Human Reproductive Biology 정리노트 Ch13 Contraception [피임]

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1. Contraception

가족계획 요구연간 213 million case의 임신 사례 중 50% 이상이 중절 →Contraception의 기본 원리는 infertility를 유도하는 것임. Prevent germ cell generation, sperm and egg meeting, fertilization. Female contraception 1 - Hormonal contraception: 프로게스테론 및 유사체 투여(+에스트로겐) → luteal-phase like situation 유지 하여 배란을 억제. Female contraception 2 - Intrauterine device(IUD): 면역반응에 의해 정자를 죽임. Female contraception 3 - Spermicide: 질 차단, Prevent sperm entering the 자궁 경부. Female contraception 4 - Diaphragm: 여성형 콘돔. Female contraception 5 - Cervical cap: 자궁경부 진입 방지. Female contraception 6 - Sponge contraceptive. Female contraception 7 - Surgical sterilization: Tubal sterilization, Hysterectomy, Oophorectomy. Male contraceptives 1 - Condom: Mechanical barrier to sperm transport. Male contraceptives 2 - Vasectomy: 정관수술.
2. Hormonal Contraception

프로게스테론 및 유사체 투여(+에스트로겐) → luteal-phase like situation 유지 하여 배란을 억제. None of the ovulation at luteal phase & pregnancy. High level of progesterone. Suppressed GnRH → Gonadotrophin( Follicle development suppressed Principle GnRH성선 자극 호르몬) reduces →분비에 대한 부정적인 피드백 루프를 강화. Prevent tertiary follicle growth, 자궁 내막 성장 억제 → 착상방지. 가벼운 부작용; 구토, 두통, 자궁출혈, 혈당상승 등 / 심각한 부작용; 암 (ER Overexpression 원인 여성암 → 논란의 여지가 있음).
3. Intrauterine Device (IUD)

면역반응에 의해 정자를 죽임. Cooper type은 자체적으로 spermicide (sperm killer) 기능을 함. Changed endometrium properties(자궁내막 특성 변화) → Prevent embryoimplantation and pregnancy. 체외물질이므로 면역반응을 유발, 부작용 : 월경량을 늘리거나 자궁의 미생물 오염 위험.
4. Spermicide and Diaphragm

Spermicide: 질 차단, Prevent sperm entering the 자궁 경부. Diaphragm: 여성형 콘돔.
5. Surgical Sterilization

Tubal sterilization; excise, plug, or tie oviduct. Hysterectomy; remove uterus. Oophorectomy; remove uterus and ovary. 암수술의 결과로 수반됨.
6. Male Contraceptives

Condom: Mechanical barrier to sperm transport, spermicide를 발라 sperm membrane 파괴. Vasectomy: 정관수술. 남성 피임약 개발을 위한 새로운 시도: Hormonal treatment, Non-hormonal, novel male contraceptive systems.
7. Non-Hormonal Male Contraceptives

Target spermiogenesis and sperm function (Post-meiosis post-meiotic event를 타겟팅 할 때 이점 1. 정자 기능에 필수적인 다양한 고환 특이적 단백질 2. 남성 생식력을 제외하고 생리적 결함을 유발하지 않음(ko 마우스 시험 결과) 3. 가역적인 피임효과를 기대 4. 빠른 대응). Altering Ca2+ homeostasis in sperm: CATSPER channel; Ca2+ influx, PMCA4 (Ca2+ ATPase); Ca2+ efflux.

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1. Contraception

Contraception is a critical aspect of reproductive health and family planning. It allows individuals and couples to have control over their fertility and make informed decisions about when and whether to have children. Contraceptive methods range from barrier methods like condoms to hormonal options like birth control pills, and more permanent solutions like sterilization. Each method has its own advantages, disadvantages, and considerations in terms of effectiveness, safety, and personal preference. Ultimately, the choice of contraceptive method should be a personal decision made in consultation with a healthcare provider, taking into account individual circumstances, values, and reproductive goals. Accessible and affordable contraception is essential for promoting reproductive autonomy, reducing unintended pregnancies, and improving overall health outcomes.
2. Hormonal Contraception

Hormonal contraception, such as birth control pills, patches, rings, and injections, are widely used and generally effective methods of preventing pregnancy. These methods work by regulating the body's hormones to prevent ovulation and thicken the cervical mucus, making it harder for sperm to reach the egg. Hormonal contraceptives have the advantage of being highly effective, reversible, and convenient. However, they also carry some potential side effects, such as changes in menstrual patterns, mood changes, and increased risk of certain health conditions. It is important for individuals to discuss the risks and benefits of hormonal contraception with their healthcare provider, and to be aware of the potential side effects and how to manage them. Ongoing research and development in hormonal contraception aim to improve safety, reduce side effects, and expand the range of options available to meet the diverse needs of individuals.
3. Intrauterine Device (IUD)

The intrauterine device (IUD) is a highly effective, long-acting, and reversible contraceptive method. IUDs are small, T-shaped devices that are inserted into the uterus by a healthcare provider. They work by preventing fertilization and implantation, and can be effective for several years, depending on the type of IUD. IUDs are considered one of the most reliable contraceptive options, with a failure rate of less than 1% in typical use. They are also convenient, as they do not require daily or monthly administration like some other contraceptive methods. However, IUD insertion can be uncomfortable, and there is a small risk of expulsion or uterine perforation. Additionally, some individuals may experience heavier or more painful menstrual periods with certain types of IUDs. Overall, the IUD is a safe and effective contraceptive option that can provide long-term protection against pregnancy with minimal user effort.
4. Spermicide and Diaphragm

Spermicides and diaphragms are barrier contraceptive methods that work by physically preventing sperm from entering the uterus. Spermicides are chemical substances that immobilize and kill sperm, while diaphragms are dome-shaped devices that are inserted into the vagina to cover the cervix and block sperm from entering. These methods are generally less effective than hormonal or long-acting reversible contraceptives, with typical use failure rates around 12-18%. However, they have the advantage of being non-hormonal and allowing for spontaneous sexual activity. Diaphragms also provide some protection against sexually transmitted infections. The use of spermicides and diaphragms requires careful insertion and timing, and they may be less suitable for individuals with certain medical conditions or anatomical differences. While not as widely used as other contraceptive options, these methods can still play a role in family planning for some individuals.
5. Surgical Sterilization

Surgical sterilization, such as tubal ligation for women and vasectomy for men, is a highly effective and permanent form of contraception. These procedures involve the surgical blocking or cutting of the vas deferens (in men) or fallopian tubes (in women) to prevent the passage of sperm and egg, effectively preventing pregnancy. Sterilization is considered a safe and reliable contraceptive option, with a failure rate of less than 1%. It is an appropriate choice for individuals who are certain they do not want to have (more) children in the future. The procedures are generally considered irreversible, although in some cases reversal may be possible. Surgical sterilization is a significant decision that should be made carefully, with a full understanding of the implications and in consultation with a healthcare provider. It is an important option for those seeking a permanent contraceptive solution.
6. Male Contraceptives

Male contraceptive methods, such as condoms and vasectomy, play a crucial role in shared responsibility for family planning and reproductive health. Condoms are a widely used and effective barrier method that protects against both pregnancy and sexually transmitted infections. Vasectomy, a surgical sterilization procedure for men, is a highly reliable permanent contraceptive option. While male contraceptive options are more limited compared to the range of options available for women, their importance cannot be overstated. Increasing access to and education about male contraceptive methods can empower men to take an active role in family planning, promote gender equity, and contribute to overall reproductive health and well-being. Ongoing research and development in male contraceptive technologies, such as hormonal and non-hormonal methods, hold promise for expanding the choices available to men in the future.
7. Non-Hormonal Male Contraceptives

Non-hormonal male contraceptive methods, such as condoms and vasectomy, offer important alternatives to hormonal contraceptive options that are primarily focused on women. Condoms are a widely used and effective barrier method that protects against both pregnancy and sexually transmitted infections. Vasectomy, a surgical sterilization procedure for men, is a highly reliable permanent contraceptive option. While the range of non-hormonal male contraceptive choices is more limited compared to the options available for women, their significance cannot be overstated. Increasing access to and education about non-hormonal male contraceptive methods can empower men to take an active role in family planning, promote gender equity, and contribute to overall reproductive health and well-being. Ongoing research and development in non-hormonal male contraceptive technologies, such as reversible methods, hold promise for expanding the choices available to men in the future.