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127-510: An intrauterine device ( IUD ), also known as an intrauterine contraceptive device ( IUCD or ICD ) or coil , is a small, often T-shaped birth control device that is inserted into the uterus to prevent pregnancy . IUDs are a form of long-acting reversible contraception (LARC). Users are more satisfied with contraceptive implants such as IUDs than any other birth control method. IUDs are safe and effective in adolescents as well as those who have not previously had children. Once an IUD

254-467: A bioactive component. They are made of inert materials like stainless steel (such as the stainless steel ring (SSR), a flexible ring of steel coils that can deform to be inserted through the cervix) or plastic (such as the Lippes Loop, which can be inserted through the cervix in a cannula and takes a trapezoidal shape within the uterus). They are less effective than copper or hormonal IUDs, with

381-480: A medical exam —including birth control pills, injectable or implantable birth control, and condoms. For example, a pelvic exam , breast exam , or blood test before starting birth control pills does not appear to affect outcomes. In 2009, the World Health Organization (WHO) published a detailed list of medical eligibility criteria for each type of birth control. Hormonal contraception

508-493: A pacifier , and feeding solids all increase the chances of becoming pregnant while breastfeeding. In those who are exclusively breastfeeding, about 10% begin having periods before three months and 20% before six months. In those who are not breastfeeding, fertility may return as early as four weeks after delivery. Emergency contraceptive methods are medications (sometimes misleadingly referred to as "morning-after pills") or devices used after unprotected sexual intercourse with

635-424: A progestin ) and the progestogen-only pills (sometimes called minipills). If either is taken during pregnancy, they do not increase the risk of miscarriage nor cause birth defects . Both types of birth control pills prevent fertilization mainly by inhibiting ovulation and thickening cervical mucus. They may also change the lining of the uterus and thus decrease implantation. Their effectiveness depends on

762-551: A tenaculum , and then use an insertion device to place the IUD in the uterus. The insertion device goes through the cervix. The procedure itself, if uncomplicated, should take no more than five to ten minutes. For immediate postpartum insertion, the IUD is inserted following the removal of the placenta from the uterus . The uterus is larger than baseline following birth, which has important implications for insertion. After vaginal deliveries, insertions can be done using placental forceps,

889-434: A 6% first-year rate with the diaphragm. Condoms have the additional benefit of helping to prevent the spread of some sexually transmitted infections such as HIV/AIDS , however, condoms made from animal intestine do not. Contraceptive sponges combine a barrier with a spermicide. Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective. Typical failure rates during

1016-487: A 90% decrease in bleeding with hormonal IUDs. Cramping can be treated with NSAIDs . More serious potential complications include expulsion (2–5%) and rarely perforation of the uterus (less than 0.7%). IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion . The use of IUDs increased within the United States from 0.8% in 1995 to 7.2% from

1143-399: A UK study, when a three-month "bridge" supply of the progestogen-only pill was provided by a pharmacist along with emergency contraception after sexual activity, this intervention was shown to increase the likelihood that the person would begin to use an effective method of long-term contraception. Levonorgestrel pills, when used within 3 days, decrease the chance of pregnancy after

1270-687: A base covered in oils or other gummy substances. Many of Soranus's methods were probably also ineffective. In medieval Europe, any effort to halt pregnancy was deemed immoral by the Catholic Church , although it is believed that women of the time still used a number of birth control measures, such as coitus interruptus and inserting lily root and rue into the vagina. Women in the Middle Ages were also encouraged to tie weasel testicles around their thighs during sex to prevent pregnancy. The oldest condoms discovered to date were recovered in

1397-496: A doctor's office (meant to be left indefinitely), and surgical removal is usually needed. Until the mid-1990s, the state-preferred IUD was a stainless steel ring, which had a higher rate of complications compared to other types of IUD. It gave rise to the idiom 上环 ( Shànghuán ) meaning "insert a loop". Nowadays, the IUDs include T and V shapes, the former being the most common and easiest to remove. To implement

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1524-572: A female's womb. For many years the embryo was inserted into the uterus two to three days after fertilization. However at this stage of development it is very difficult to predict which embryos will develop best, and several embryos were typically implanted. Several implanted embryos increased the likelihood of a developing fetus but also led to the development of multiple fetuses. This was a major problem and drawback for using embryos in IVF. The use of blastocysts for human IVF has proved successful. A blastocyst

1651-479: A fluid-filled cavity opens up in the morula , the early embryonic stage of a ball of 16 cells . The blastocyst has a diameter of about 0.1–0.2 mm and comprises 100-200 cells following 7-8 rounds of cleavage (cell division without cell growth). About seven days after fertilization, the blastocyst undergoes implantation , embedding into the endometrium of the uterine wall where it will undergo further developmental processes, including gastrulation . Embedding of

1778-893: A given method during the first year, and sometimes as a lifetime failure rate among methods with high effectiveness, such as tubal ligation . Birth control methods fall into two main categories: male contraception and female contraception . Common male contraceptives are withdrawal , condoms , and vasectomy . Female contraception is more developed compared to male contraception, these include contraceptive pills (combination and progestin-only pill), hormonal or non-hormonal IUD , patch , vaginal ring , diaphragm , shot , implant , fertility awareness , and tubal ligation . The most effective methods are those that are long acting and do not require ongoing health care visits. Surgical sterilization, implantable hormones, and intrauterine devices all have first-year failure rates of less than 1%. Hormonal contraceptive pills, patches or vaginal rings, and

1905-425: A longer inserter specialized for postpartum insertions, or manually, where the provider uses their hand to insert the IUD in the uterus. After cesarean deliveries, the IUD is placed in the uterus with forceps or manually during surgery prior to suturing the uterine incision. Generally, the removal is uncomplicated and reported to be not as painful as the insertion because there is no instrument that needs to go through

2032-491: A man's erect penis and physically block ejaculated sperm from entering the body of a sexual partner. Modern condoms are most often made from latex , but some are made from other materials such as polyurethane , or lamb's intestine. Female condoms are also available, most often made of nitrile , latex or polyurethane. Male condoms have the advantage of being inexpensive, easy to use, and have few adverse effects. Making condoms available to teenagers does not appear to affect

2159-527: A pregnancy, delivery and care of a newborn in the United States is on average $ 21,000 for a vaginal delivery and $ 31,000 for a caesarean delivery as of 2012. In most other countries, the cost is less than half. For a child born in 2011, an average US family will spend $ 235,000 over 17 years to raise them. Globally, as of 2009, approximately 60% of those who are married and able to have children use birth control. How frequently different methods are used varies widely between countries. The most common method in

2286-433: A previous delivery. Delaying another pregnancy after a miscarriage , however, does not appear to alter risk and women are advised to attempt pregnancy in this situation whenever they are ready. Teenage pregnancies , especially among younger teens, are at greater risk of adverse outcomes including early birth , low birth weight , and death of the infant . In 2012 in the United States 82% of pregnancies in those between

2413-435: A primary method have backup methods available (such as condoms or emergency contraceptive pills). The lactational amenorrhea method involves the use of a woman's natural postpartum infertility which occurs after delivery and may be extended by breastfeeding . For a postpartum woman to be infertile (protected from pregnancy), their periods have usually not yet returned (not menstruating), they are exclusively breastfeeding

2540-513: A regular or emergency method of contraception, copper-releasing IUCs act primarily to prevent fertilization. Emergency insertion of a copper IUC is significantly more effective than the use of ECPs, reducing the risk of pregnancy following unprotected intercourse by more than 99%. This very high level of effectiveness implies that emergency insertion of a copper IUC must prevent some pregnancies after fertilization. Emergency contraceptive pills To make an informed choice, women must know that ECPs—like

2667-497: A result of rape, and public health efforts emphasizing abstinence to reduce unwanted pregnancy may have limited effectiveness, especially in developing countries and among disadvantaged groups . Deliberate non-penetrative sex without vaginal sex or deliberate oral sex without vaginal sex are also sometimes considered birth control. While this generally avoids pregnancy, pregnancy can still occur with intercrural sex and other forms of penis-near-vagina sex (genital rubbing, and

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2794-853: A result, they are used to treat menorrhagia (heavy menses ), once pathologic causes of menorrhagia (such as uterine polyps ) have been ruled out. In a 10-year study, the levonorgestrel coil was found to be as effective as oral medicines (tranexamic acid, mefenamic acid, combined oestrogen–progestogen or progesterone alone); the same proportion of women had not had surgery for heavy bleeding and had similar improvements in their quality of life. The progestin released by hormonal IUDs primarily acts locally; use of Mirena results in much lower systemic progestin levels than other very-low-dose progestogen only contraceptives . Regardless of IUD type, there are some potential side effects that are similar for all IUDs. Some of these side effects include bleeding pattern changes, expulsion, pelvic inflammatory disease (especially in

2921-407: A side effect profile similar to copper IUDs. Their primary mechanism of action is inducing a local foreign body reaction , which makes the uterine environment hostile both to sperm and to implantation of an embryo. They may have higher rates of preventing pregnancy after fertilization, instead of before fertilization, compared to copper or hormonal IUDs. Inert IUDs are not yet approved for use in

3048-554: A single episode of unprotected sex or condom failure by 70% (resulting in a pregnancy rate of 2.2%). Ulipristal , when used within 5 days, decreases the chance of pregnancy by about 85% (pregnancy rate 1.4%) and is more effective than levonorgestrel. Mifepristone is also more effective than levonorgestrel, while copper IUDs are the most effective method. IUDs can be inserted up to five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex (pregnancy rate of 0.1 to 0.2%). This makes them

3175-590: A survey of biological parents, 9% stated they would not have had children if they were able to do it over again. Although sterilization is considered a permanent procedure, it is possible to attempt a tubal reversal to reconnect the fallopian tubes or a vasectomy reversal to reconnect the vasa deferentia . In women, the desire for a reversal is often associated with a change in spouse. Pregnancy success rates after tubal reversal are between 31 and 88 percent, with complications including an increased risk of ectopic pregnancy . The number of males who request reversal

3302-458: A wider range of sizes and shapes than hormonal IUDs. Disadvantages include the possibility of heavier menstrual periods and more painful cramps. IUDs that contain gold or silver also exist. Other shapes of IUD include the so-called U-shaped IUDs, such as the Load and Multiload, and the frameless IUD that holds several hollow cylindrical minuscule copper beads. It is held in place by a suture (knot) to

3429-474: A woman drink a copper salt dissolved in water, which it claimed would prevent pregnancy for a year. This method was not only ineffective, but also dangerous, as the later medical writer Soranus of Ephesus ( c. 98–138 AD) pointed out. Soranus attempted to list reliable methods of birth control based on rational principles. He rejected the use of superstition and amulets and instead prescribed mechanical methods such as vaginal plugs and pessaries using wool as

3556-401: A woman has not become pregnant and the uterus sheds its lining in preparation for the next cycle. IUDs tend to thin the lining of the uterus, leading to less menses by volume or a lack of menstruation altogether. There is a condition known as polycystic ovarian syndrome (PCOS) which causes women to miss their periods and can lead to an increased risk of endometrial cancer. However, an IUD causes

3683-504: A year. Part of the reason that many women are without birth control is that many countries limit access due to religious or political reasons, while another contributor is poverty. Due to restrictive abortion laws in Sub-Saharan Africa, many women turn to unlicensed abortion providers for unintended pregnancy , resulting in about 2–4% obtaining unsafe abortions each year. The Egyptian Ebers Papyrus from 1550 BC and

3810-404: Is 0.2%; the typical use first failure rate is 6%. Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from entering the uterus . They include male condoms , female condoms , cervical caps , diaphragms , and contraceptive sponges with spermicide . Globally, condoms are the most common method of birth control. Male condoms are put on

3937-486: Is a high concern, using two methods at the same time is reasonable. For example, two forms of birth control are recommended in those taking the anti- acne drug isotretinoin or anti-epileptic drugs like carbamazepine , due to the high risk of birth defects if taken during pregnancy. Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% of deaths if

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4064-585: Is also a form of birth control, but abstinence-only sex education may increase teenage pregnancies if offered without birth control education, due to non-compliance. In teenagers , pregnancies are at greater risk of poor outcomes. Comprehensive sex education and access to birth control decreases the rate of unintended pregnancies in this age group. While all forms of birth control can generally be used by young people, long-acting reversible birth control such as implants, IUDs, or vaginal rings are more successful in reducing rates of teenage pregnancy. After

4191-403: Is available in a number of different forms, including oral pills , implants under the skin, injections , patches , IUDs and a vaginal ring . They are currently available only for women, although hormonal contraceptives for men have been and are being clinically tested. There are two types of oral birth control pills, the combined oral contraceptive pills (which contain both estrogen and

4318-575: Is available in the form of tubal ligation for women and vasectomy for men. Tubal ligation decreases the risk of ovarian cancer . Short term complications are twenty times less likely from a vasectomy than a tubal ligation. After a vasectomy, there may be swelling and pain of the scrotum which usually resolves in one or two weeks. Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1–2% of men. With tubal ligation, complications occur in 1 to 2 percent of procedures with serious complications usually due to

4445-414: Is between 2 and 6 percent. Rates of success in fathering another child after reversal are between 38 and 84 percent; with success being lower the longer the time period between the vasectomy and the reversal. Sperm extraction followed by in vitro fertilization may also be an option in men. Behavioral methods involve regulating the timing or method of intercourse to prevent introduction of sperm into

4572-439: Is imperative. In the developing world, birth control increases economic growth due to there being fewer dependent children and thus more women participating in or increased contribution to the workforce – as they are usually the primary caregiver for children. Women's earnings, assets, body mass index , and their children's schooling and body mass index all improve with greater access to birth control. Family planning , via

4699-428: Is implanted five to six days after the eggs have been fertilized. After five or six days it is much easier to determine which embryos will result in healthy live births. Knowing which embryos will succeed allows just one blastocyst to be implanted, cutting down dramatically on the health risk and expense of multiple births. Now that the nutrient requirements for embryonic and blastocyst development have been determined, it

4826-417: Is labeled with the term intrauterine system (IUS). levonorgestrel levonorgestrel levonorgestrel -Prevents ovulation at times -Emergency contraception -Lighter periods after 3 months; some users experience amenorrhea Most copper IUDs have a T-shaped frame that is wound around with pure electrolytic copper wire and/or has copper collars (sleeves). The arms of the frame hold the IUD in place near

4953-417: Is much easier to give embryos the correct nutrients to sustain them into the blastocyst phase. Embryo transfer following in vitro fertilization is a procedure in which a catheter is inserted into the vagina, guided through the cervix via ultrasound, and into the uterine cavity where the blastocysts are inserted into the womb. Blastocysts also offer an advantage because they can be used to genetically test

5080-425: Is no scientific agreement on whether using a menstrual cup increases the risk of IUD expulsion; more rigorous studies are needed. Unlike condoms, the IUD does not protect against sexually transmitted infections. Modern IUDs do not lead to infertility or make it harder for a woman to become pregnant, and fertility typically returns within days of removal. Some prior studies found an association between infertility and

5207-538: Is on mouse embryos and specific factors may differ between mammals. During implantation, the trophoblast gives rise to extraembryonic membranes and cell types that will eventually form most of the fetal placenta, the specialized organ through which the embryo obtains maternal nourishment necessary for subsequent exponential growth. The specification of the trophoblast is controlled by the combination of morphological cues arising from cell polarity with differential activity of signaling pathways such as Hippo and Notch, and

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5334-418: Is recommended that birth control be continued for one year after the last menstrual period . About 222 million women who want to avoid pregnancy in developing countries are not using a modern birth control method. Birth control use in developing countries has decreased the number of deaths during or around the time of pregnancy by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% if

5461-728: Is removed, even after long-term use, fertility returns to normal rapidly. Copper devices have a failure rate of about 0.8%, while hormonal ( levonorgestrel ) devices fail about 0.2% of the time within the first year of use. In comparison, male sterilization and male condoms have a failure rate of about 0.15% and 15%, respectively. Copper IUDs can also be used as emergency contraception within five days of unprotected sex. Although copper IUDs may increase menstrual bleeding and result in painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. However, women can have daily spotting for several months after insertion, and it can take up to three months for there to be

5588-435: Is stronger in humans, which could contribute to its fragmentation . Until this developmental stage, cells ( blastomeres ) were not specified to any particular cell lineage but, when reaching the 16-cell stage, cells at the surface of the embryo begin to differentiate into trophectoderm while cells with inner position initiate their differentiation into inner cell mass fate. The morula then develops by cavitation to become

5715-404: Is the factor measured in a pregnancy test . hCG can be measured in both blood and urine to determine whether a woman is pregnant. More hCG is secreted in a multiple pregnancy. Blood tests of hCG can also be used to check for abnormal pregnancies. In vitro fertilization (IVF) is an alternative to traditional in vivo fertilization for fertilizing an egg with sperm and implanting that embryo into

5842-556: Is the practice of ending intercourse ("pulling out") before ejaculation. The main risk of the withdrawal method is that the man may not perform the maneuver correctly or in a timely manner. First-year failure rates vary from 4% with perfect usage to 22% with typical usage. It is not considered birth control by some medical professionals. There is little data regarding the sperm content of pre-ejaculatory fluid . While some tentative research did not find sperm, one trial found sperm present in 10 out of 27 volunteers. The withdrawal method

5969-566: Is the source of embryonic stem cells , which are broadly applicable in stem cell therapies including cell repair, replacement and regeneration. Assisted zona hatching may also be used in IVF and other fertility treatments. The name "blastocyst" arises from the Greek βλαστός blastós ("a sprout") and κύστις kýstis ("bladder, capsule"). The blastocyst stage occurs between 5 and 9 days after conception. During embryonic development , after fertilization (approximately 5–6 days in

6096-544: Is the use of methods or devices to prevent pregnancy . Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning . Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable. The World Health Organization and United States Centers for Disease Control and Prevention provide guidance on

6223-550: Is used as birth control by about 3% of couples. Sexual abstinence may be used as a form of birth control, meaning either not engaging in any type of sexual activity, or specifically not engaging in vaginal intercourse, while engaging in other forms of non-vaginal sex. Complete sexual abstinence is 100% effective in preventing pregnancy. However, among those who take a pledge to abstain from premarital sex , as many as 88% who engage in sex, do so prior to marriage. The choice to abstain from sex cannot protect against pregnancy as

6350-532: The Dalkon Shield , an early IUD design which is no longer available. Modern IUDs do not cause increased infection, though the earlier Dalkon Shield may have, because it contained multifilament strings, which provided bacteria a space to grow and move up the string. IUDs manufactured after 2008 use monofilament strings in order to prevent this from happening. However, as with any medical intervention, IUDs can lead to increased risk of infection immediately after

6477-498: The Kahun Papyrus from 1850 BC have within them some of the earliest documented descriptions of birth control: the use of honey, acacia leaves and lint to be placed in the vagina to block sperm. Silphium , a species of giant fennel native to north Africa, may have been used as birth control in ancient Greece and the ancient Near East . Due to its desirability, by the first century AD, it had become so rare that it

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6604-480: The amniotic sac and epiblast . There are two types of blastomere cells: The blastocoel fluid cavity contains amino acids , growth factors , and other molecules necessary for cellular differentiation . Multiple processes control cell lineage specification in the blastocyst to produce the trophoblast, epiblast, and primitive endoderm. These processes include gene expression, cell signaling, cell-cell contact and positional relationships, and epigenetics . Once

6731-635: The anesthesia . Neither method offers protection from sexually transmitted infections. Sometimes, salpingectomy is also used for sterilization in women. Non-surgical sterilization methods have also been explored. Fahim et al. found that heat exposure, especially high-intensity ultrasound, was effective either for temporary or permanent contraception depending on the dose, e.g. selective destruction of germ cells and Sertoli cells without affecting Leydig cells or testosterone levels. Chemical, e.g. drug-based methods are also available, e.g. orally-administered Lonidamine for temporary, or permanent (depending on

6858-493: The blastocyst . The types of intrauterine devices available, and the names they go by, differ by location. In the United States, there are two types available: The WHO ATC labels both copper and hormonal devices as IUDs. In the United Kingdom, there are more than 10 different types of copper IUDs available. In the United Kingdom, the term IUD refers only to these copper devices. Hormonal intrauterine contraception

6985-591: The fundus of the uterus . It is mainly available in China and Europe. A framed copper IUD called the IUB SCu300 coils when deployed and forms a three-dimensional spherical shape. It is based on a nickel titanium shape memory alloy core. In addition to copper, noble metal, and progestogen IUDs, women in China can get copper IUDs with indomethacin . This non-hormonal compound reduces the severity of menstrual bleeding, and these coils are popular. Inert IUDs do not have

7112-404: The homeodomain protein, Cdx2 . This transcription factor represses the expression of Oct4 and Nanog transcription factors in the trophoblast . These genomic alterations allow for the progressive specification of both epiblast and primitive endoderm lineages at the end of the blastocyst phase of development preceding gastrulation. Much of the research conducted on these early embryonic stages

7239-573: The lactational amenorrhea method (LAM), if adhered to strictly, can also have first-year (or for LAM, first-6-month) failure rates of less than 1%. With typical use, first-year failure rates are considerably higher, at 9%, due to inconsistent use. Other methods such as condoms, diaphragms, and spermicides have higher first-year failure rates even with perfect usage. The American Academy of Pediatrics recommends long acting reversible birth control as first line for young individuals. While all methods of birth control have some potential adverse effects,

7366-408: The two-child policy , the government announced that IUD-removals would be paid for by the government. IUD removals are free for women "who are allowed to have another child" (see one-child policy ) or "who cannot continue to have the IUD for health reasons." In the United States, the price of an IUD may range from $ 0 to $ 1,300. The price includes medical exams, insertion, and follow-up visits. Under

7493-407: The workforce , and/or less use of scarce resources. Birth control methods include barrier methods , hormonal birth control , intrauterine devices (IUDs), sterilization , and behavioral methods. They are used before or during sex while emergency contraceptives are effective for up to five days after sex. Effectiveness is generally expressed as the percentage of women who become pregnant using

7620-414: The 3rd cleavage division, the embryo begins the process of compaction, which, in human, is only completed when the embryo consists of 8-16 cells, then becoming known as the morula . Compaction results from increased contractility of the actomyosin cortex , which pull cells together into a tighter configuration. Increased contractility during compaction is observed in both mouse and human embryos, but

7747-543: The Affordable Care Act, most insurance plans are required to cover all forms of birth control, including IUDs, although they may not cover all IUD brands. Among birth control methods, IUDs, along with other contraceptive implants , result in the greatest satisfaction among users. A study found that female family planning providers choose LARC methods more often (41.7%) than the general public (12.1%). Mechanism of action Copper-releasing IUCs When used as

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7874-478: The DNA base excision repair pathway. Trophoblasts express integrin on their cell surfaces which allow for adhesion to the extracellular matrix of the uterine wall. This interaction allows for implantation and triggers further specification into the three different cell types, preparing the blastocyst for gastrulation. The level of human chorionic gonadotropin (hCG) secreted by the blastocyst during implantation

8001-516: The Nazi regime, when contraception was considered a threat to Aryan women. He moved to the United States, where his colleagues H. Hall and M. Stone took up his work after his death and created the stainless steel Hall-Stone Ring. A Japanese doctor named Tenrei Ota also developed a silver or gold IUD called the Precea or Pressure Ring. Jack Lippes helped begin the increase of IUD use in the United States in

8128-510: The UK) work by releasing a small amount of levonorgestrel , a progestin . Each type varies in size, amount of levonorgestrel released, and duration. The primary mechanism of action is making the inside of the uterus uninhabitable for sperm. They can also thin the endometrial lining and potentially impair implantation, but this is not their usual function. Because they thin the endometrial lining, they can also reduce or even prevent menstrual bleeding. As

8255-612: The US FDA, the National Institutes of Health and the American College of Obstetricians and Gynecologists (ACOG). Ulipristal acetate (UPA). One study has demonstrated that UP can delay ovulation.... Another study found that UPA altered the endometrium, but whether this change would inhibit implantation is unknown. p. 122: Progestin-only emergency contraceptive pills. Early treatment with ECPs containing only

8382-560: The United States, UK, or Canada. In China, where IUDs are the most common form of contraception, copper IUD production replaced inert IUD production in 1993. However, as of 2008, the most common IUD used by immigrants presenting to Canadian clinics for removal of IUDs placed in China was still the SSR. Because the SSR has no string for removal, it can present a challenge to healthcare providers unfamiliar with IUD types not available in their region. Hormonal IUDs (referred to as intrauterine systems in

8509-412: The age of 30, about 6% regret their decision, as compared with 20–24% of women who received sterilization within one year of delivery and before turning 30, and 6% in nulliparous women sterilized before the age of 30. By contrast, less than 5% of men are likely to regret sterilization. Men who are more likely to regret sterilization are younger, have young or no children, or have an unstable marriage. In

8636-469: The age of onset of sexual activity or its frequency. In Japan, about 80% of couples who are using birth control use condoms, while in Germany this number is about 25%, and in the United States it is 18%. Male condoms and the diaphragm with spermicide have typical use first-year failure rates of 18% and 12%, respectively. With perfect use condoms are more effective with a 2% first-year failure rate versus

8763-867: The ages of 15 and 19 years old are unplanned. Comprehensive sex education and access to birth control are effective in decreasing pregnancy rates in this age group. Birth control methods, especially hormonal methods , can also have undesirable side effects. Intensity of side effects can range from minor to debilitating, and varies with individual experiences. These most commonly include change in menstruation regularity and flow, nausea, breast tenderness, headaches, weight gain, and mood changes (specifically an increase in depression and anxiety). Additionally, hormonal contraception can contribute to bone mineral density loss, impaired glucose metabolism, increased risk of venous thromboembolism. Comprehensive sex education and transparent discussion of birth control side effects and contraindications between healthcare provider and patient

8890-582: The birth control pill, patch, ring, shot, and implant,and even like breastfeeding—prevent pregnancy primarily by delaying or inhibiting ovulation and inhibiting fertilization, but may at times inhibit implantation of a fertilized egg in the endometrium. However, women should also be informed that the best available evidence indicates that ECPs prevent pregnancy by mechanisms that do not involve interference with post-fertilization events. ECPs do not cause abortion or harm an established pregnancy. Pregnancy begins with implantation according to medical authorities such as

9017-465: The blastocyst into the endometrium requires that it hatches from the zona pellucida , the egg coat that prevents adherence to the fallopian tube as the pre-embryo makes its way to the uterus. The use of blastocysts in in vitro fertilization (IVF) involves culturing a fertilized egg for five days before transferring it into the uterus. It can be a more viable method of fertility treatment than traditional IVF. The inner cell mass of blastocysts

9144-546: The blastocyst, or in many other animals the blastula. Cell differentiation then further commits the morula's cells into two types: trophectoderm cells that surround the lumen and the inner mass of cells (the embryoblast). The inner cell mass is at the origin of embryonic stem cells . The conceptus is then known as the blastocyst. Before cell differentiation takes place there are two transcription factors , Oct-4 and nanog that are uniformly expressed in all cells, but both of these transcription factors are turned off in

9271-440: The body. In China , the use of IUDs by state health services was part of the government's efforts to limit birth rates. From 1980 to 2014, 324 million women were inserted with IUDs, in addition to the 107 million who had tubal ligation . Women who refused could lose their government employment and their children could lose access to public schools . The IUDs inserted in this way were modified such that they could not be removed in

9398-458: The cells to check for genetic problems. There are enough cells in a blastocyst that a few trophectoderm cells can be removed without disturbing the developing blastocyst. These cells can be tested for chromosome aneuploidy using preimplantation genetic screening (PGS), or specific conditions such as cystic fibrosis , often known as preimplantation genetic diagnosis (PGD). In an embryo transfer procedure following an initial ultrasound ,

9525-530: The cervical mucus, preventing sperm from reaching the fallopian tubes. Hormonal IUDs may also sometimes prevent ovulation. Copper IUDs do not contain any hormones, but release copper ions, which are toxic to sperm. They also cause the uterus and fallopian tubes to produce a fluid that contains white blood cells, copper ions, enzymes, and prostaglandins , which is also toxic to sperm. The very high effectiveness of copper-containing IUDs as emergency contraceptives implies they may also act by preventing implantation of

9652-514: The cervix. This process requires the health care provider to find the cervix with a speculum and then use ring forceps, which only go into the vagina, to grasp the IUD strings and then pull the IUD out. IUD placement and removal can be taught both by manufacturers and other training facilities. The history of intrauterine devices dates back to the early 1900s. Unlike modern intrauterine devices, early inter uterine (from Latin inter- meaning "between" as opposed to intra- ) devices crossed both

9779-437: The copper IUD include its ability to provide emergency contraception up to five days after unprotected sex. It is the most effective form of emergency contraception available. It works by preventing fertilization or implantation but does not affect already implanted embryos. It contains no hormones, so it can be used while breastfeeding, and fertility returns quickly after removal. Copper IUDs also last longer and are available in

9906-411: The day of the cycle. They have typical first-year failure rates of 24%; perfect use first-year failure rates depend on which method is used and range from 0.4% to 5%. The evidence on which these estimates are based, however, is poor as the majority of people in trials stop their use early. Globally, they are used by about 3.6% of couples. If based on both basal body temperature and another primary sign,

10033-416: The delivery of a child, a woman who is not exclusively breastfeeding may become pregnant again after as few as four to six weeks. Some methods of birth control can be started immediately following the birth, while others require a delay of up to six months. In women who are breastfeeding, progestin-only methods are preferred over combined oral birth control pills . In women who have reached menopause , it

10160-524: The developed world is condoms and oral contraceptives, while in Africa it is oral contraceptives and in Latin America and Asia it is sterilization. In the developing world overall, 35% of birth control is via female sterilization, 30% is via IUDs, 12% is via oral contraceptives, 11% is via condoms, and 4% is via male sterilization. While less used in the developed countries than the developing world,

10287-469: The device only lasted for one year of use. Progestasert was manufactured until 2001. One commercial hormonal IUD which is currently available, Mirena, was also developed by Luukkainen and released in 1976. The manufacturer of the Mirena, Bayer AG , became the target of multiple lawsuits over allegations that Bayer failed to adequately warn users that the IUD could pierce the uterus and migrate to other parts of

10414-399: The dose) fertility management. Boris provides a method for chemically inducing either temporary or non-reversible sterility, depending on the dose, "Permanent sterility in human males can be obtained by a single oral dosage containing from about 18 mg/kg to about 25 mg/kg". The permanence of this decision may cause regret in some men and women. Of women who have undergone tubal ligation after

10541-415: The endometrial lining of a uterus to thin, which is the opposite of what occurs with PCOS.   The main mechanisms of action of IUDs occur prior to fertilization, by preventing sperm from ever reaching the egg. The copper-bearing IUD acts as a spermicide, killing or impairing sperm so they cannot reach the egg. IUDs that contain progestin cause the cervical mucus to thicken, which stops sperm from entering

10668-409: The endometrial lining, while autocrine growth factors such as human chorionic gonadotropin (hCG) and insulin-like growth factor (IGF) allow the blastocyst to further invade the endometrium. Implantation in the uterine wall allows for the next step in embryogenesis, gastrulation , which includes the formation of the placenta from trophoblastic cells and differentiation of the inner cell mass into

10795-460: The female reproductive tract, either altogether or when an egg may be present. If used perfectly the first-year failure rate may be around 3.4%; however, if used poorly first-year failure rates may approach 85%. Fertility awareness methods involve determining the most fertile days of the menstrual cycle and avoiding unprotected intercourse. Techniques for determining fertility include monitoring basal body temperature , cervical secretions , or

10922-785: The first 21 days after insertion), and rarely uterine perforation. A small probability of pregnancy remains after IUD insertion, and when it occurs, there is a greater risk of ectopic pregnancy . IUDs with progestogen confer an increased risk of ovarian cysts , and IUDs with copper confer an increased risk of heavier periods. Mirena lists among its side effects mental health changes including nervousness, depressed mood, or mood swings. Menstrual cup companies recommend that women with IUDs who are considering using menstrual cups should consult with their gynecologists before use. There have been rare cases in which women using IUDs dislodged them when removing their menstrual cups, however, this can also happen with tampon use. Despite reports, as of 2023, there

11049-481: The first copper IUD, TCu200. Improvements by Tatum led to the creation of the TCu380A ( ParaGard ), which is currently the preferred copper IUD. The hormonal IUD was also invented in the 1960s and 1970s; initially the goal was to mitigate the increased menstrual bleeding associated with copper and inert IUDs. The first model, Progestasert, was conceived of by Antonio Scommegna and created by Tapani J. V. Luukkainen, but

11176-514: The first year depend on whether or not a woman has previously given birth, being 24% in those who have and 12% in those who have not. The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward. Allergic reactions and more severe adverse effects such as toxic shock syndrome have been reported. The current intrauterine devices (IUD) are small devices, often T-shaped, containing either copper or levonorgestrel , which are inserted into

11303-454: The full demand for birth control were met. By lengthening the time between pregnancies, birth control can improve adult women's delivery outcomes and the survival of their children. In the developing world, women's earnings, assets, and weight, as well as their children's schooling and health, all improve with greater access to birth control. Birth control increases economic growth because of fewer dependent children, more women participating in

11430-428: The full demand for birth control were met. These benefits are achieved by reducing the number of unplanned pregnancies that subsequently result in unsafe abortions and by preventing pregnancies in those at high risk. Birth control also improves child survival in the developing world by lengthening the time between pregnancies. In this population, outcomes are worse when a mother gets pregnant within eighteen months of

11557-616: The hope of preventing pregnancy. Emergency contraceptives are often given to victims of rape. They work primarily by preventing ovulation or fertilization. They are unlikely to affect implantation, but this has not been completely excluded. A number of options exist, including high dose birth control pills , levonorgestrel , mifepristone , ulipristal and IUDs. All methods have minimal side effects. Providing emergency contraceptive pills to women in advance of sexual activity does not affect rates of sexually transmitted infections, condom use, pregnancy rates, or sexual risk-taking behavior. In

11684-444: The human), the cells of the morula begin to undergo cell differentiation , and the morula changes into the blastocyst by pumping fluid to grow a lumen . In the uterus the zona pellucida surrounding the blastocyst breaks down, allowing it to implant into the uterine wall. Implantation marks the end of the germinal stage of embryogenesis, and the beginning of gestation . The zygote undergoes several rounds of mitosis . After

11811-543: The increased risk, they are included in decision tools such as the DASH score and PERC rule used to predict the risk of blood clots. The effect on sexual drive is varied, with increase or decrease in some but with no effect in most. Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer. They often reduce menstrual bleeding and painful menstruation cramps . The lower doses of estrogen released from

11938-455: The infamous Dalkon Shield , whose poor design caused bacterial infection and led to thousands of lawsuits. Although the Dalkon shield was removed from the market, it had a lasting, negative impact on IUD use and reputation in the United States. Lazar C. Margulies developed the first plastic IUD using thermoplastics in the 1960s. His innovation allowed insertion of the IUD into the uterus without

12065-401: The infant, and the baby is younger than six months. If breastfeeding is the infant's only source of nutrition and the baby is less than 6 months old, 93–99% of women are estimated to have protection from becoming pregnant in the first six months (0.75–7.5% failure rate). The failure rate increases to 4–7% at one year and 13% at two years. Feeding formula, pumping instead of nursing, the use of

12192-490: The injectable version should be used. Progestin-only pills may improve menstrual symptoms and can be used by breastfeeding women as they do not affect milk production . Irregular bleeding may occur with progestin-only methods, with some users reporting no periods . The progestins drospirenone and desogestrel minimize the androgenic side effects but increase the risks of blood clots and are thus not first line. The perfect use first-year failure rate of injectable progestin

12319-439: The inner cell mass has been established within the blastocyst, it prepares for further specification into the epiblast and primitive endoderm. This process of specification known as cell fate determination is carried out in part by fibroblast growth factor (FGF) signaling which generates a MAP kinase pathway to alter cellular genomes. Further segregation of blastomeres into the trophectoderm and inner cell mass are regulated by

12446-853: The insertion. According to the U.S. Medical Eligibility Criteria for Contraceptive Use , published by the CDC , women and adolescents under the age of 20 and women who have not given birth are classified in category 2 for IUD use, mainly due to "the risk for expulsion from nulliparity and for STDs from sexual behavior in younger age groups." According to the CDC, benefits generally outweigh the risks, and IUDs are recommended for young and nulliparous women, although more careful attention may be required. Women over age 20 and those who have previously given birth are placed in category 1, meaning no special concerns are placed on use. Some women experience amenorrhea , or lack of menstruation while using an IUD. Menstruation occurs when

12573-451: The late 1950s. In this time, thermoplastics , which can bend for insertion and retain their original shape, became the material used for first-generation IUDs. Lippes also devised the addition of the monofilament nylon string, which facilitates IUD removal. His trapezoid shape Lippes Loop IUD became one of the most popular first-generation IUDs. In the following years, many different shaped plastic IUDs were invented and marketed. These included

12700-521: The male before ejaculation . Sterilization, while highly effective, is not usually reversible; all other methods are reversible, most immediately upon stopping them. Safe sex practices, such as with the use of condoms or female condoms , can also help prevent sexually transmitted infections . Other methods of birth control do not protect against sexually transmitted infections. Emergency birth control can prevent pregnancy if taken within 72 to 120 hours after unprotected sex. Some argue not having sex

12827-434: The mammalian embryo. The side of the blastocyst where the inner cell mass forms is called the embryonic pole, and the opposite side is the abembryonic pole. The blastocoel , trophectoderm , and inner cell mass are hallmarks of the blastocyst. Implantation is critical to the survival and development of the early human embryo. It establishes a connection between the mother and the early embryo which will continue through

12954-411: The method is referred to as symptothermal. First-year failure rates of 20% overall and 0.4% for perfect use have been reported in clinical studies of the symptothermal method. A number of fertility tracking apps are available, as of 2016, but they are more commonly designed to assist those trying to get pregnant rather than prevent pregnancy. The withdrawal method (also known as coitus interruptus)

13081-417: The most effective form of emergency contraceptive. In those who are overweight or obese , levonorgestrel is less effective and an IUD or ulipristal is recommended. Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy. This can be with condoms either alone or along with another birth control method or by the avoidance of penetrative sex . If pregnancy

13208-783: The most widely used form of reversible contraception, with more than 180 million users worldwide. Evidence supports effectiveness and safety in adolescents and those who have and have not previously had children. IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion. Once removed, even after long term use, fertility returns to normal immediately. While copper IUDs may increase menstrual bleeding and result in more painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. Cramping can be treated with painkillers like non-steroidal anti-inflammatory drugs . Other potential complications include expulsion (2–5%) and rarely perforation of

13335-408: The mother, specifically a peak in luteinizing hormone (LH), prepare the endometrium to receive and envelop the blastocyst. The immune system is also modulated to allow for the invasion of the foreign embryonic cells. Once bound to the extracellular matrix of the endometrium, trophoblast cells secrete enzymes and other factors to embed the blastocyst into the uterine wall. The enzymes released degrade

13462-466: The need to dilate the cervix . The invention of the copper IUD in the 1960s brought with it the capital T-shaped design used by most modern IUDs. U.S. physician Howard Tatum determined that the 'T' shape would work better with the shape of the uterus, which forms a 'T' when contracted. He predicted this would reduce rates of IUD expulsion. Together, Tatum and Chilean physician Jaime Zipper discovered that copper could be an effective spermicide and developed

13589-1006: The number of women using IUDs as of 2007 was more than 180 million. Avoiding sex when fertile is used by about 3.6% of women of childbearing age, with usage as high as 20% in areas of South America. As of 2005, 12% of couples are using a male form of birth control (either condoms or a vasectomy) with higher rates in the developed world. Usage of male forms of birth control has decreased between 1985 and 2009. Contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006. As of 2012, 57% of women of childbearing age want to avoid pregnancy (867 of 1,520 million). About 222 million women, however, were not able to access birth control, 53 million of whom were in sub-Saharan Africa and 97 million of whom were in Asia. This results in 54 million unplanned pregnancies and nearly 80,000 maternal deaths

13716-469: The penis exiting from anal intercourse ) where sperm can be deposited near the entrance to the vagina and can travel along the vagina's lubricating fluids. Abstinence-only sex education does not reduce teenage pregnancy . Teen pregnancy rates and STI rates are generally the same or higher in states where students are given abstinence-only education, as compared with comprehensive sex education . Some authorities recommend that those using abstinence as

13843-520: The period of 2006 to 2014. The use of IUDs as a form of birth control dates from the 1800s. A previous model known as the Dalkon shield was associated with an increased risk of pelvic inflammatory disease (PID). However, current models do not affect PID risk in women without sexually transmitted infections during the time of insertion. IUDs primarily work by preventing fertilization . The progestogen released from hormonal IUDs mainly works by thickening

13970-423: The procedure. The use of intrauterine lidocaine (paracervical block) is underutilized in the United States as an effective method to reduce pain associated with insertion. IUD insertion can occur at multiple timepoints in a woman's reproductive lifespan: During the insertion procedure, health care providers use a speculum to find the cervix (the opening to the uterus), pinch the cervix to stabilize it open with

14097-401: The progestin levonorgestrel has been shown to impair the ovulatory process and luteal function. p. 123: Combined emergency contraceptive pills. Several clinical studies have shown that combined ECPs containing ethinyl estradiol and levonorgestrel can inhibit or delay ovulation. Birth control Birth control , also known as contraception , anticonception , and fertility control ,

14224-402: The remainder of the pregnancy. Implantation is made possible through structural changes in both the blastocyst and endometrial wall. The zona pellucida surrounding the blastocyst breaches, referred to as hatching . This removes the constraint on the physical size of the embryonic mass and exposes the outer cells of the blastocyst to the interior of the uterus. Furthermore, hormonal changes in

14351-401: The restriction to outer cells of lineage specifiers such as CDX2. In the mouse, primordial germ cells are specified from epiblast cells, a process that is accompanied by extensive genome -wide epigenetic reprogramming. Reprogramming involves global DNA demethylation and chromatin reorganization resulting in cellular totipotency . The process of genome -wide demethylation involves

14478-466: The risk is less than that of pregnancy. After stopping or removing many methods of birth control, including oral contraceptives, IUDs, implants and injections, the rate of pregnancy during the subsequent year is the same as for those who used no birth control. For individuals with specific health problems, certain forms of birth control may require further investigations. For women who are otherwise healthy, many methods of birth control should not require

14605-614: The ruins of Dudley Castle in England, and are dated back to 1640. They were made of animal gut, and were most likely used to prevent the spread of sexually transmitted infections during the English Civil War . Casanova , living in 18th-century Italy, described the use of a lambskin covering to prevent pregnancy; however, condoms only became widely available in the 20th century. Blastocyst In humans, blastocyst formation begins about five days after fertilization when

14732-626: The safety of birth control methods among women with specific medical conditions. The most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in females, intrauterine devices (IUDs), and implantable birth control . This is followed by a number of hormone-based methods including contraceptive pills , patches , vaginal rings , and injections . Less effective methods include physical barriers such as condoms , diaphragms and birth control sponges and fertility awareness methods . The least effective methods are spermicides and withdrawal by

14859-511: The top of the uterus. The Paragard TCu 380a measures 32 mm (1.26") horizontally (top of the T), and 36 mm (1.42") vertically (leg of the T). Copper IUDs have a first year failure rate ranging from 0.1 to 2.2%. They work by damaging sperm and disrupting their motility so that they are not able to join an egg. Specifically, copper acts as a spermicide within the uterus by increasing levels of copper ions, prostaglandins, and white blood cells within

14986-409: The trophoblast once it has formed. The outer cells of the trophectoderm pump sodium ions into the blastocyst, which causes water to enter through osmosis . Water accumulation between cell-cell contacts breaks them open via hydraulic fracturing . The fluid then collects into a single lumen in a process akin to Ostwald ripening to form the blastocoel , which determines the first axis of symmetry of

15113-506: The use of modern birth control, is one of the most cost-effective health interventions. For every dollar spent, the United Nations estimates that two to six dollars are saved. These cost savings are related to preventing unplanned pregnancies and decreasing the spread of sexually transmitted illnesses. While all methods are beneficial financially, the use of copper IUDs resulted in the greatest savings. The total medical cost for

15240-406: The user's adherence to taking the pills. Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial blood clots . Venous clots, on average, increase from 2.8 to 9.8 per 10,000 women years which is still less than that associated with pregnancy. Due to this risk, they are not recommended in women over 35 years of age who continue to smoke. Due to

15367-450: The uterine and tubal fluids. The increased copper ions in the cervical mucus inhibit the sperm's motility and viability, preventing sperm from traveling through the cervical mucus, or destroying it as it passes through. Copper can also alter the endometrial lining, and while studies show that while this alteration can prevent implantation of a fertilized egg (" blastocyst "), it cannot disrupt one that has already been implanted. Advantages of

15494-442: The uterus (less than 0.7%). A previous model of the intrauterine device (the Dalkon shield ) was associated with an increased risk of pelvic inflammatory disease ; however, the risk is not affected with current models in those without sexually transmitted infections around the time of insertion. IUDs appear to decrease the risk of ovarian cancer . Two broad categories exist, surgical and non-surgical. Surgical sterilization

15621-659: The uterus. It is difficult to predict what a woman will experience during IUD insertion or removal. Some women describe the insertion as cramps, some as a pinch, and others do not feel anything. Only 9% of nulliparous women considered the procedure painless, 72% moderately painful, and 17% experience substantial pain with insertion that needs active management. Approximately 11% of parous women feel similar pain. In such cases, NSAIDs can be effective when given in response to post-insertion pain, but have no significant effect when given prophylactically. Topical lidocaine has been found as an effective pain management drug when applied before

15748-415: The uterus. They are one form of long-acting reversible contraception which are the most effective types of reversible birth control. Failure rates with the copper IUD is about 0.8% while the levonorgestrel IUD has a failure rates of 0.2% in the first year of use. Among types of birth control, they, along with birth control implants, result in the greatest satisfaction among users. As of 2007 , IUDs are

15875-525: The vagina and the uterus, causing a high rate of pelvic inflammatory disease. The first IUD was developed in 1909 by the German physician Richard Richter, of Waldenburg. His device was made of silkworm gut and was not widely used. Ernst Gräfenberg , another German physician (after whom the G-spot is named), created the first Ring IUD, Gräfenberg's ring , made of silver filaments. His work was suppressed during

16002-433: The vaginal ring may reduce the risk of breast tenderness, nausea , and headache associated with higher dose estrogen products. Progestin-only pills, injections and intrauterine devices are not associated with an increased risk of blood clots and may be used by women with a history of blood clots in their veins. In those with a history of arterial blood clots, non-hormonal birth control or a progestin-only method other than

16129-467: Was worth more than its weight in silver and, by late antiquity, it was fully extinct. Most methods of birth control used in antiquity were probably ineffective. The ancient Greek philosopher Aristotle ( c. 384–322 BC) recommended applying cedar oil to the womb before intercourse, a method which was probably only effective on occasion. A Hippocratic text On the Nature of Women recommended that

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