Reproductive Health

The purpose of reproductive health is the enhancement of life and personal relations, normally counselling an care related to reproduction and sexually transmitted diseases. Counselling and creating awareness among people above reproductive organs, adolescence and associated changes, safe and hygienic sexual practices, sexually transmittr diseases (STDs) including AIDS, etc., is the primary step towards the reproductive health. It also addresses the problem, like menstrual irregularities, pregnancy related aspects, delivery, medical termination of pregnancy, STDs, birth control infertility, post natal child and maternal health is another important aspect of the Reproductive and Child Health Care Prograrnmes. An overall improvement in reproductive health has taken place in our country as indicated by reduce maternal and infant mortality rates, early detection and cure of STDs, assistance to infertile couples, etc.

 RCH Programmes

The Reproductive and Child Health Care (RCH) Programmes are aimed to create awareness among people, about various reproduction related aspects and provide facilities and support for building up a reproductively health society are the major tasks under these programmes. The programme called 'Family Planning' is initiated in 1951 WP> periodically assessed over the past decades. Improved programmes covering wider reproduction-related areas a: currently in operation under this popular name called as 'Reproductive and Child Health Care (RCH) Programmes'.

The Government and various Non-governmental agencies have taken various steps to create awareness among the people about reproduction-related aspects. Parents, other close relatives, teachers and friends, also have a major role the dissemination of the above information. These steps are :

1.Introduction of sex education in schools should also be encouraged to provide right information to the your generation. This will discourage children from believing in myths and having misconceptions about sex-relate: aspects.

  1. Proper information about reproductive organs, adolescence and related changes, safe and hygienic sexu-practices, sexually transmitted diseases (STD), AIDS, etc., would help adolescent age group to lead -reproductively healthy life.

3.The fertile couples and those in marriageable age group should be educated about available birth contr: options, care of pregnant mother, postnatal care of the mother and child, importance of breast feeding, equal opportunities for the male and the female child, etc.

  1. Awareness of problems due to uncontrolled population growth, social evils like sex-abuse and sex-related crime etc., need to be created to aware people to think and take up necessary steps to prevent them and thereby building up a socially responsible and healthy society.
  2. Successful implementation of various action plans to attain reproductive health requires strong infrastructure facilities, professional expertise and material support. These are essential to provide medical assistance ar care to people in reproduction-related problems like pregnancy, delivery, STDs, abortions, contraception menstrual problems, infertility, etc.
  3. Implementation of better techniques and new strategies from time to time are also required to provide mo:, efficient care and assistance to people.
  4. Strict ban should be on amniocentesis (a foetal sex-determination test based on the chromosomal pattern the amniotic fluid surrounding the developing embryo) for sex-determination to legally check increasing female foeticides.
  5. Child immunization, are also some programmes that take major place in RCH programmes.
  6. Research on various reproduction-related areas are encouraged and supported by the Governmental ar. Non-governmental agencies to find out new methods and/or to improve upon the existing ones.

 Population

The total number of individuals of a species living in an area or all the areas of the world is known as population. Human population is the number of human beings living on Earth (Total human population) or permanently residing a country, state, city, town, village, etc. Total world human population in 2000 AD was 6.1 billion while that of India's was 1.02 billion.

The study of all aspects of population like number, birth rate, death rate, age groups, sex ratio, emigration, immigration, status, occupation, education, etc., in human beings is called demography. Demography also predicts future trends. The human population growth can be positive, negative or zero.

  1. Positive Population Growth:- It is the increase in population. Because, the sum total of natality and immigration is higher than the mortality and emigration.
  2. Negative Poulation Growth:- This is the decrease in the population. Because, the sum total of the natality and imigration is lower than the sum total of mortality and emigration.
  3. Zero population Growth:- The population size is maintained at an existing level, due to sum total of natality and immigration being equal to sum total of mortality and emigration.
  4. Natality or Birth Rate:- It is the number of births per thousand or per hundred individuals per year under normal conditions (realized birth rate). It always has a positive value.
  5. Mortality or Death Bate:- It is the number of deaths per thousand or per one hundred individuals per year under existing condition.
  6. Emigration:- It is the permanent movement of people out of an area.
  7. Immigration: It is the permanent coming of people from outside into an area.

Another factor related to population growth is proportionate abundance of pre-reproductive (15-18 years.), reproductive (15-19 to 45-59 years) and post reproductive (beyond 46-60 years). Population will have a built in momentum for growth, if the size of prereproductive age group is high. In such a case, population will continue to grow, if the size of prereproductive age group is high.

 Population Explosion

An all round development in various fields significantly improved the quality of life of the people in the last century. The improved health facilities along with better living conditions had an explosive impact on the growth of population The world population which was around 2 billion (2000 million) in 1900 rocketed to about 6 billions by 2000. In India similar trend was observed too. A rapid decline in death rate, maternal mortality rate (MMR) and infant mortality rate  (IMR) as well as an increase in number of people in reproducible age are probable reasons for this. According to the 20 census report, the population growth rate was still around 1.7 percent, i.e., 17-100 year, a rate at which our populat: could double in 33 years.

  Reason of Population Explosion

The main reasons of population explosion are :

(i) Agricultural development that has increased food output and reduced mortality from starvation.

(ii) Medical facilities which has brought down mortality from diseases and epidemics.

(iii) Longevity provided by better food and health services.

Effect of Population Explosion

Population explosion has become a grave problem because it has created :

(i) Socioeconomic problems due to shortage of space, food, educational and medical facilities and due unemployment and poverty,

 (ii) Energy crisis due to greater demand for oil and electricity,

(iii) Rapid ecodegradation due to deforestation and pollution. Therefore, the government is forced to take up serious measures to check this population growth rate. Therefore. I only way for the survival and welfare of human race is to check the population growth by birth control.

 Birth Control

The regulation of conception by preventive methods or devices to limit the number of offsprings is called birth control. A variety of methods are known for birth control. The methods which deliberately prevent fertilization called contraceptive methods and the process is called contraception. The various methods of birth control.

 Medical Termination of Pregnancy (MTP)

The willing termination of pregnancy before full term is called Medical Termination of Pregnancy (MTP) induced abortion. It is the termination or removal of embryo from the uterus by using pharmacological or surgical methods. About 45 to 50 million MTPs are performed in a year all over the world which accounts to l/5th of the t number of conceived pregnancies in a year. Due to this, MTP has a significant role in decreasing the population though is not meant for that purpose.

 Government of India legalized MTP in 1971 with some strict conditions to avoid its misuse. Such restrictions are the more important to check indiscriminate and illegal female foeticides which are reported to be high in India. MTPs L also essential in certain cases where continuation of the pregnancy could be harmful or even fatal either to the mother to the foetus or both. MTPs are considered relatively safe during the first trimester, i.e., upto 12 weeks of pregnancy. Second trimester abortions are much more riskier. A majority of the MTPs are performed illegally by unqualified person which are not only unsafe but could be fatal too. Another dangerous trend is the misuse of amniocentesis to determine sex of the unborn child. Frequently, if the foetus is found to be female, it is followed by MTP. Such practices should avoided because these are dangerous both for the young mother and the foetus. Counselling on the need to avoid unprotected coitus and the risk factors involved in illegal abortions as well as providing more health care facilities co change the trend of misuse of MTP.

 Sexually Transmitted Diseases

Diseases or infections which are transmitted through sexual intercourse are collectively called as Sexual Transmitted Diseases (STDs) or Veneral Diseases (VD) or Reproductive Tract Infections (RTI). Gonorrhea, syphilis, genital herpes, chlamydiasis, genital warts, trichomoniasis, hepatitis-B and AIDS are some of the common STDs. Sexually transmitted diseases if not cured in time, can lead to complications later, which include pelvic inflammatory diseases (PID), abortions, still births, ectopic pregnancies, infertility or even cancer of the reproductive tract. STDs are a major threat to a healthy society. The common sexually transmitted diseases are gonorrhoea, syphilis, chlamydia, trichomoniasis, AIDS, genital herpes and hepatitis-B.

 1. Gonorrhea:- It is a sexually transmitted disease (STD) which is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men.

 2. Syphilis:- It is a sexually transmitted disease (STD) caused by a bacterium named Treponema pallidium that can grow and multiply easily in the warm, moist areas of the reproductive tract.Chlamydia is a common sexually transmitted disease that is caused by a bacterium named Chlamydia Trachomatis which can damage a women's reproductive organs. Chlamydia infection lead to infertility in women.

 3. Trichomoniasis:- It is a very common sexually transmitted disease that is caused by infection with a protozoan parasite called Trichomonas vaginalis.

 4. AIDS (Acquired Immunodeficiency Syndrome):- It is a disorder of Human Immunodeficiency Virus (HIV). The virus is pathogenic to human beings as it damages the immune system of the human body. The first AIDS case reported from California in 1981 (US). HIV was first isolated by Montagnier el at. (1983) of the Pasteur Institute of Paris. The more detail about AIDS is discussed in chapter 'Human health and Diseases'. Genital Herpes It is a sexually transmitted disease caused by the herpes simplex viruses-type 1 (HSV-1) or e 2 (HSV-2). Most genital herpes is caused by HSV-2. Some of these infections like hepatitis-B and HIV can also be transmitted by sharing of injection needles, surgical instruments, etc., with infected persons, transfusion " blood or from an infected mother to the foetus too.

 Symptoms of STDs:-

The initial symptoms of most of the sexually transmitted diseases mentioned above are minor. These include itching (irritation inside the penis), burning after urination or ejaculation, fluid discharge, mild pain, swellings, etc., in the genital region. Infected females may often be asymptomatic and hence, may remain undetected for long. In women, the commonly infected part of the body is the lower genital tract (vulva, vagina, or urethra), and in men, the most commonly infected body part is the inside of the penis (urethra).

Abscence or less significant symptoms in the early stages of infection and the social stigma attached to the STDs, deter the infected persons from going for timely detection and proper treatment. Sexually transmitted diseases can increase the risk of getting or spreading other sexually transmitted infections such as AIDS.

Except for hepatities-B, genital herpes and HIV infections, other diseases are completely curable, if detected early and treated properly.

  Preventive Measures of STDs

Prevention of sexually transmitted diseases can be done by the simple practices given below :

  1. Avoid sex with unknown partners/multiple partners.
  2. Always use condoms during coitus.
  3. Use of sterilized needles and syringes.
  4. Education about the sexually transmitted diseases should be given to the people.
  5. Any genital symptoms such as discharge or burning during urination or unusual sore or rash should be a signal STDs and to see a doctor immediately.
  6. Screening of blood donors should be mandatory.

 Infertility:-

Infertility means apparent failure of a couple to conceive, and produce children. The reasons for this could be mar such as physical, congenital, diseases, drugs, immunological or even psychological. Infertility is termed as primary conception has never occurred and secondary if the patient fails to conceive after having achieved a prasvious conception. The incidence of infertility in many community varies between 5% to 15%. The infertility of lactation period regarded as relative. In one third of all cases of infertility, the male is directly responsible.

 Reasons of Infertility in Man

(i) Disorders of spermatogenesis,

(ii) Obstruction of the efferent ducts.

(iii) Disorders of sperm motility.

(iv) Sexual dysfunction.

(v) Sperm count below 20 million/mL are usually associated with infertility.

 Reasons of Infertility in Woman

(i) Irregular menstrual cycle which lead to polycystic ovary is one of the reason of infertility,

(ii) Blockage of fallopian tube.

(iii) Vaginal and cervical infections.

(iv) Hypothalamic and pituitary dysfunction.

 Assisted Reproductive Technology

Assisted reproductive technology (ART) (which includes IVF, ICSI, ZIFT, etc) now provides hope for many infertile couples who previously could not be treated. Basically the aim of ART treatment is to stimulate the ovary to produce several follicles so that more than one egg can be retrived during egg pick-up, fertilize them in the laboratory under str. and monitored conditions and put the fertilized egg back into the uterus, thus hoping to achieve a successful pregnancy. A brief account of various ARTs is given below:

 In Vitro Fertilization (IVF)

It is a technique in which egg cells are fertilized by sperm outside the woman's womb. IVF is a major treatment in infertility when other methods of achieving conception have failed. The process  involves hormonally controlled ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilize them in a fluid medium. The fertilized egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy. The term in vitro is used to refer to any biological procedure that is performed outside the organism's body. In in vivo procedure, the tissue remains inside the living organism within which it is normally found. A general term for babies conceived due to IVF is test tube babies.

Initially, IVF was developed to overcome infertility due to the problems of the fallopian tube but it also turned successful in many other infertility situations such as pelvic inflammatory disease, endometrosis, failed convention fertility methods with injectable drugs, and/or intrauterine insemination and uterine factors or cervical mucus problem

 Intracytoplasmic Sperm Injection (ICSI)

This is the technique to assist fertilization of an egg. In this, one sperm is injected into the cytoplasm of an egg using a microscopic technique. The fertilization occurs outside the woman's body. This technique is used when it is unlikely the sperm can penetrate the coating of the egg (the zona pellucida) on its own. The commonest situation is when there is significant problem with the sperm (the absolute number or the number of sperm moving are very low, or there are large numbers of abnormally shaped sperm).

The first reported birth from this technique was in 1992. A pregnancy rate of 10 to 30% is expected, depending on the woman's age and the number and quality of the embryos transferred. ICSI is normally performed in cases of very low sperm count and motility, surgical sperm retrieval in cases of azoospermia, previous fertilization failure in IVF cycles, carry low number of eggs, etc.

 Intra Uterine Insemination(IUI) :-

This technique combines a small amount of ovarian stimulation to maximize the maturity of the egg and the lining of the uterus with intrauterine insemination of the best of the sperm from a man's ejaculate. It is suitable for couples with Breed infertility or minor semen problems provided the woman's fallopian tubes are normal. The aim is to maximize the number of normal, motile sperms around the egg at the time it is in the fallopian tube. Analysis of the studies IUI indicates that it is 2 to 3 times more effective, if the ovarian stimulation is given via injection rather than with clomiphene tablets.

 Artificial Donor Insemination (IUDI)

There is a treatment in which donated sperm is inseminated into woman's uterus. It is suitable for couples where the partner has no sperm in the reproductive tract. It is also suitable, if the man carries a genetic disease, he does not wish to pass on to his children. The woman needs to have normal fallopian tubes. The first reported birth from this technique was in 1994.

 Oocyte Donation Procedure (DOP)

This is a treatment for women who are no longer producing their own eggs or who have a significant egg problem embryos are unlikely to result in a pregnancy. It involves a donor, who can be known to the couple, going an IVF treatment cycle. The donor's eggs are fertilized with the partner's sperm and the embryos transferred uterus of his partner. The first reported birth from this technique was in 1983.

 Gamete Intra Fallopian Transfer (GIFT)

In this technique, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's This allows fertilization to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilization not an in vitro fertilization. This technique is only suitable for couples where the fallopian tubes have been shown to be healthy, and the sperm have been shown to produce adequate fertilization rates on a previous IVF cycle. If more than two eggs are collected to transfer at GIFT, the extra eggs can be fertilized with IVF and the resultant embryos frozen for later use. The first reported birth from this technique was in 1984.

 Zygote Intra Fallopian Transfer (ZIFT):-

In this process, the pre embryos (zygotes) are transferred into the oviducts rather than gametes. The advantage of ZIFT over IVF is that the pre embryo enters the uterus naturally by the way of oviducts.

 Testicular Sperm Extraction (TESE):-

These are surgical techniques to collect sperm from the testis or epididymis of a man who has blockage in the ducts between his testes and penis, and therefore no sperm in his ejaculate. Collection is usually done by needle aspiration or a small biopsy of the testes.

 Pre Implantation Genetic Diagnosis (PGD):-

This is a technique used when one or both partner's carry a serious genetic disease. It combines the techniques of IVF & ICSI with the removal of 1 or 2 cells from the embryo, when it is at least three days old. The cells are examined to see if the embryo is at risk of having the genetic condition. Only those embryos that are not affected are transferred. It is an alternative for couples who wish to avoid the possibility of a termination later in pregnancy. The first reported birth from this technique was in 1985.

 Amniocentesis:-

It (also referred to as amniotic fluid test of AFT) is a medical procedure used in prenatal diagnosis of chromosomal ities and foetal infections. In a small amount of amniotic fluid, which contains foetal tissues, is sampled from on or amniotic sac surrounding a developing foetus, and the foetal DNA is examined for genetic abnormalities.

Using this process, the sex of a child can be determined and hence, this procedure has some legal restrictions in some gender biased countries.

Misuse of Amniocentesis   Unfortunately this technique is being misused to kill the normal female foetus as can help to detect the sex of foetus. Determination of sex by amniocentesis has been banned.

 

Important Notes by AKB Sir :-

1. Term Nulliparas is used for the women with no children.

2. Louis Brown was the first test-tube baby, born in England in 1978.

3. IVF technique is useful to save endangered species. In 1990, the first test-tube tiger was born.

4. IVF technique is useful for the patients with blocked oviducts, damaged oviducts, endometriosis, low sperm count or abnormal sperm and where the male and female are producing antibodies against the sperm. Intra Cytoplasmic Sperm Infection Technique (ICSI).

5. Abortion is the premature termination of a pregnancy.

6. Male infertility is the failure to achieve pregnancy due to some problem in male such as absence of sperm (Azoospermia), low sperm count abnormal sperm, autoimmunity, premature ejaculation, impotence, etc.

7. Female infertility is the failure to achieve pregnancy due to some problem in female such as failure to ovulate, damage to the oviducts; uterus damage, cervix damage, antibodies to sperm, etc.

8.The blastula with blastocoel is called coeloblastula, e.g., frog, Amphioxus.

9. In certain animals, the blastula is solid and is known as Stereoblastula, e.g., Cnidaria, Annelida (Nereis) and some Mollusca.

10. The blastula formed as a result of superficial cleavage is called superficial blastula, e.g., Insects. « Superficial blastula is also known as Periblastula.

11. Discoblastula is formed as a result of discoidal cleavage, e.g., Birds.

12. Problems of adolescence include (i) health matters (ii) accidental injury (iii) depression and suicide (iv) substance abuse (v) eating borders (vi) violence (vii) unwanted pregnancy (viii) Sexually transmitted diseases, ie major community health services are:

(a) Health centres

(b) National programmes

(c) Universal immunization programmes

(d) Bloodbanks

13. AIDS can be treated by azidothymidine.

14. Year 2000 was declared as health for all.

15. Following four AIDS reference centres have been established in India :

(i) National Institute of virology, Pune.

(ii) All India Institute of Medical Science (AIIMS, New Delhi).

(iii) Centre for Advanced Research on Virology, Vellore (Maharashtra).

(iv) National Institute of Communicable Disease, (New Delhi).

16. Census  is the counting of population and preparing data about age groups, births, deaths, sex ratio, education and other aspects. First census was carried out in India in 1891 and continued thereafter regularly at interval of a decade, the last being in 2001.

17. Growth curve is the mathematical expression of the growth of a population from its beginning till it stabilizes. A growth curve is made by plotting the number of individuals of a species against the time factor.

18. There are two types of growth curves e.g., S-shaped and J-shaped.

19. Total fertility rate is the average of total number of children born per woman in an area/country during their entire child bearing years. TFR was 2.5 in developed countries and 6.5 in developing countries.

20. Demographic  Cycle:-  During technological and social development of a country, the population growth passes through 4-5 steps.

(i) First step  Both birth and death rates are high.

(ii) Second step Death rate fails but birth rate continues to be high,

(iii) Third step Both birth and death rates fall.

(iv) Fourth step Both birth and death rates are low.

(v)Firth step It is temporary and shows birth rate to be lower than death rate so that population tends to fall

21. True birth rates are live births per 1000, in relation to average or mid year female population of child bearing age.

22.Regular rise of a population in a fixed proportion of its own size during a specific period of time is called exponential growth

22. Life expectancy is the average number of years a new born individual is expected to live, life expectancy in developed countries is 75-80 years.

23. Test tube babies can be produced in surogate mother also.

 

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