Reproductive Health refers to a state of complete physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. It implies that people are able to have a responsible, satisfying, and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so.
Importance of Reproductive Health:
Responsible Parenthood: Enables individuals to make informed decisions about family size and spacing of children.
Prevention of STDs: Reduces the incidence of sexually transmitted diseases.
Maternal and Child Health: Improves the health of mothers and children, reducing maternal and infant mortality rates.
Population Control: Helps in managing population growth.
Awareness: Promotes awareness about reproductive organs, adolescence, safe and hygienic sexual practices.
Reproductive and Child Health (RCH) Programs:
Initiated by the Government of India in 1951 (Family Planning Programs).
Aim to create awareness among people about various aspects of reproductive health and provide facilities and support for building a reproductively healthy society.
Key Objectives:
Creating awareness about reproductive health.
Providing support for safe and hygienic sexual practices.
Population Explosion: The rapid and alarming increase in the human population, particularly after the mid-20th century, due to a sharp decline in death rates (improved healthcare, sanitation) and a relatively high birth rate.
Contraception refers to methods used to prevent unwanted pregnancies. An ideal contraceptive should be user-friendly, easily available, effective, reversible with no or minimal side effects, and should not interfere with sexual drive.
Periodic Abstinence (Rhythm Method): Avoiding coitus from day 10 to 17 of the menstrual cycle when ovulation is expected. High chances of failure.
Coitus Interruptus (Withdrawal Method): Male withdraws penis from vagina just before ejaculation to prevent insemination. High chances of failure.
Lactational Amenorrhea: Absence of menstruation during intense lactation (after parturition). Prevents conception for up to six months due to high prolactin levels suppressing ovulation. Effective only if the mother breastfeeds fully and exclusively.
a. Barrier Methods: Prevent physical meeting of sperm and ovum.
Condoms: Thin rubber/latex sheaths used to cover the penis (male condom) or line the vagina/cervix (female condom). Prevent deposition of semen in the vagina. Also protect against STDs.
Diaphragms, Cervical Caps, Volts: Reusable rubber barriers inserted into the female reproductive tract to cover the cervix during coitus. Used with spermicidal creams/jellies.
b. Intrauterine Devices (IUDs): Devices inserted by doctors into the uterus.
Non-medicated IUDs: (e.g., Lippes Loop) Increase phagocytosis of sperm within the uterus.
Copper-releasing IUDs: (e.g., CuT, Cu7, Multiload 375) Release copper ions that suppress sperm motility and fertilizing capacity.
Hormone-releasing IUDs: (e.g., Progestasert, LNG-20) Make the uterus unsuitable for implantation and the cervix hostile to sperm.
c. Oral Contraceptives (Pills):
Combined Pills: Contain progestogen and estrogen combination. Taken daily for 21 days, starting within the first 5 days of the menstrual cycle, followed by a 7-day gap.
Progestogen-only Pills (Mini-pills): Contain only progestogen.
Mechanism: Inhibit ovulation and implantation, and alter the quality of cervical mucus to prevent sperm entry.
Saheli: A new oral contraceptive for females, developed by CDRI, Lucknow. It is a non-steroidal preparation, taken once a week, with very few side effects.
Indian InnovationSaheli was the world's first non-steroidal oral contraceptive pill. Developed by the Central Drug Research Institute (CDRI) in Lucknow, it is famous for having a high contraceptive value with almost zero side effects.
d. Implants: Progestogen or progestogen-estrogen combinations inserted under the skin. Effective for longer periods.
e. Surgical Methods (Sterilization): Terminal methods, highly effective, but irreversible.
Vasectomy (Male Sterilization): A small part of the vas deferens is cut or tied up, preventing sperm from reaching the urethra.
Tubectomy (Female Sterilization): A small part of the fallopian tube is cut or tied up, preventing the ovum from reaching the uterus and preventing sperm from reaching the ovum.
Sexually Transmitted Diseases (STDs), also known as Venereal Diseases (VD) or Reproductive Tract Infections (RTI), are infections that are primarily transmitted through sexual contact.
Amniocentesis is a fetal sex determination and disorder detection test based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo.
Procedure: A small amount of amniotic fluid is withdrawn from the uterus of a pregnant woman. Fetal cells present in the fluid are cultured, and their chromosomes are analyzed.
Detection of Genetic Disorders: (e.g., haemophilia, sickle-cell anemia, cystic fibrosis).
Misuse: Often misused for illegal female foeticide, leading to a ban on sex determination tests in India.
Legal Regulation (PCPNDT Act): The Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 was enacted to stop female foeticide and arrest the declining sex ratio in India. It prohibits the use of any technique for sex determination and mandates the registration of all diagnostic centers.
Infertility is the inability to conceive or produce children even after 1-2 years of unprotected sexual cohabitation. The causes can be in male or female partners, or both.
Assisted Reproductive Technologies (ART): Techniques used to help infertile couples have children.
In Vitro Fertilization (IVF) - Test-tube Baby Program:
Definition: Fertilization of ovum by sperm outside the body, in a laboratory setting.
Application: For females who cannot conceive due to blocked fallopian tubes or males with low sperm count.
Process: Ova are collected from the female and sperm from the male. Fertilization is induced in vitro. The zygote or early embryo (up to 8 blastomeres) is then transferred.
Embryo Transfer (ET):
Zygote Intrafallopian Transfer (ZIFT): Transfer of zygote or early embryo (up to 8 blastomeres) into the fallopian tube.
Intra Uterine Transfer (IUT): Transfer of embryo with more than 8 blastomeres into the uterus.
Gamete Intrafallopian Transfer (GIFT):
Definition: Transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce ova but can provide a suitable environment for fertilization and development.
Application: For females who cannot produce ova.
Intracytoplasmic Sperm Injection (ICSI):
Definition: A specialized procedure to form an embryo in the laboratory in which a sperm is directly injected into the ovum.
Application: For males with very low sperm count or inability to fertilize the ovum.
Artificial Insemination (AI):
Definition: Semen collected from the husband or a healthy donor is artificially introduced into the vagina or uterus of the female.
Application: For males with very low sperm count or inability to inseminate the female.
Intra Uterine Insemination (IUI): Semen is directly injected into the uterus.
These technologies have provided hope for many infertile couples to have children. However, they are expensive and require specialized medical professionals and facilities.
Definition: An arrangement where a woman (the surrogate) agrees to bear a child for another person or couple (the intended parents), who will become the legal parents of the child after birth.
Gestational Surrogacy: The most common form today, where IVF is used to create an embryo (using the intended parents' or donors' gametes), which is then transferred to the surrogate's uterus. The surrogate has no genetic link to the child.
Definition: The process of freezing and storing biological tissues (sperms, eggs, or embryos) at very low temperatures (usually in liquid nitrogen at -196°C).
Utility:
Allows individuals to preserve their fertility before undergoing treatments like chemotherapy.
Facilitates the storage of donor gametes for ART procedures.
Allows unused embryos from an IVF cycle to be saved for future use.
Definition: Fertilization that occurs inside the body of a female donor.
Procedure: Embryos are formed within the reproductive tract of a donor and then collected to be transferred into a recipient (surrogate) who can provide the necessary environment for pregnancy but cannot conceive on her own.
Definition: A screening test performed on embryos during IVF before they are transferred to the uterus.
Purpose: To detect specific genetic diseases (e.g., Down's Syndrome, Thalassemia) or chromosomal abnormalities, ensuring that only healthy embryos are selected for implantation.