of fertility and the female cycle. It is important to know and
understand them in order to then also understand what a specific method
of family planning does or does not do to one's body. Within family planning, we
distinguish between natural methods and contraceptional
methods . Natural Methods
The natural methods are based
on the observation of naturally occurring signs and symptoms of the fertile
and infertile phase of the menstrual cycle. Since female fertility is
cyclical, not every act of intercourse can result in fertilisation. The
awareness of the fertile phase can allow a couple to time intercourse
so as to either avoid or also to achieve a pregnancy. In order to avoid
a pregnancy, one must abstain from intercourse on the potentially fertile
days, of which there are 6 to 10 during one cycle. In order to achieve
a pregnancy, especially in difficult cases, one can maximise the possibility
of pregnancy by having intercourse on the fertile days, while abstaining
on the infertile days. The actual chance of becoming pregnant on the fertile
days is even only 40%. The natural methods are by definition not methods
of contraception, because they can also be used to achieve conception. The current method that we
refer to as NFP actually consists of a number of single
methods put together: - the rhythm method, which
is the oldest method, named after Knaus - Ogino. The symptothermal method combines
the recording of the basal body temperature with the observation of the
characteristics of the cervical mucus and other physiological indicators
of ovulation, such as tenderness of the breasts, mid-cycle pain, spotting
or bleeding, and abdominal heaviness around the time of ovulation, which
are all influenced by and change with hormon levels. As already discussed, the
cervical mucus becomes clear and stretchy under the influence of the rising
oestrogen levels in the pre-ovulatory phase and the basal body temperature
rises under the influence of progesterone. Couples may also observe changes
in the position, degree of opening, and texture of the cervix, influenced,
once again, by hormon levels, or include calendar calculations in their
practice of the method in order to avoid or to achieve pregnancy. To avoid
pregnancy, one must abstain from intercourse from the appearance of wet
cervical mucus until the evening of the third day of elevated temperature,
or the fourth day after the peak day of mucus, whichever comes later.
The use of NFP requires a period of abstinence from intercourse at the
time the woman is fertile. This should not be confused with abstinence
from sexuality. During this period a couple rather accepts a certain creative
sexual tension in order to transcend immediate satisfaction and allow
love to grow. The actual fertile phase of the cycle is 4 or 5 days. Before going any further,
we will now take a look at the so-called "Pearl Index". The Pearl Index
expresses the effectiveness of a given method by statistically determining
the number of unplanned pregnancies per 100 couples per year using a certain
method. For example, a method with the P.I. of 1 states that of 100 couples
using this method for one year, one couple will become pregnant within
that year. The P.I. of the symptothermal
method of NFP, if properly done, is 0.2 to 0.8, which is comparable to
that of the contraceptive pill. The actual effectivity depends on the
couple using the method. The couple must learn how to identify the fertile
and the infertile days correctly and avoid intercourse on those days. Natural Family Planning (NFP)
users have to understand - the method, for which a
period of instruction is usually required NFP is a user dependent method,
which means that it depends on motivation and on the cooperation of both
man and woman. NFP requires self-awareness, self-acceptance, discipline,
and conscious decision-making each day. It is psychologically important
for a woman to understand and accept her cycle and fertility as an important
part of what makes her a woman. It takes @ 3 to 6 cycles to
learn this method correctly. Its success depends on mutual respect, understanding,
and communication between the man and the woman. Cooperation and understanding
between partners are vital to the success of NFP. The only expense involved
in learning this method is for training. It is mostly taught on a couple
to couple basis. It does not necessarily require the guidance of a medical
practitioner. All one otherwise needs is a pencil, a paper chart and a
thermometer. One's level of formal education
is not a relevant factor in a person's ability to learn NFP. The World Health Organisation
did a 5-country study which resulted in stating that up to 99.5% of women,
representing a wide range of socioeconomic and educational levels, were
able to correctly identify fertile and infertile phases during the first
menstrual cycle following instruction in NFP. NFP also works very well
in third world countries with a high rate of illiteracy. In these countries,
NFP is tought effectively by using very simple terms, such as by explaining
that something can only grow when it is wet, and not when it is dry, refering
to the differring mucus patterns during the fertile and infertile phases
of a cycle. The question often arises,
if breast feeding mothers can also use NFP. It is a proven fact that for
twelve weeks after childbirth, a woman remains infertile if she breast
feeds her child completely. Completely means that the child receives nothing
else, is fed only through the breast, and also during the night. If one
of these conditions is missing, one must assume fertility. NFP can be
used throughout the time a child is breast fed. Women with irregular cycles
or who have recently stopped using the pill, as well as women within menopause,
can also effectively use NFP. Where can one learn NFP? In Canada, Serena, short for
Service for the Regulation of Natality, is the main organization teaching
NFP. NFP teachers, mostly young married couples, help other couples learn
about their fertility pattern and how to use this information in deciding
on when to have intercourse and when not. It takes @ 3 - 6 cycles to properly
learn NFP. Contraceptive methods
We will now take a look at
the different contraceptive methods. A method is by definition contraceptive
when it interferes with fertilisation or with the implantation of a fertilised
egg cell in the uterus, which is referred to as nidation. Hindrance of
implantation of a fertilised egg is abortion in the earliest phases. We
will try to classify the different methods, although this is not always
easy, for many methods are used combined with others and could therefore
fall into one or the other category. First of all, let us examine
the mechanical barrier methods , which are: - the condom, - the vaginal diaphragm, and - the contraceptive sponge. The condom ,
a male contraceptive, is a thin rubber sheath which is placed on the erect
penis just before penetration in order to collect the ejaculated sperm.
Some condoms have a spermicidal coating. The P.I. of the condom is rather
high, namely between 7 and 10. This means that 7 to 10 pregnancies will
occur among 100 couples using this method for one year. Disadvantages
of the condom are interference with spontaneity by having to place the
condom on the penis during intercourse and the diminishing of sensation.
The condom is one of the most frequently used methods. Recently, in the UK and in
the US, women are experimenting with a type of female condom which is
inserted into the vagina. It is supposed to protect from STDs while also
being a contraceptive. The diaphragm
is a saucer-shaped rubber membrane mounted on a semi-rigged ring. A woman
must insert it into the vagina before sexual intercourse in order to prevent
sperm from reaching the cervix, which is the entrance into the uterus.
The first fitting must be carefully made by a physician, who determines
the correct diaphragm size and instructs the woman how to insert it. The
P.I. of the diaphragm is @ 10. The contraceptive sponge
is a small, circular foam-rubber pad impregnated with spermicide, of which
it contains a considerable dose. It is less effective for women who have
previously given birth and the P.I. is @ 15 - 30. The next methods we will take
a look at are the chemical methods , or, spermicides,
which are easy to use and readily available. These agents are sperm-killing
or sperm-immobilizing products available in the form of jellies, foams,
creams, tablets or suppositories inserted by the woman into the vagina
immediately before intercourse, or which are added to the use of the diaphragm
or the condom. The P.I., again, is quite high, namely between 10 and 30.
Research has also shown that spermicides can change the DNA of a possibly
fertilised egg and thus lead to early abortion. Another method of contraception
is coitus interruptus . Here the male withdraws just
before ejaculation. Since not all men are able to determine or control
the exact time of ejaculation, the P.I. is 10 to 25. This method is often
used as an emergency measure since it requires no purchase or previous
planning. One of the most controversial
methods are contraceptive pills , or oral contraceptives
, which contain hormones such as oestrogen and progestagen, female sex-steroids,
which are synthetically produced in laboratories and resemble the natural
hormones produced by the ovary glands during a woman's menstrual cycle.
These contraceptives can be divided into 3 basic types: Number one: The standard combined
pills, which use a regimen of 21 tablets, each containing fixed
dosages of the two hormones, preventing ovulation. These are the oldest
oral contraceptives. The levels of oestrogen have been reduced over the
years with the appearance of more and more side effects. Medication is
given for 21 days and is then discontinued during the following 7 days,
in which it then comes to a so-called withdrawal bleeding. This is not
a menstrual bleeding, for, using this method, a woman does not have a
menstrual cycle according to its natural definition. In short: the administered
hormones oerstrogen and progestagen are supposed to prevent ovulation
by simulating a pregnancy. The second type of pill is
called "phasic" , which means that the hormone levels vary
2 to 3 times during the 21 day regimen. The third type of pill, which
is sometimes called the "mini-pill ", contains only a daily
and continuous low dose of progesterone. It is mostly used for breast-feeding
women and causes the mucus in the cervix to thicken, thus creating a barrier
for the sperm. In many cases this type of pill is abortive and it has
a P.I. of 2 - 10. Recent research shows that the effects of progesterone
are not only to close the cervix and make the cervical secretions less
favourable to spermatozoa, but also that they act on the tubes and the
uterine muscles and render the endometrium inhospitable for implantation.
This is what causes early abortion: a fertilised egg cannot implant itself
into the endometrium, which is the innermost lining of the uterus, and
thereby dies. Since progesterone is used in all pills, causing them to
be abortive in a certain percentage of cases, the term contraceptive is
not completely appropriate. The P.I. of oral contraceptives,
save the "mini-pill", is @ 0.8. The effectiveness of oral contraceptives
may decrease in cases of prolonged diarrhoea, vomiting, anti-convulsion
treatment, if taken together with anti-histamines, tranquillizers, antacids
and antibiotics. Oral contraceptives are composed
of hormones with far-reaching and complex effects on the human system
which go far beyond the desired contraceptive effect. In general, healthy
young women can take oral contraceptives continuously until age 35. Women
over 35 who smoke or have other risk factors, such as untreated high blood
pressure or untreated high cholesterol levels have been reported to have
a 40 times increased risk of death from circulatory diseases, including
stroke, heart attack and blood clots. (Example of Mother who died of liver-vein
thrombosis, leaving three little children.) Common side effects of oestrogens
are nausea, breast-tenderness, fluid retentions, higher blood pressure,
and depression. Those of progesterone are weight gain, acne, nervousness,
vaginal infections such as yeast infections, plus the effects as already
mentioned on nearly every other organ system. The use of the pill can cause: - a change of serum proteins:
especially the globulins involved in the clotting process: hypercoagulable
state, - the incidence of deep vein
thrombophlebitis and thromboembolism is 3 to 4 times as high as normal, - pulmonary embolism - hepatic vein thrombosis, Increased risk of
thromboembolic disease . - Increased blood pressure. - Alterations in glucose metabolism
(contraindication in diabetic women). - Sodium retention: edema. - Alterations of serum levels
of some vitamins, trace elements and lipids. - O.C's accelerate gallstone
formation. - Benign liver adenomas - Melasma (hyperpigmentation) - Infections (yeast). - Cancer (cervix, uterus,
ovaries, breast, skin, liver) - Eye problems - Psychological problems. Contraceptive hormones may
also be administered as intramuscular injections or implants
, which is a capsule containing hormones inserted under the skin, or as
a ring or pessary deep in the vagina. Hormones are then released into
the body for a period of 30 days to five years. These are usually progestagens. The so-called "morning after
pill" consists of combined oral contraceptives, progestagen or oestrogen,
taken in high dosages within the three days immediately following a particular
act of intercourse during the supposedly fertile phase. It hinders implantation
and is thus abortive. Furthermore we have the so-called
IUD , short for intra-uterine device, which is made of
plastic in the shape of a "T". It can contain copper or release progesterone.
The physician inserts it in the uterus at the beginning of a cycle and
it remains in place from 2 up to 5 years. The device can be expelled spontaneously
and the doctor or woman should periodically check if the IUD is still
in place, which should be done at least after every menstruation. What
an IUD basically does is prevent implantation of a fertilised egg by keeping
the endometrium in a state of agitation as to reject the fertilised egg.
This, once again, results in early abortion. Many anatomical and functional
changes take place similar to inflammation. The use of an IUD can lead
to endometritis and adnexitis, which can in turn lead to infertility.
Therefore, IUDs are generally not given to young women without children.
Complications that can occur are perforation of the uterus or implantation
of a fertilised egg in the fallopian tube. This is called an ectopic pregnancy
and is a very dangerous situation. The P.I. of the IUD as @ 1. Finally, we have sterilisation
, which is often chosen when no more children are wanted. According to
statistics, one partner is sterilised in about 30% of all married couples
in the U.S. Sterilisation is the most popular contraceptive method for
couples in which the wife is over 30. In female sterilisation, the
fallopian tubes are severed or blocked in order to prevent sperm from
meeting egg cells released by the ovaries. Techniques used include ligation,
sectioning, cauterisation and the use of clips or rings. In male sterilisation, or
vasectomy, the vasa deferentia are either cut, ligated, electro-coagulated,
or clipped through a scrotal incision under local anaesthesia. This operation
does not require hospitalisation. The goal is to produce a sperm-free
ejaculate. The P.I. of sterilisation is between 0.2 and 1. Sterilisation
can cause many psychological problems and other as yet not sufficiently
studied or recorded side-effects. NFP Theological Aspects A correctly formed conscience
is paramount in making this decision in a morally acceptable way. The
couple is not free to proceed completely at will but must conform their
activity to the creative intention of God. If NFP is used for purely selfish
reasons, its use is illicit. However, NFP, employed for serious reasons,
is a virtuous practice." (Pope Paul VI, Humanae Vitae
10, July 25th, 1968) Conclusion:
I hope we were successful
in explaining that NFP is a safe and effective method of family planning.
Again: NFP does require an effort. An effort of love and understanding.
It encompasses the whole human being in its totality, not as man or woman,
but the human being: man and woman, united as one, created in the image
and likeness of God. NFP develops self-awareness, mutual respect, shared
sexual responsibility and the experience of sexuality as part of a loving
and fulfilling relationship. According to our personal belief and the
teaching of the Catholic Church, it is also the only option we should
consider using.
Nikolaj & Karin Hornykewycz
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