There are 600 Million women of

reproductive age in the world

today and 39 Trillion acts of
intercourse annually, 12 Thousand
ejaculations per second, and
60 Million sperms per ejaculation
equaling 720 Trillion sperms
released per second worldwide.
WHO

100 Million acts of

intercourse
take place daily resulting in
910 Thousand conceptions
50% unplanned
25% definitely unwanted
WHO

About 150 Thousand

pregnancies are terminated
daily by induced abortion
with 5 Thousand deaths due
to unsafe conditions.
WHO

Some 129 Live Babies are

born in the world every 31
seconds and 50 people die at
the same time.
In other words, 79 inhabitants
are added in the world.

With this increase about

83 Million each year are
added to the world
population.
In fact we celebrated the
6th Billion inhabitant last
October 1999

Global Population Forecast

1900: 1.5 billion
1920: 2 billion
1975: 4 billion
1987: 5 billion
2000: 6 billion
2030: 10 billion

The Philippines ranks

no. 3 in Southeast ASIA
no. 9 in ASIA
no. 14 in the World
as the most populated Nation

As of May 2000, The

Philippines population has hit
75.3 Million according to the
National Statistics Office.

2005 ------- 86M

2008 ------- 90M

In less than 30 years

from now, The population
will double to more than
150 Million

This will put tremendous

pressure on the countrys
natural resources and
economy, now already
reeling from an official
poverty level of more than
30% of the total population.

In the human Development

Index drawn up by the United
Nations, measuring income, life
expectancy and educational
attainment, the Philippines is
already ranked no. 78 among
more than 140 countries.

The Philippines is even lower

than Chile (ranked 35),
Malaysia (57), Cuba (59) and
Thailand (68).

Around 2.1 Million children born in

Philippines during 2003.
That is 5,700 births a day.

Fertility Rate = 3.5

(NDHS 2003)

Fertility denotes the capability to

reproduce of individuals, couples or
population. Measured by birth rate.

Population Growth Rate (PGR) 2.32%

the average annual change in
population size during a given period.

To help curb population growth,

estimated at 1.6 Million new babies
a year or a growth of 2.32%.
A bill entitled, Reproductive Health
Bill, has been filed in the
House of Representatives.

Why should the population be

of concern to us - Doctors,
especially
OBSTETRICIANS?

As believers in voluntary family

planning, we do not view contraception
for individual couple primarily as a
means of reducing population growth.
We are interested in helping individuals
achieve their reproductive life goals
whatever they may be. Nevertheless,
individual reproductive
choices do have aggregate
consequences, since they determine
the fertility of a population.

Take care of the couples the people and the

population will take care of
themselves.

FAMILY PLANNING

VIRGILIO R. OBLEPIAS, MD

Family Planning is the joint effort

of the husband and wife to regulate
the number and spacing of births.

Family planning usually connotes the

use of birth control to avoid
pregnancy but also includes efforts
of the couples to induce pregnancy.

Contraception
Birth Control
Fertility Control
Fertility Regulation
Fertility Management
Reproductive Health

Reproductive health refers to the state of

complete physical, mental & social
well-being and not merely absence of
disease or infirmity, in all matters relating to
the reproductive system & its functions and
processes.

Contraceptive Methods
I Temporary Contraceptive Methods
(Reversible, Active)
II Permanent Contraceptive Methods
(Terminal)

Temporary Contraceptive Methods

1.

Traditional
1.1
Coitus interruptus
1.2
Coitus reservatus
2. Natural Family Planning (NFP)
2.1
Rhythm (Calendar)
2.2
Basal Body Temperature (BBT)
2.3
Cervical Mucus (Billing Method)
2.4
Sympto-Thermal (ST)
2.5
Lactation Amenorrhea (LAM)

Temporary Contraceptive Methods

3. Artificial
3.1 Barrier Methods
Mechanical
Condoms
Diaphragm
Cervical caps
Chemical
Vaginal suppositories
Sponge
Jellies and cream

3. Artificial (continued)
3.2 Hormonal
Oral pills
Injectables
Implants
Vaginal Ring
Patch
3.3 Intrauterine Device (IUD)
Non-medicated
Medicated
Copper
Hormones

Permanent Contraceptive Methods

1. Female Sterilization
1.1 Surgical (Bilateral Tubal Ligation)
1.2 Chemical
2. Male Sterilization
2.1 Surgical (Vasectomy)
2.2 Chemical

Effectiveness of
Contraceptive Method

Perfect Use Effectiveness

The rate of effectiveness when the
contraceptive method is always
used correctly. Previously called
method used.

Typical Use Effectiveness

Over-all effectiveness rate in
actual use for a specific contraceptive
method. Previously called use
effectiveness

Contraceptive Failure Rate

Pregnancy rates with various types of
contraceptives at different intervals,
usually years. This rate is frequently
expressed as a number of pregnancies
per 100 women at 1 year or
per 100 women years.

Pearl Index
A non-actuarial method use
For determining the pregnancy (failure)
Rate of any contraceptive technique.
number of pregnancies
X 1200
Pregnancy rate = -------------------------------Woman months of
use

Half of Filipino married women use a

method of family planning
49% of married women are users
33% modern methods
16% traditional

Most popular methods

Modern methods
Pills = 13% of married women
Female Sterilization = 11% of
married women
Traditional methods
Calendar / Rhythm = 7% of
married women
Withdrawal = 8% of married
women

Contraceptive Prevalence Rate (CPR)

The percentage of currently married
women reporting current use of any method
of family planning
15% in 1968
49% in 2003

Updates
and

Recent Advances

Natural Family Planning

(NFP)

Periodic abstinence from intercourse

during the periovulatory time of the cycle.

Fertility Awareness Based Methods

Fertility Awareness is necessary

for Natural Family Planning (NFP)

Fertility Awareness means a woman learns

to recognize when the fertile time of her
menstrual cycle starts and ends.
Fertile Time is the time when she can
become pregnant.

A woman can use several methods to tell

when her fertile time begins and ends.
1) Calendar Method (Ogino-Knaus)
2) Cervical Mucus Secretions (Billings)
3) Basal Body Temperature (BBT)
4) Feel of Cervix
5) Standard Days Method (SDM)

Calendar Method (Ogino-Knaus)

shortest cycle 18 = first day of fertile time
longest cycle 11 = last day of fertile time
Example:
26 18 = 8
30 11= 19
fertile time is from day 8 to day 19 of
the menstrual cycle

Cervical Mucus Secretions

- Cervical Mucus charting requires that one
takes a sample of any mucus (discharge)
from the vagina daily
- Close to or during ovulation, the mucus
should become clear, elastic and slippery.
- if one charts the cervical mucus findings
over several months , one may see a pattern
that will allow one to predict the next fertile
time.

Basal Body Temperature

- the BBT method is based on the fact that
just before or at ovulation, the body
temperature drops & then rises steadily for a
few days.
- taking the temperature daily on waking up
for several months (6-8) & plot it on a chart,
one will probably be able to see the pattern.
This pattern will predict the fertile time.

Client Instructions for Basal Body Temperature

Method (Thermal Shift Rule)
- Take temperature at about same time each morning
(before rising) after at least 3 hours of uninterrupted
sleep and record temperature on chart provided by
natural family planning instructor.
- Use temperatures recorded on chart for first 10 days
of menstrual cycle to identify highest of normal, low
temperatures (i.e., daily temperatures charted in typical
pattern without any unusual conditions)
- Disregard any temperatures that are abnormally high
due to fever or other disruptions

- Draw a horizontal line above highest temperatures of

days 6-10. This line is called the cover line or
temperature line
- Count the first 3 consecutive temperature above the
cover line and mark day 1,2,3 (Thermal Shift Rule)
- Draw a vertical line between day 2 and day 3 from top
to the bottom of the chart\
- If any temperature falls on or below cover line during
the 3-day count, this may be a sign that ovulation has
not yet taken place. To avoid pregnancy, wait until 3 `
consecutive temperatures are recorded above the
cover line before resuming intercourse.

- The infertile phase begins on the third consecutive

day that temperature stays above the cover line
(Thermal Shift Rule)
- Abstain from sexual intercourse from beginning of
menstrual period until beginning of infertile phase
- If any of 3 temperatures falls on or below cover line
during 3-day count, this may be a sign that ovulation
has not yet taken place. To avoid pregnancy, wait until
3 consecutive temperatures are recorded above cover
line before resuming intercourse
- After infertile phase begins, you may stop taking
temperature until next menstrual cycle begins and continue
until first day of next menstrual period

Feel of the cervix

- as the fertile time begins, the opening of the
cervix feels softer, opens slightly, and is
moist.
- when not fertile, the opening is firmer &
closed. (Seldom used as the only sign)

Standard Days Method (SDM)

- makes use of a mnemonic device called
CycleBeads, a string of beads, with each bead
representing a day of the cycle
(also called collar)
- the CycleBeads consists of 32 bead
- the bead representing the first day of the
menstruation is red, followed by 6 brown
beads (indicates the first 7 days of the cycle
are
not fertile)

- these are followed by 12 white beads, w/c

represent the fertile time
- the rest of the beads are brown again
indicating in fertile days.
- The black rubber ring is moved per day so
she can tell if she is in the infertile or fertile
days.

- A woman may use one of these or in combination.

- to tell when the fertile time starts, she can use
calendar calculations and cervical secretions.
- to tell when the fertile time and she can use BBT,
cervical secretions & calendar method.

Sympto-Thermal or multi-index
(usually cervical secretions & BBT
and perhaps also calendar method &
feel of cervix.

To become pregnant the couple should have

sexual intercourse during the fertile time.
To prevent pregnancy, the couple should
refrain from having sexual intercourse during the
fertile time. Or the couple can use barrier method
or by withdrawal method.

How effective is it as Contraceptive

Method
1) Only somewhat effective as commonly used
- 20 pregnancies per 100 woman in the first
year of use (1 in every 5)
2) Effective or very effective when used
consistently and correctly.

1) Cervical secretions: 3 pregnancies per 100

woman in first year use (1 in every 33)
2) Basal Body Temperature: 1 pregnancy per
100 woman in first year of use
3) Calendar method: 9 pregnancies per 100
woman in first year of use (1 in every 11)
4) Symto-Thermal or multi-index (Cervical
Secretions & BBT, calendar and feeling of
Cervix) 2 pregnancies per 100 woman in first
year of use (1 in every 50)

Natural Family Planning

1.
2.
3.
4.
5.

Calendar Method
Basal Body Temperature
Cervical Mucus
Sympto-thermal Method
Lactational Amenorrhea Method (LAM)

Lactational Amenorrhea Method (LAM) :

Mechanism of Action
1) Frequent intense suckling disrupts secretion
of gonadotrophin releasing hormone (GnRH)
2) Irregular secretion of GnRH interferes with
release of follicle stimulating hormone (FSH)
and leutinizing hormone (LH)
3) Decreased of FSH and LH disrupts follicular
development in the ovary to suppress ovulation

Lactational Amenorrhea Method

Contraceptive Benefits
- Effective (1-2 pregnancies per 100 women
during the first 6 months of use)
- Effective immediately
- Does not interfere with sexual intercourse
- No systemic side effects
- No medical supervision necessary
- No supplies required
- No cost involved

Lactational Amenorrhea Method:

Non-contraceptive Benefits
For child:
- Passive immunization and protection from
other infectious diseases
- Best source of nutrition
- Decreased exposure to contaminants in
water, other milk or formulas, or on
utensils
For mother:
- Decreased postpartum bleeding

Lactational Amenorrhea Method:

Limitations
- User-dependent (requires following
instructions regarding breastfeeding
practices)
- May be difficult to practice due to social
circumstances
- Highly effective only until menses return or up
to 6 months
- Does not protect against STDs

Who can Use Lactational Amenorrhea Method

Women who:
- Are fully nearly fully breastfeeding
- Have not had return of menses
- Are less than 6 months postpartum 1
WHO recommends supplementation at 6 months. If
begun earlier, LAM is not as effective

Lactational Amenorrhea Method:

Client Instructions on Breastfeeding
- Breastfeed from both breasts on demand
(about 6-10 times per day)
- Breastfeed at least once during night (no more
than 6 hours should pass between any two
feedings)
- Do not substitute other food or liquids for
breastmilk meal
- If baby does not want breastfeed 6-10 times per
day or baby chooses to sleep through the night,
LAM will be less effective as contraceptive method
- Once you substitute other food or drink for
breastfeeding meals, the baby will suckle less,
and
LAM will no longer be effective contraceptive method

Other methods of determining

ovulation

Determination of Ovulation

LH surge
LH color
ORGANON

Quedels Test

Determination of Ovulation

Ultrasound
Follicle Monitoring

Are these cost-effective?

Barrier Methods

Barrier Methods
Mechanical
Chemical

Mechanical
Male Condom
Female Condom
Female Diaphragm
Female Cervical Cap

Male Condom

Male Condom
MECHANISM OF ACTION
> NO MEETING OF SPERMS & OVUM
> SEMEN / SPERMS COLLECTED
INSIDE CONDOM
> NO SPILLAGE IN THE VAGINA

Male Condom
MATERIALS USED
> Natural Condom
> Latex Condom
> Plastic Condom

Philippine Studies by LAING

- 26% Failure Rate

USA Studies by Grady

- 14% Failure Rate

Advantages
1) Protective against STD
including HIV & Hepatitis B
2) very convenient for emergency cases
3) occasional sex
4) no side effects

Disadvantages
1) May decrease sensation
2) must use all the time to be effective
3) may embarrass some people to buy,
put on, take-off or throw away

Female Condom

Female Condom
- A sheath made of thin, transparent soft &
polyurethane plastic, 15 cms. long & 7
cms. in diameter. Before sex, a woman
places the sheath in her vagina
- during sex the mans penis goes inside
the female condom

Female Condom
Mechanism of Action
- Same mechanism of action as the male
condom
- Same effectiveness as the male condom

May come as
Femshield
Femidon
Reality

Female Condom

Female Diaphragm

Cervical Cap (Fem cap)

Leas Shield
silicone cup with an air valve
& a loop
fits snugly over the cervix
comes in only one size

Chemical or Spermicides

A local contraceptive containing surfactant

which may be toxic to the
sperms.

SPERMICIDAL AGENTS : SURFACTANTS

Nonoxynol-9
Octoxynol-9
Menfegol
Benzalkonium Chloride (BZK)
Sodium Colate (NACOL)
Homemade Spermicide

Aloe Vera Gel (Lemon or Acetic Acid)

Vaginal Sponge
Vaginal Film

Vaginal Sponge

Today (USA)
Pharmatex (Europe)
Protectaid (Canada)

Vaginal Contraceptive Film (VCF)

a 2 x 2 inch paper-thin, translucent
sheet with nonoxynol(N-9)
effective for up to 3 hours
wait for at least 15 minutes after
insertion before intercourse

RECENT STUDIES :
Vaginal spermicides containing (N-9) are
not effective in preventing certain STIs such
as gonorrhea, chlamydia & HIV infection

Frequent use of spermicides (N-9) : causes

irritation & breaks in the mucus layer or
skin of the genital tract, creating a point of
entry for the virus & increasing the risk of
HIV transmission

What are Microbicides?

MICROBICIDES
reduce transmission of HIV or
other STIs
also function as spermicides to
provide contraceptive protection

Microbicides Under Phase III Clinical Trials

MICROBICIDE

MECHANISM

POTENTIAL
PREGNANCY
PREVENTION

POTENTIAL
STI/HIV
PREVENTION

NAME

OF ACTION

BUFFER GEL

YES

(CARBOMER 974P)

VAGINAL
DEFENSE
ENHANCER

HIV, CHLAMYDIA,
HERPES, HPV

C31G

SURFACTANT

YES

HIV, CHLAMYDIA,
HERPES

ENTRY & FUSION

INHIBITOR

NO

HERPES, HPV,
GONORRHEA

ENTRY & FUSION

INHIBITOR

YES

HIV,
GONORRHEA,
HERPES

ENTRY & FUSION

INHIBITOR

YES

GONORRHEA

(SAVVY)

CARRAGUARD
(PC-515)

PRO 2000
(POLYNAPHTHALENE
SULFONATE)

CELLULOSE
SULFATE
(USHERCELL)

Intrauterine Device
(IUD)

Medicated IUD
IUD with copper
IUD with hormones

Mechanism of Action of Copper IUDs

Prevents fertilization by:
Impairing the viability of the sperm
Interfering with sperm movement

Intrauterine Device
TCu 380A (Paraguard)
T-shaped device
Polyethylene with barium sulfate
66 sq. mm of copper in horizontal
arms
214 sq. mm of copper in vertical
stem
36 mm long, 32 mm wide
With monofilament string
10 years approved duration of use
Failure rate of .6 to .8 per 100 in
1st year of use

New IUDs in the Market

Frameless IUD (Gynefix)

without plastic T-shaped

frame
consists of several
copper cylinders tied
together on a string
intended to cause less
bleeding and pain

Population Reports 2005

New IUDs in the Market

Levonorgestrel IUD

less bleeding than TCu 380A

amenorrhea more common than TCu 380A
can be used for treatment of heavy,
prolonged bleeding and menstrual cramps
useful alternative to hysterectomy and
endometrial ablation
as part of HRT in menopause
Contraceptive Technology 2004
Population Reports 2005

New IUDs in the Market

Levonorgestrel IUD

levonorgestrel (progestin) releasing

intrauterine system

Mirena (LevoNova in Scandinavia)

approved for use in 100 countries

failure rate of .1 (per 100 in 1st year of

use, U.S.)

Five years approved duration of use

delivers 20 mcg LNG/day

New IUDs Being Developed

Femilis

Femilis T-shaped LNG releasing IUD

Femilis Slim for nulligravid

For easy insertion which does not require plunger

Population Reports 2005

New IUDs Being Developed

Fibroplast LNG

frameless IUD which releases LNG

releases 14 mcg LNG
effective for 3 years
initial studies suggest high acceptability
and reduction in bleeding

Population Reports 2005

Intrauterine Device
Mechanism of Action
Question
Are IUDs abortifacients?

Answer
IUDs are not abortifacients

IUDs work primarily by

preventing fertilization
Contraceptive Technology 2004

Mechanism of Action
How does IUD prevent fertilization?
TCU 380A increase
in uterine and tubal
fluids containing
copper ions, enzymes,
prostaglandins, and
macrophages that
impair sperm function

LNG IUS thickening of

cervical mucus,
inhibiting sperm
capacitation and survival

Contraceptive Technology 2004

Proof
Mechanism of Action

Tubal flushing studies no fertilized eggs

recovered among IUD users

Sensitive assays for early pregnancy negative among IUD users

Contraceptive Technology 2005

Intrauterine Device
Effectiveness
IUD
TCu 380A
LNG IUD

Failure Rate
Perfect Use
0.6
0.1

Typical Use
0.8
0.1

Hormonal
Contraceptives

Types:
1. Oral Pills
2. Injectables
3. Implants
4. Vaginal Ring
5. Patch
6. IUD

Oral Contraceptives Pills (OCPs)

Combined Oral Contraceptives
Progestin + Estrogen (COCs)
Progestin only Pills (POPs)

Mechanism of Action of OCPs

1. Ovulation suppression
2. Cervical mucus hostility
3. Endometrial changes

Progestins
Desogestrel
Gestodene
Levonorgestrel
Cyproterone
Drospirenone

Progestin + Ethinylestradiol = COC

Commercial Preparations of COCs

Desogestrel

Levonorgestrel

Gracial

Lady

Marvelon

Logaynon

Mercilon

Microgynon

Gestodene

Nordette

Gynera

Nordiol

Meleane

Regividon

Minulet

Trinordiol

Cyproterone
Diane-35
Althea

Trust pills
Drospirenone
Yasmin

Commercial Preparations of POPs

Desogestrel
Cerazette
Lynestrenol
Exluton
Daphne
Norethindrone
Micronor or NOR QD
Norgestrel
Ovrette

Cyrpoterone and Drospirenone are

progestins useful in controlling
acne, hirsutism & alopicea

Drospirenone (DRSP) gives improvement in

symptoms e.g. bloating, swelling or weight
gain related to fluid retention &
improvement in acne & reduction in
greasiness of the skin & hair. May also
give relief of pre-menstrual symptoms &
menstrual pain

Low dose OCPs

The estrogen (ethinyl estradiol) is
usually lower than 50 mcg

Emergency Contraceptive Pills (ECPs)

- sometimes called
postcoital contraception or
morning after pills

ECPs

Mechanism of Action
Prevent pregnancy after unprotected
intercourse
Precise mechanism is unknown
Will not disrupt an established pregnancy
Cause temporary changes in the ovaries,
fallopian tubes and endometrium

Low dose COCs containing less than 50mcg of

Ethinylestradiol + Levonorgestrel 4 tabs at a
time
High dose COCs containing 50 g or more of
Ethinylestradiol + Levonorgestrel 2 tabs at a
time.
Within 72 hrs. & repeat after 12 hrs.
Postinor 750 g LNG tab 2 tabs OD

Can be used:
Any time during cycle
More than once during cycle

ECPs should not be used in place of any

Family Planning Method

Progestin-Only Pills (POPs)

POPs Available Worldwide

1. Exluton
2. Micronor, NOR-QD,

0.500 mg lynestrenol
0.350 mg norethindone

Noriday, Norod
3 Microval, Noregeston, 0.030 mg. levonorgestrel
Microlut
4 Ovrette, Neogest

0.075 mg norgestrel

5 Femulen

0.500 mg ethynodial
diacetate

Mechanism of Action

Effects Differ from Woman to Woman

POPs

Primary Action

Secondary
Action

Breastfeeding
Women

Ovulation
Thickened
suppression
cervical mucus
(synergistic with
effects of lactation)

NonBreastfeeding
Women

Thickened cervical Ovulation

mucus
suppression
(occur 60% of the
time)

NON-CONTRACEPTIVE BENEFITS
OF OCPS
Benign tumors of the breast
Benign ovarian cysts
Anemia
Rheumatoid arthritis
Ectopic pregnancy
Acute pelvic inflammatory disease
Ovarian cancer
Endometrial cancer

Endometrial Cancer
OCP use protect against endometrial cancer
Risk is reduced by about 50%
longer use increases benefits
reduction in risk persists after
discontinuation of OCP

Ovarian Cancer
- OCP use protects against ovarian cancer
- risk is reduced by about 40%
- longer use increases benefits
- Reduction in risk persists after discontinuation
of OCP

Liver Tumors and OCP

- long term OCP use and risk of hepatocellular
carcinoma
- Further studies are needed to determine
potential effect on hepatocellular
carcinoma

Injectables

Currently available Injectables

Depot medroxyprogerterone acetate 150mgs

every 3mos
Depoprovera (DMPA)
Megestrone
Depotrust
Lyndavel

Norethisterone enanthate or Net-en 200mgs

every 2 mos.
Noriterat

New Monthly Injectables

Depot medroxyprogerterone acetate 25mgs +

5mgs Estradiol cypronate
Cycloprovera
Cyclofem
Lunelle

Norethisterone enanthate or Net-en 50mgs +

5mgs Estradiol valerate
Mesigyna
Norignon

Implants

Types
1. Non biodegradable
1.1 Norplant
1.2 Implanon
2. Biodegradable
2.1 Copronor

Norplant is a great breakthrough in

contraception.

Norplant appears to be the most

effective reversible contraception yet
developed. It has a contraceptive
effectiveness comparable to that of
sterilization and higher than the oral
contraceptives, IUD and Barrier
method.

Norplant 2
(Jadelle)

Hormonal Contraceptives
may also come as:
1) IUD (Mirena, Progestasert),
2) Vaginal Ring (Nuvaring) and
3) Patch (Evra)

Vaginal ring
(Nuvaring)

Contraceptive ring is a flexible, soft,

transparent ring shaped device
containing etonogestrel & ethinyl
estradiol that is placed in the vagina.
The steroids are delivered into the
circulation at a constant rate for 3
weeks.

Patch (Evra)

Patch is an adhesive matrix 20cm2.

Patch containing ethinyl estradiol &
norelgestromin that is placed
transdermally by the user. Steroids
are delivered into circulation for 1
week.

Sterilization

Sterilization
Female (Bilateral Tubal Ligation)
Male (Vasectomy)

Different Approaches in Bilateral Tubal

Ligation or Occlusion
Abdominal

Vaginal

Transcervical

Mini-Lap

Colpotomy

Hysteroscopy

Laparoscopy

Culdoscopy

Chemicals

By
Minilaparotomy
Modified Pomeroy
Laparoscopy
Bipolar coagulation
Falope ring (Yoon)
Filshie clip
Hulka / wolf clip
Hysteroscopy
Chemical
Ovabloc
Essure-Microfil

Minilaparotomy

Laparoscopy

Transcervical / Chemical

MCA
Phenol paste

Quenacrine

Hysteroscopy

Ovabloc
Silicon / Urethane

Microinsert
a device that is inserted
transcervically through a
hysteroscope into the proximal
portion of the oviducts to provide
permanent tubal occlusion

Hysteroscopy

Adiana Procedure

Hysteroscopy

Essure-Microfil

Hysteroscopy

Hysteroscopy

Male Sterilization
Vasectomy

Standard
No scalpel

Chemical
Mechanical

IVT
IVD
RIOD

Vasectomy
Standard

Vasectomy
No-Scalpel

Vasectomy
No-Scalpel

Vasectomy
No-Scalpel

Chemical

Mechanical (IVD)

Mechanical (IVD)

Mechanical
(RIOD)

Mechanical (RIOD)

Reversal of Sterilization
Microsurgery
Laser

Contaceptive Development
Improving existing methods
Developing new methods

 Biodegradeble implants
Injectable microspheres
Implanted microcapsules
Vaginal ring
Patches
Microbicides
Vaccines
GnRH Agonist and Antagonist
Microbicides