Birth Control and Family Planning
Which form of birth control you choose depends on a number of different factors, including your health, how often you have sex, and whether or not you want children. While choosing birth control methods one may consider effectiveness of the method; cost; health risk; partner involvement; permanence; prevention of HIV and sexually transmitted diseases (STDs); Availability; etc.


CONDOMS
A condom is a thin latex or polyurethane sheath. The male condom is placed around the erect penis. The female condom is placed inside the vagina before intercourse. Semen collects inside the condom, which must be carefully removed after intercourse.

Latex condoms help prevent HIV and other STDs. Polyurethane condoms may give some protection against STDs, but they are not as effective as latex ones.

Risks include irritation and allergic reactions, particularly to latex.
Condoms are used only once.

SPERMICIDES
Spermicides are chemical jellies, foams, creams, or suppositories that kill sperm. This method used by itself is not very effective. Spermicides are generally combined with other methods (such as condoms or diaphragm) as extra protection. The spermicide nonoxynol-9 can help prevent pregnancy, but also may increase the risk of HIV transmission. Risks include irritation and allergic reactions.


DIAPHRAGM AND CERVICAL CAP
A diaphragm is a flexible rubber cup that is filled with spermicidal cream or jelly. It is placed into the vagina over the cervix, before intercourse, to prevent sperm from reaching the uterus. It should be left in place for 6 to 8 hours after intercourse. Diaphragms must be prescribed by a woman's health care provider, who determines the correct type and size of diaphragm for the woman. A similar, smaller device is called a cervical cap.


VAGINAL SPONGE
Vaginal contraceptive sponges are soft synthetic sponges saturated with a spermicide. Prior to intercourse, the sponge is moistened, inserted into the vagina, and placed over the cervix. After intercourse, the sponge is left in place for 6 to 8 hours. It is quite similar to the diaphragm as a barrier mechanism, but you do not need to be fitted by your doctor. The sponge can be purchased over the counter.


COMBINATION BIRTH CONTROL PILLS
Also called oral contraceptives or just the "pill", this method combines the hormones estrogen and progestin to prevent ovulation. A health care provider must prescribe birth control pills. The method is highly effective if the woman remembers to take her pill consistently each day. Women who experience unpleasant side effects on one type of pill are usually able to adjust to a different type. Birth control pills may cause a number of side effects including: Dizziness, irregular menstrual cycles, nausea, mood changes, and weight gain. In rare cases, they can lead to high blood pressure, blood clots, heart attack, and stroke.


THE MINI-PILL
The "mini-pill" is a type of birth control pill that contains only progestin, no estrogen. It is an alternative for women who are sensitive to estrogen or cannot take estrogen for other reasons. The effectiveness of progestin-only oral contraceptives is slightly less than that of the combination type.


THREE-MONTH PILL (SEASONALE)
It is taken for three straight months, followed by one week of inactive pills. A women gets her period about four times a year, during the 13th week of her cycle. The risks are similar to other birth control pills. Some women may have more spotting between periods. The pills must be taken daily, preferably at the same time of day.


PROGESTIN IMPLANTS
Implants are small rods implanted surgically beneath the skin, usually on the upper arm. The rods release a continuous dose of progestin to prevent ovulation. Implants work for 5 years. The initial cost is generally higher than some other methods, but the overall cost may be less over the 5-year period.


HORMONE INJECTIONS
Progestin injections, such as Depo-Provera, are given into the muscles of the upper arm or buttocks. This injection prevents ovulation. A single shot works for up to 90 days.


SKIN PATCH
The skin patch (Ortho Evra) is placed on your shoulder, buttocks, or other convenient location. It continually releases progestin and estrogen. Like other hormone methods, a prescription is required. The patch provides weekly protection. A new patch is applied each week for three weeks, followed by one week without a patch.


VAGINAL RING
The vaginal ring (NuvaRing) is a flexible ring about 2 inches in diameter that is inserted into the vagina. It releases progestin and estrogen. The woman inserts it herself and it stays in the vagina for 3 weeks. Then, she takes it out for one week.


IUD
The IUD is a small plastic or copper device placed inside the woman's uterus by her health care provider. Some IUDs release small amounts of progestin. IUDs may be left in place for up to ten years, depending on the device used. The method should not be used by women who have a high risk of getting a pelvic infection. Women who get pregnant with an IUD in place have a higher risk of ectopic pregnancy.


NATURAL FAMILY PLANNING
This method involves observing a variety of body changes in the woman (such as cervical mucus changes, basal body temperature changes) and recording them on a calendar to determine when ovulation occurs. The couple abstains from unprotected sex for several days before and after the assumed day ovulation occurs. This method requires education and training in recognizing the body's changes as well as a great deal of continuous and committed effort.


TUBAL LIGATION
During tubal ligation, a woman's fallopian tubes are cut, sealed, or blocked by a special clip, preventing eggs and sperm from entering the tubes. It is usually performed immediately after childbirth, or by laparoscopic surgery. Tubal ligations are best for women and couples who believe they never wish to have children in the future. While viewed as a permanent method, the operation can sometimes be reversed if a woman later chooses to become pregnant.


VASECTOMY
A vasectomy is a simple, permanent procedure for men. The vas deferens (the tubes that carry sperm) are cut and sealed. A vasectomy is performed safely in a doctor’s office using a local anesthetic to numb the area. Vasectomies are best for men and couples who believe they never wish to have children in the future. While often viewed as a permanent method, they can sometimes be reversed.


EMERGENCY ("MORNING AFTER") BIRTH CONTROL
The "morning after" pill consists of two doses of hormone pills taken as soon as possible within 72 hours after unprotected intercourse. The pill may prevent pregnancy by temporarily blocking eggs from being produced, by stopping fertilization, or keeping a fertilized egg from becoming implanted in the uterus. The morning after pill may be appropriate in cases of rape; having a condom break or slip off during sex; missing two or more birth control pills during a monthly cycle; and having unplanned sex.


UNRELIABLE METHODS
Coitus interruptus is the withdrawal of the penis from the vagina prior to ejaculation. Some semen frequently escapes prior to full withdrawal, enough to cause a pregnancy.

Douching shortly after sex is ineffective because sperm can make their way past the cervix within 90 seconds after ejaculation.

Breastfeeding. Despite the myths, women who are breastfeeding can become pregnant.

MEDICAL TERMINATION OF PREGNANCY (MTP)
This is not a method of birth control. However, MTP may be important for certain women due to varied reasons. Different countries have different rules for MTP. India has wide ranging MTP rules, and permit MTP in case of threat to physical as well as psychological health.

Infertility
Infertility is the inability to achieve a pregnancy after 12 months of unprotected intercourse. Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse. Secondary infertility describes couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy. Causes of infertility include a wide range of physical as well as emotional factors. Approximately 30 - 40% of all infertility is due to a "male" factor such as retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count. Some factors affecting sperm count are heavy marijuana use or use of prescription drugs such as cimetidine, spironolactone, and nitrofurantoin. A "female" factor -- scarring from sexually transmitted disease or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumor, or transport system abnormality from the cervix through the fallopian tubes -- is responsible for 40 - 50% of infertility in couples. The remaining 10 -30% of infertility cases may be caused by contributing factors from both partners, or no cause can be identified. It is estimated that 10 - 20% of couples will be unable to conceive after 1 year of trying to become pregnant. It is important that pregnancy be attempted for at least 1 year. The chances for pregnancy occurring in healthy couples who are both under the age of 30 and having intercourse regularly is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and particularly after age 40), the likelihood of getting pregnant drops to less than 10% per month. In addition to age-related factors, increased risk for infertility is associated with the following: Multiple sexual partners (increases risk for sexually transmitted diseases); Sexually transmitted diseases; History of PID (pelvic inflammatory disease); History of orchitis or epididymitis in men; Mumps (men); Varicocele (men); A past medical history that includes DES exposure (men or women); Eating disorders (women); Anovulatory menstrual cycles; Endometriosis; Defects of the uterus (myomas) or cervical obstruction; or Long-term (chronic) disease such as diabetes.

A complete history and physical examination of both partners is essential. Tests may include: Semen analysis; Measuring basal body temperature; Monitoring cervical mucus changes throughout the menstrual cycle; Postcoital testing (PCT) to evaluate sperm-cervical mucus interaction; Measuring serum progesterone (a blood test); Biopsying the woman's uterine lining (endometrium); Biopsying the man's testicles; Measuring the amount of luteinizing hormone in urine; Progestin challenge when the woman has sporadic or absent ovulation; Serum hormonal levels (blood tests); Hysterosalpingography (HSG); Laparoscopy; and/or Pelvic exam for the woman to determine if there are cysts.

Treatment depends on the cause of infertility for any given couple. It may range from simple education and counseling, to the use of medications that treat infections or promote ovulation, to highly sophisticated medical procedures such as in vitro fertilization.

Hysterectomy
A hysterectomy is a surgical removal of the uterus, resulting in the inability to become pregnant (sterility). There are many reasons a woman may need a hysterectomy. During a hysterectomy, the uterus may be completely or partially removed. The fallopian tubes and ovaries may also be removed. A partial (or supracervical) hysterectomy is removal of just the upper portion of the uterus, leaving the cervix intact. A total hysterectomy is removal of the entire uterus and the cervix. A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix (parametrium), and the upper part of the vagina.

Hysterectomy may be done through an abdominal incision (abdominal hysterectomy), a vaginal incision (vaginal hysterectomy), or through laparoscopic incisions (small incisions on the abdomen -- laparoscopic hysterectomy). Hysterectomy may be recommended for: Tumors in the uterus like uterine fibroids or endometrial cancer; Cancer of the cervix or severe cervical dysplasia (a precancerous condition of the cervix); Cancer of the ovary; Endometriosis; Severe, long-term (chronic) vaginal bleeding that cannot be controlled by medications; Prolapse of the uterus; or Complications during childbirth (like uncontrollable bleeding). Most patients recover completely from hysterectomy. Removal of the ovaries along with the uterus in premenopausal women causes immediate menopause, and estrogen replacement therapy may be recommended. Researchers have found that sexual function after a hysterectomy depends most on sexual function before the surgery.

Uterine fibroids
Uterine fibroids are non-cancerous tumors that develop within or attach to the wall of the uterus, a female reproductive organ. Uterine fibroids are the most common pelvic tumor. The cause of uterine fibroid tumors is unknown. Fibroids begin as small seedlings that spread throughout the muscular walls of the uterus. They can be so tiny that you need a microscope to see them. However, they can also grow very big. They may fill the entire uterus, and may weigh several pounds. Although it is possible for just one fibroid to develop, usually there is more than one. Sometimes, a fibroid hangs from a long stalk, which is attached to the outside of the uterus. Such a fibroid is called a pedunculated fibroid. It can become twisted and cause a kink in blood vessels feeding the tumor. This type of fibroid may require surgery.

Treatment depends on the severity of symptoms, the patient's age, whether or not she is pregnant, the desire for future pregnancies, her general health, and characteristics of the fibroids. Some women may just require monitoring of the fibroid. This requires pelvic exams or ultrasounds every once in a while. In some cases, hormonal therapy involving drugs such as injectable Depo Leuprolide is prescribed to shrink the fibroids. This medicine reduces the production of the hormones estrogen and progesterone. The hormones create a situation in the body that is very similar to menopause. Side effects can be severe and may include hot flashes, vaginal dryness, and loss of bone density. Hormone treatment may last several months. Fibroids will begin to grown as soon as treatment stops. In some cases, hormone therapy is used for a short period of time before surgery or when the woman is expected to reach menopause soon.

Hysteroscopic resection of fibroids (an outpatient surgical procedure) may be needed for women with fibroids growing inside the uterine cavity. In this procedure, a small camera and instruments are inserted through the cervix into the uterus to remove the fibroid tumors. A myomectomy is a surgical procedure to remove just the fibroids. It is frequently the chosen treatment for premenopausal women who want to have children, because it usually can preserve fertility. Another advantage of a myomectomy is that it controls pain or excessive bleeding that some women with uterine fibroids have.

(Information given here has been abridged from authentic sources like NIH, USA)