Reproductive Health

GIFT – Gamete Intra Fallopian Transfer is one of the methods of Assisted Reproductive Technology (ART). GIFT is the process of transferring an ovum collected from a donor into the fallopian tube of another female who cannot produce an ovum but can provide a suitable internal environment for fertilisation. So option (a) is incorrect.

ZIFT – Zygote Intra Fallopian Transfer is another method of Assisted Reproductive Technology. In ZIFT the zygote or early embryos (with up to 8 blastomeres) is transferred into the fallopian tube to complete its further development. So option (b) is incorrect.

ICSI – Intra Cytoplasmic Sperm Injection is one of the specialised procedures to form an embryo in the laboratory in which a sperm is directly injected into the ovum.

ET – Embryo Transfer is transferring embryo using various methods or techniques.

So the method of directly injecting sperm into ovum in Assisted Reproductive Technology is called ICSI.

Hence the correct answer is option (c).

IMR is Infant Mortality Rate and MMR is Maternal Mortality Rate. IMR and MMR are responsible for affecting the growth rate.

If both decrease, it will result in an explosive population, i.e., a rapid increase in the growth rate. And if both increase it will result in a decline in growth rate. So, options (a), (b) and (d) are incorrect.

Increased IMR results in increased infant death and decreased MMR results in lower death rate of pregnant women. Hence the total effect is almost nil. Here IMR is rising (more infant deaths) and MMR is decreasing (lower maternal death rate) so it will not cause any significant change in the growth rate.

So the correct answer is option (c).

Intense lactation affects the production of certain reproductive hormones. It is known to suppress the production of Gonadotropin-Releasing Hormone (GRH) and Follicle Stimulating Hormone (FSH) also.

So the correct answer is option (a).

Sterilization techniques are utilised by both male and female partner. It is permanent and terminal method to prevent any more pregnancies. This method blocks gamete transport and thereby prevents conception. It is a surgical procedure. It is almost irreversible.

So the correct answer is option (a).

India on of the first countries in the world to start action plans and programmes at the national level to attain total reproductive health as a social goal. These programmes called 'family planning' were initiated in 1951. These programmes major tasks are to create awareness among people about various reproductions related topics, provide facilities and support for building up a reproductively healthy society.

So the correct answer is option (a).

Emergency contraceptives are effective if used within 72 hours of coitus. These drugs delay/disrupt the ovulation and fertilization.

So the correct answer is option (a).

IUDs - Intra Uterine Devices (IUDs) are devices inserted by doctors or expert nurses only in the uterus through vagina. So option (a) is not correct.

IUDs do not suppress gametogenesis this takes place in the ovary, while lUDs are inserted in the uterus. So option (c) is not correct.

IUDs need to be replaced if required. IUDs comes for a specific period of time. So, option (d) is incorrect.

Non-mediated IUDs increase phagocytosis of sperms within the uterus and the Cu ions released suppress sperm motility and the fertilising capacity of sperms.

So the correct answer is option (b).

MTP – Medical Termination of Pregnancy also known as abortion is intentional or voluntary termination of pregnancy. MTPs are essential when continuation of the pregnancy could be harmful or even fatal either to the mother or to the foetus or both.

MTPs are considered safe if performed during the first trimester of the pregnancy. So statement (i) is correct.

MTPs are not always surgical they can be done even with certain pills in few cases. So statement (iii) is incorrect.

MTPs require the assistance of qualified medical personnel; otherwise they are unsafe and could also be fatal of mother.

So, correct answer is option (c).

Syphilis can infect sex organs and sometimes lips and mouth as well. They can spread from one person to another. So option (a) is incorrect.

Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix. So option (c) is incorrect.

Genital warts are contagious, fleshy growths in the genital or anal area. They are one of the most common types of STDs. So, option (d) is incorrect.

AIDS (Acquired Immuno Deficiency Syndrome) is a set of symptoms caused by HIV virus in humans. The HIV virus does not directly affect sex organs but produces other set of symptoms in the body of infected person.

So, correct answer is option (b).

Condoms is one of the barrier methods of contraceptives. It prevents the pregnancy by stopping sperm from meeting an egg. It is also a safeguard against transmission of AIDS and other Sexually Transmitted Diseases (STDs). They do not interfere with coital act.

Hence the correct answer is option (d).

ZIFT - Zygote Intra Fallopian Transfer is also one of the methods of Assisted Reproductive Technology (ART). In ZIFT the zygote or early embryos (with up to 8 blastomeres) is collected from female donor and is transferred into the fallopian tube to complete its further development.

So, correct answer is option (b).

Vasectomy is sterilisation or surgical procedure in male as a contraceptive method.

Tubectomy is sterilisation or surgical procedure in female as a contraceptive method.

So, correct answer is option (c).

Diaphragms are barriers inserted into the female reproductive tract and not uterus to cover the cervix during coitus. So statement (i) is incorrect.

They prevent conception by blocking the entry of sperms through the cervix. They are reusable.

Spermicidal agents like creams, jellies and foams are usually used with these barriers to increase their contraceptive efficiency.

So, correct answer is option (c).

According to the World Health Organisation (WHO), reproductive health means a total well-being in all aspects of reproduction, i.e., physical, emotional, behavioural and social. That is normal functioning of all the reproductive organs.

So a society with people having physically and functionally normal reproductive organs and normal emotional and behavioural interactions among them in all sex-related aspects might be called reproductively healthy and not just healthy reproductive functions.

‘Reproductive and Child Health Care (RCH) programmes’ are programmes that create awareness about various reproduction related areas or topics among people, they also provide facilities related to these. These programmes support government to build a reproductively healthy society.

RCH was previously known as ‘Family Planning Programmes were first launched in October 1951 in India.

RCH’s main aim is to reduce mortality rates of infants, children and mothers.

RCH give basic importance to child and mother health.

The present population growth rate in India is alarming. This could lead to absolute scarcity of even the basic requirements, i.e., food, shelter and clothing.

This can be checked by:

i. By motivating smaller families to use contraceptive methods or birth control methods.

ii. By providing incentives to couples with small families so that people can be motivated to have smaller families.

iii. By educating people about consequences of uncontrolled population growth.

Many couples, mostly the young, urban, working ones have even adopted a ‘one child norm’.

Government of India advertises in the media as well as in posters, showing a happy couple with two children with a slogan “Hum Do Hamare Do” (We two, our two).

STDs are diseases or infections which are transmitted through sexual intercourse , they are also known as venereal diseases (VD) or reproductive tract infections (RTI).

Gonorrhoea, syphilis, genital herpes, chlamydia, genital warts, trichomoniasis, hepatitis-B and AIDS are some of the common STDs.

Though STDs can be transmitted unknowingly sometimes but most of the times STDs are considered as self-invited diseases because

i. Individuals have sex with unknown partners/multiple partners.

ii. Many times individuals do not use condoms during coitus thus, increasing chances of contracting STDs.

iii. When in doubt individuals do not go to a qualified doctor for early detection and thereby avoiding complete treatment if diagnosed.

iv. Individuals share needles with infected persons, which could also lead to STDs.

The reproduction-related aspects in which counselling should be provided at the school levels are as follows:

i. Providing correct information to the young children so that children don’t believe in myths or develop misconceptions about sex-related aspects.

ii. Detailed information about reproductive organs, adolescence and related changes, safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS, etc., would help children and people, especially those in the adolescent age group to lead a reproductively healthy life.

iii. Creating awareness of problems due to uncontrolled population growth, social evils like sex-abuse and sex-related crimes, etc.

iv. Educating people about available birth control options

v. Creating awareness of taking care of pregnant mothers, post-natal care of mother and child,

vi. Educating people about the importance of breastfeeding, equal opportunities for the male and female child.

ART – Assisted Reproductive Technology is collection of special techniques (like ZIFT, IUT, GIFT, ICSI, etc) to overcome infertility.

The primary aim of the “Assisted Reproductive Technology” (ART) programme is to help infertile couples to have children through these special techniques.

The significance of progesterone-estrogen combination as a contraceptive measure is as follows:

i. Oral administration of small doses of either progestogens or progestogen-estrogen combinations is mostly used as a form of female contraception. These are called pills. Pills inhibit ovulation and implantation as well as alter the quality of cervical mucus to prevent/ retard entry of sperms. Pills are very effective with lesser side effects.

ii. Progestogens alone or in combination with estrogen can be injected or implanted under the skin. Their effective periods are much longer.

iii. Administration of progestogens or progestogen-estrogen combinations or IUDs within 72 hours of coitus has been found to be very effective as an emergency contraceptive as they can be used to avoid unwanted pregnancy.

i. MTPs are often used to abort foetuses if they’re found to be female. To avoid this cruel and sexist practice, strict guidelines and laws are to be put in place.

iI. MTPs are sometimes illegally performed by unqualified people which is unsafe in some cases fatal too.

Scrotum has a protective function, they act like a climate control system for testes and allow formation and development of sperm in the testes.

Testes are very sensitive to temperature, if they do not descend into the scrotum prior to adolescence, they will stop producing sperms. This leads to inhibition of gametogenesis and hence causes infertility.

Intensely lactating mothers have absence of menstruation. This phenomenon is known as lactational amenorrhea.

The advantages of lactational amenorrhea as a contraceptive method are:

i. Breastfeeding leads to increased levels of prolactin, a hormone that inhibits ovulation and thereby no pregnancy.

ii. Also intense lactation affects the production of certain reproductive hormones. It is known to suppress the production of Gonadotropin-Releasing Hormone (GRH) and Follicle Stimulating Hormone (FSH).

iii. She would not need to use any pill or devices for birth control. So, there will be no side effects.

iv. It does not require any insertion of any type of devices.

Important steps to be taken to improve the reproductive health standards in India are as follows:

i. Introduction of sex education at school level to create awareness about various sex-related aspects

ii. Create awareness related to various reproduction-related aspects too

iii. By providing infrastructural facilities and professional expertise to attain reproductive health.

iv. With the help of audio-visual and the print-media, governmental and non-governmental agencies awareness can be spread.

v. Parents, other close relatives, teachers and friends, also have a major role in the dissemination of the above information.

vi. Educating people, especially fertile couples and those in marriageable age group, about available birth control options, care of pregnant mothers, post-natal care of the mother and child, importance of breastfeeding, equal opportunities for the male and the female child, etc., would address the importance of bringing up socially conscious healthy families of desired size.

vii. Also educating people about safe and hygienic sexual practices and safeguard against STDs.

viii. Awareness of problems due to population explosion, social evils like sex-abuse and sex-related crimes.

ix. Statutory ban on amniocentesis to legally check female foeticides.

GIFT – Gamete Intra Fallopian Transfer is one of the methods of Assisted Reproductive Technology (ART). GIFT is transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce an ovum, but can provide suitable environment for fertilisation.

And if the gametes/ovum is transferred to the uterus, from uterus they cannot move to fallopian tube. And also fertilisation does not take place in uterus as uterine environment is not congenial for the survival of the gametes. Hence the same results cannot be achieved.

And also if gametes are directly transferred to uterus they get degenerated or could be phagocylosed and hence viable zygote is not formed. So, same result is not possible.

Copper ions-releasing IUDs are more efficient than non-medicated methods because:

i. Cu ions released suppress sperm motility and fertilizing capacity of sperms.

ii. It increases phagocytosis of sperms within the uterus.

iii. They are one of the safest and most effective.

iv. They are easy to get inserted so convenient. And these IUDs can be removed whenever not required, so reversible in nature.

v. They are less expensive.

iv. It has no side-effects and can be safely used by breastfeeding women.

Population explosion means sudden and rapid rise in the population growth.

The probable factors that contributed to population explosion in India are:

i. In India the quality of life of people improved. This led to increased health facilities and better living conditions. This is one of the reasons of population explosion.

ii. Rapid decline in death rate, maternal mortality rate (MMR) and infant mortality rate (IMR)

iii. Increase in number of people of reproducible age.

iv. People mostly in rural areas are unaware and their ignorance about the ill effects of increasing population is also leading to population explosion.

v. Poverty and illiteracy

vi. Social stigmas surrounding girl child.

vii. Desire to have a male child makes people to have more children.

IVF – In Vitro Fertilisation is the process of fertilisation outside the body in conditions similar to the body’s internal environment.

This method is preferable for females who cannot conceive.

IVF is also known as test tube baby programme.

In this method the gametes from the male (sperm) and female (ova) are collected hygienically and are allowed to fuse (to form zygote) in a laboratory set up under simulated conditions.

The zygote formed is collected and is introduced into the uterine region of a host or surrogate mother at an appropriate time.

ET – Embryo Transfer, IVF is followed by ET in many ways like IUT or, ZIFT

It is final step of IVF process.

The main purpose of ET is to facilitate conception following fertilisation from IVF procedure.

The advantages of natural methods of contraception over artificial methods are:

i. There are no side effects in natural methods since neither medicines nor any intra uterine devices are used.

ii. There is no surgical intervention, so natural methods aren’t irreversible.

iii. Natural method can be used at any stage of the reproductive cycle.

iv. Natural methods are cost-effective.

v. Immediate return of fertility occurs when not in use.

Medical Termination of Pregnancy also known as abortion is intentional or voluntary termination of pregnancy.

The conditions in which medical termination of pregnancy is advised are as follows:

i. MTPs are advised when continuation of the pregnancy could be harmful or even fatal either to the mother, the foetus or to both.

ii. MTPs are advised if the foetus is suffering from an incurable disease.

iii. MTPs are considered safe if done in first trimester of the pregnancy.

iv. MTPs are advisable when one wants to terminate an unwanted pregnancy.

v. MTPs require the assistance of qualified medical personnel; otherwise they are unsafe and could also be fatal of mother.

The essential features of an ideal contraceptive are:

i. Ease of availability

ii. User friendliness

iii. Highly effective

iv. Reversibility with no or less side-effects

v. No interference with sexual drive

vi. Cost effective

vii. Protection from STDs

RTIs – Reproductive Tract Infections

STDs – Sexually Transmitted Diseases

Common STDs are gonorrhoea, syphilis, genital herpes, Chlamydia, hepatitis B, AIDS, etc.

These STDs do not cause reproductive tract infections. Among the common STDs, hepatitis-B and AIDS are not infections of the reproductive organs through their mode of transmission could be through sexual contact also. Hence all STDs are not RTIs.

All other diseases like gonorrhoea, syphilis, genital herpes, and hepatitis-B are transmitted through sexual contact and are also infections of the reproductive tract. So, they are RTIs which are STDs.

Therefore all RTIs are STDs, but all STDs are not RTIs.

Inability to conceive or produce children even after unprotected coitus is called infertility.

ART – Assisted Reproductive Technology is collection of special techniques (like Test Tube Baby Programme, ZIFT, IUT, GIFT, ICSI, etc) to overcome infertility.

The primary aim of the “Assisted Reproductive Technology” (ART) programme is to help infertile couples have children.

i. Test Tube Baby Programme

IVF – In Vitro Fertilisation is fertilisation outside body in same condition as it would happen inside the body.

IVF is also known as test tube baby programme.

In this method the gametes from the male (sperm) and female (ova) are collected hygienically and allowed to fuse (to form a zygote) in a laboratory set up under simulated conditions.

The zygote formed is collected and is introduced into the uterine region of a host or surrogate mother at an appropriate time (secretory phase).

In vitro fertilisation (IVF) followed by embryo transfer (ET) is a method to treat infertility and commonly known as the ‘Test tube baby’ programme.

If the zygote or early embryos (up to 8 blastomeres) is transferred into fallopian tube it is known as ZIFT (Zygote Intra Fallopian Transfer)

And if the embryos with more than 8 blastomeres is transferred into uterus then it is known as IUT (Intra Uterine Transfer

After ET further development takes place.

ii. GIFT - Gamete Intra Fallopian Transfer

GIFT is transfer of an ovum collected from a donor into the fallopian tube of another female who cannot produce an ovum, but can provide suitable environment for fertilisation and further development of the embryo takes place here.

iii. ICSI – Intra Cytoplasmic Sperm Injection

ICSI is one of the specialised procedures to form an embryo in the laboratory in which a sperm is directly injected into the ovum.

iv. AI Technique

This technique is mostly for infertile males. That is when male is unable to inseminate sperms in the female reproductive tract or due to very low sperm count in the ejaculation.

In this technique, the semen collected either from the husband or a healthy donor is artificially introduced, either into the vagina or into the uterus (IUI-Intra Uterine Insemination) of the female.

Hormonal contraceptives are trusted devices to prevent conception.

The mode of action and advantages of hormonal contraceptives are as follows:

i. Oral administration of small doses of either progestogens or progestogen-estrogen combinations, mostly target to females, is known as pills. Pills inhibit ovulation and implantation as well as alter the quality of cervical mucus to prevent/ retard entry of sperms. Pills are very effective, have lesser side effects and are well accepted by women.

Pills have to be taken daily for a period of 21 days preferably within the first 5 days of menstrual cycle. After a gap of 7 days (during which menstruation occurs) it has to be repeated in the same pattern.

ii. Progestogens alone or in combination with estrogen can also be used as injections or implants under the skin. Their effective periods are much longer.

iii. Administration of progestogens or progestogen-estrogen combinations or IUDs within 72 hours of coitus has been found to be very effective as an emergency contraceptive.

iv. Hormone-based contraceptive are completely reversible allowing pregnancy to occur on discontinued usage.

Disadvantages of hormonal contraceptives:

i. They can have many serious side effects.

ii. They can cause allergic reaction.

iii. They can sometimes damage the normal hormonal balance and later even if desired, pregnancy may not be achieved.

iv. They disturb the menstrual cycle so that level of menstrual flow can be either too low or high and lead to irregular menstruation cycles.

v. Hormonal balance is disturbed that may lead to nausea, abdominal pain, breakthrough bleeding, irregular menstrual bleeding or even breast cancer.

STDs are diseases or infections which are transmitted through sexual intercourse, they are also known as venereal diseases (VD) or reproductive tract infections (RTI).

Gonorrhoea, syphilis, genital herpes, chlamydia, genital warts, trichomoniasis, hepatitis-B and AIDS are some of the common STDs.

i. Syphilis can infect sex organs and sometimes lips and mouth as well. They can spread from one person to another. It is caused by the spirochete Treponema palladium. At final stage the infected person chronic ulcers on many body parts and damage to internal parts.

ii. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix. It can also cause arthritis and/or eye infections. It is caused by a diplococcus bacterium Neisseria gonorrhoeae.

iii. Genital warts are contagious, fleshy growths in the genital or anal area. They are one of the most common types of STDs.

iv. AIDS (Acquired Immuno Deficiency Syndrome) is a set of symptoms caused by HIV (Human Immunodeficiency virus or Human T-cell leukemia virus) virus in humans. The HIV virus does not directly affect sex organs as such but produce other set of symptoms in the body of infected person like it affects lymphocytes or macrophages, etc. AIDS is usually developed from infection after few months or can even take years. Diagnostic test for AIDS is ELISA (Enzyme Linked Immuno Sorbent Assay). Western blot can be used as confirmatory test. The virus of AIDS is transferred via blood and semen.

v. Hepatitis-B is caused by Hepatitis-B virus. It is transmitted by blood transfusions or contaminated needles or body fluids (like semen, saliva, sweat, breast milk, etc). As it can be transmitted by breast milk the baby lactating infected mother also gets infected. The infected mother can also transfer the disease to foetus via her placenta. It is incurable STD.

The preventive measures to avoid STDs are as follows:

i. Individuals should avoid sex with unknown partners/multiple partners’ especially HIV-infected people.

ii. Individuals should use condoms during coitus if there are chances of STDs.

iii. And if in doubt individuals should go to a qualified doctor for early detection and thereby getting complete treatment if diagnosed.

iv. Individuals should not share injection, needles, razors, toothbrushes; etc with infected persons especially AIDS patients, which could also lead to STDs.

v. Diagnose blood before blood donation or blood transfusions.

vi. Infected mother should not be lactating infants.

vi. Infected pregnant mother should terminate her pregnancy.

Amniocentesis is the process usually used to determine any abnormalities in the developing foetus like genetic defects or metabolic disorders.

Yes I do justify the statutory ban on amniocentesis in our country. The following are the reasons for justification:

i. But in India this amniocentesis is misused and is used to determine the sex of the foetus. And determination of sex of foetus is illegal.

ii. And if female foetus is found the pregnancy is terminated leading to female foeticide. This is done due to increasing demand for male child either due to small family or due to orthodoxy. And female foeticide is again illegal.

iii. By female foeticide the male-female ratio in the country is getting disturbed, which is leading negative impact on the society.

iv. Amniocentesis is usually done in second trimester. And termination of pregnancy in second termination can be fatal even to mother. This is again a drawback of amniocentesis.

As we can see amniocentesis is illegally used many times hence there should be strict rules as to conduct amniocentesis only if foetus is suffering from any diseases.

To avoid such circumstances we should make people aware by raising the social and economic status of women in the society.

Reasons for introducing sex education to school-going children are as follows:

i. This helps in giving correct information related to sex-related aspects and also helps protects children from myths and misconceptions related to sex-related issues.

ii. This helps in creating awareness related to various reproduction-related aspects, which thereby helps them in leading a healthy reproductive life in future. That is by providing information on reproductive organs, adolescence-related changes like menstrual cycles, menstrual problems, etc

iii. By educating children about the available birth control options, pregnancy, post-natal care of the mother and child, importance of breastfeeding, gender equality, would allow the younger generation to be educated and aware of sexual weelbeing.

iv. Educating children of age group 12 and above about safe and hygienic sexual practices ensures safeguard against STDs.

v. This helps in creating awareness of problems due to population explosion, social evils like sex-abuse and sex-related crimes.

vi. Children should know about the body changes during certain age and they should know about healthy habits including personal cleanliness and hygiene.

vii. Children should be given such education so that they overcome hesitation and gain confidence to discuss any doubts or problems with their parents or teachers.

viii. This type of education also helps in children to lead a healthy reproductive life in future.