MORE KNOWLEDGE MORE

POWER
THE VISION OF LIFE

KARTIKEY BIOLOGY
CLASSES
FOR:- XIIth, XIIth, NEET & CUET

“सांसों में अगर जीत का नशा हो तो,

हालात कहाँ मायने रखते हैं ||”
 REPRODUCTIVE HEALTH

Reproductive Health: Problem and Strategies

• India was amongst the first countries in the world to initiate to
the programmed “family planning” initiated in 1951.
• Reproductive health in society forms a crucial part of general
health.
• Improved programs covering wider reproduction-related areas
are currently in operation under the popular name
‘Reproductive and child health care (RCH) program’.
• Health and education of young people and marriage and
child bearing during more mature stages of life are important
attributes to the reproductive health of a society.

Measures taken by Government:

• Through the help of audio-visuals & print media.
• Even family members, close relations are involved in the
awareness.
• Sex education was introduced in schools to provide awareness
• Proper information about reproductive organs, adolescence
& related changes, safe & hygienic sexual practices, sexually
transmitted diseases, AIDS etc.

Amniocentesis:
It is a technique used to find out chromosomal abnormalities in
developing embryo by using amniotic fluid. It is also misused to
check foetal sex determination based on the chromosomal pattern
in the amniotic fluid surrounding the developing embryo.

Population Explosion and Birth Control:

Improved quality of life of people, increased health facilities and
better living condition had an explosive impact on explosion of
population. Rapid decline in death rate, MMR (maternal mortality
rate) and IMR (infant mortality rate) along with increase in
population of reproductive age is the main reason for population
explosion.

Steps to overcome population explosion:

• Using various contraceptive methods.
• Educating people about the demerits of large family.
 • Increasing the marriageable age of female and male
• Providing incentive to parents having 1or 2 children.
 Contraceptive methods: Contraceptive methods are used
to prevent the unwanted pregnancy and modifying the
menstrual cycle.
 An ideal contraceptive should be:-

• User friendly
• Easily available
• Effective
• Reversible
• No side effects
• No way interferes with sexual desire and sexual act.

Contraceptive methods could be divided into the following

categories:

• Natural or traditional methods.

• Barrier methods.
• IUDs.
• Oral contraceptive methods.
• Injectable.
• Implants.
• Surgical methods.

Natural methods:
Natural methods work on the principle of avoiding chances of ovum
and sperm meeting.

It includes:

Periodic abstinence: The couples avoid coitus from day 10 to 17

of menstrual cycle as chances of fertilization are very high during
this period, it is called the fertile period.

Withdrawal or coitus interruptus: Male partner withdraws

penis from vagina just before ejaculation to avoid insemination.

Lactational Amenorrhea: Absence of menstruation after

parturition and due to intense milk feeding and no ovulation in this
period, chances of fertilization is nil.

In Barrier methods:
In Barrier methods, ovum and sperms are prevented from physical
meeting with help of barrier.

This includes:

Condoms for male: Used by male, barrier made of rubber or latex

sheet used to cover penis or vagina and cervix of female. It also
prevents STDs.

Condom for female: Diaphragms, cervical cap and vaults are

barrier made of rubber that is inserted into the female reproductive
tract during coitus. Spermicidal creams, jellies and foams are
usually used along with these barriers to increase their
contraceptive efficiency.

Advantages of barrier methods:

• They are disposable.

• They can be self-inserted.
• They are reusable.
• Prevents conception by blocking entry of sperm through cervix.

Intra uterine Devices: Inserted by doctor or trained nurse into

the female uterus through vagina. IUCDs may be non-medicated
IUDs (e.g., Lippes loop),

 copper releasing IUDs (CuT, Cu7, Multiload 375)

 hormone releasing IUDs (Progestasert, LNG-20).

IUCDs increase the phagocytosis of sperm in uterus and copper

reduce the motility and fertility capacity of sperms The hormone
releasing IUDs make the uterus unsuitable for implantation and the
cervix hostile to the sperms. It is ideal for female who wants to
delay pregnancy and spacing between two children.

Oral Pills: Oral Pills are progesterone or progesterone-estrogen

combination used by females in form of tablets.
  They inhibit ovulation and implantation as well as change the
quality of cervical mucus to prevent/ retard entry of sperms.

 Administration of progesterone or progesterone- estrogen

combination within 72 hours of coitus is found to be very
effective as emergency contraceptive.
Surgical method: This method is also called sterilization. It is
used as terminal method of contraception in male and female to
prevent any more pregnancy.

Vasectomy: Vasectomy is the surgical method in male; a small

part of the vas deferens is removed or tied up through a small
incision on the scrotum to prevent release of sperms.
Tubectomy: Tubectomy is the surgical method in females in
which small part of fallopian tube is removed surgically.
  These techniques are highly effective, but their reversibility is
very poor.

Side effects of contraceptive method:

It is very important that the selection of contraceptive methods

should be taken under the consultation of the doctors.
They have ill-effects like nausea, abdominal pain, breakthrough
bleeding, irregular menstrual bleeding or even breast cancer.

Medical Termination of Pregnancy (MTP):

• Voluntary termination of pregnancy before full term is called
MTP (medical termination of pregnancy) or induced abortion.
It plays an important role in decreasing population by aborting
unwanted pregnancy.
• In India, MTP is legalized in 1971 with some restriction to
prevent its misuse such as indiscriminate and illegal female
foeticides.
• MTP is used to Get rides of unwanted pregnancy due to
unprotected intercourse or failure of contraceptives used
during coitus or rapes.
• When pregnancy continuation could be harmful or even fatal to
mother or foetus.
• MTPs are considered relatively safe during the first trimester or
up to 12 weeks of pregnancy.
Second trimester MTPs are much riskier.

Sexually Transmitted Disease (STDs):

Diseases or infections which are transmitted through sexual
intercourse are collectively called sexually transmitted disease or
venereal disease (VD) or reproductive tract infection (RTI).
 Some common STDs are Gonorrhea, syphilis, genital herpes,
chlamydiasis, genital warts, trichomoniasis, hepatitis-Ba and
AIDS.
 Hepatitis-B and HIV is also transmitted by sharing of injection
needles, surgical instruments with infected person,
transfusion of blood, or from infected mother to foetus.
 Except genital herpes, HIV and hepatitis-B are completely
curable if detected earlier and treated properly.
Timely detection and proper treatment of STDs are very important
otherwise it could lead to complications later, which include pelvic
inflammatory diseases (PID), abortions, still births, ectopic
pregnancies, infertility or even cancer of the reproductive tract.

Infections of STDs can be prevented by:

• Avoid sex with unknown partners/ multiple partners.
• Always use condoms during coitus.
• Go to a qualified doctor in case of doubt for early detection
and get complete treatment if diagnosed.

Infertility:
The couples which are unable to reproduce children despite
unprotected sexual cohabitation are called infertile. The reasons for
this could be many-physical, congenital, diseases, drugs,
Immunological or even Psychological.

Assisted reproductive technologies (ART):

Infertile couples can be assisted to have children through certain
special techniques commonly called assisted reproductive
technologies (ART),

Which includes:

In vitro fertilization (IVF): In vitro fertilization (IVF) fertilization

outside the body followed by embryo transfer, which is commonly
called test tube baby program. The ovum from wife/ donor and
sperms from husband/ donor are collected and induced to fertilize
in laboratory conditions.
ZIFT (zygote infra fallopian transfer): The zygote or early
embryo (8 blastomeres) could be transferred into fallopian tube
called ZIFT (zygote infra fallopian transfer) and embryo with more
than 8 blastomeres.

IUT (intra uterine transfer): IUT (intra uterine transfer) into the
uterus to complete further development. Embryos formed by in-
vivo fertilization (fusion of gametes within the female) also could
be used for such transfer to assist those females who cannot
conceive.

GIFT (gamete intra fallopian transfer): Transfer of gametes

collected from a donor into fallopian tube of another female who do
not produce ovum.

Intra cytoplasmic sperm injection (ICSI): Specialized procedure

to form an embryo in laboratory in which sperm is directly injected
into ovum.

Artificial insemination: Infertility cases in which male partner is

unable to produce healthy sperms are treated by this technique in
which semen collected from donor is artificially introduced into
vagina or into uterus, IUI (intra uterine insemination) of the female.

All these techniques require extremely high precision handling by

specialized professional and expensive instruments. Therefore,
their benefits are limited to certain countries and people.
Emotional, religious, and social factors also prevent the adoption of
these methods.
 Mind map : learning made simple Chapter - 4
 Hepatitis B
 Increased female foeticides.  Genital herpes
Diseases transmitted
 Misused to detect the sex of  HIV, Gonorrhoea, Syphilis etc
through sexual intercourse.
the child before birth and
female fetus is then aborted.
on
niti  To avoid unwanted pregnancies
i
Def  In cases where continuation of pregnancy
is harmful to the mother or foetus or both
It helps to detect any congenital
disease or any metabolic disorder
in foetus.
They are performed illegally and causes
misuse of amniocentesis.
ni ti on Reproductiv
According to WHO, reproductive Defi
health means a total well-being e
in all aspects of reproduction Health
(Zygote Intra Fallopian Transfer)
Vasectomy (in Males)

(Intra Cytoplasmic Sperm Injection)

Tubectomy (in Females)
(Intra Uterine Transfer)
 Withdrawal of penis
before ejaculation (Gamete Intra Fallopian Transfer)
 Not very reliable

(Artificial Insemination)
 Avoiding coitus from days
10-17 of menstural cycle.
 Chances of fertilisation ea
is very high. rrh  Use of Condoms
eno
l am  Diaphragm, Cervical
na caps and vaults  Contains progesterone
 Intercourse is avoided at the tatio
Lac  Spermicidal creams,  Non-medicated IUDs (e.g. Lippes loop) and estrogen
ovulation period
jellies and foams.  Copper releasing IUDs (e.g. CuT, Cu7, Multiload 375)  It prevents
 Cannot be exactly predicted
 Hormone releasing IUDs (e.g. Progestasert, LNG-20) implantation of
blastula
 Important Questions
➢ Multiple Choice
Questions:
1. The method of directly injecting a sperm into ovum in assisted
reproductive technology is called:
(a) GIFT
(b) ZIFT
(c) ICSI
(d) ET
2. Increased IMR and decreased MMR in a population will:
(a) Cause rapid increase in growth rate
(b) Result in decline in growth rate
(c) Not cause significant change in growth rate
(d) Result in an explosive population.
3. Intensely lactating mothers do not generally conceive due to the:
(a) Suppression of gonadotropins
(b) Hyper secretion of gonadotropins
(c) Suppression of gametic transport
(d) Suppression of fertilisation.
4. Sterilisation techniques are generally foolproof methods of
contraception with least side effects. Yet, this is the last option for the
couples because:
i. It is almost irreversible
ii. Of the misconception that it will reduce sexual urge/drive
iii. It is a surgical procedure
iv. Of lack of sufficient facilities in many parts of the country Choose
the correct option:
(a) i and iii
(b) ii and iii
(c) ii and iv
(d) i, ii, iii and iv
5. A national level approach to build up a reproductively healthy society
was taken up in our country in:
(a) 1950s
(b) 1960s
(c) 1980s
(d) 1990s.
6. Emergency contraceptives are effective if used within:
 (a) 72 hrs of coitus
(b) 72 hrs of ovulation
(c) 72 hrs of menstruation
(d) 72 hrs of implantation
7. Choose the right one among the statements given below:
(a) lUDs are generally inserted by the user herself
(b) lUDs increase phagocytosis reaction in the uterus
(c) lUDs suppress gametogenesis
(d) lUDs once inserted need not be replaced.
8. The following statements are given regarding MTP. Choose the
correct options given below:
(i) MTPs are generally advised during first trimester
(ii) MTPs are used as a contraceptive method
(iii) MTPs are always surgical
(iv) MTPs require the assistance of qualified medical personnel
(a) i and iii
(b) ii and iii
(c) i and iv
(d) i and ii
9. From the sexually transmitted diseases mentioned below, identify the
one which does not specifically affect the sex organs:
(a) Syphilis
(b) AIDS
(c) Gonorrhoea
(d) Genital warts
10. Condoms are one of the most popular contraceptives because of the
following reasons:
(a) These are effective barriers for insemination
(b) They do not interfere with coital act
(c) These help in reducing the risk of STDs
(d) All of the above.
11. Choose the correct statement regarding the ZIFT procedure:
(a) Ova collected from a female donor are transferred to the fallopian
tube to facilitate zygote formation
(b) Zygote is collected from a female donor and transferred to the
fallopian tube
(c) Zygote is collected from a female donor and transferred to the uterus
 (d) Ova collected from a female donor and transferred to the uterus
12. The correct surgical procedure as a contraceptive method is:
(a) Ovariectomy
(b) Hysterectomy
(c) Vasectomy
(d) Castration.
[Link] are contraceptive devices used by females. Choose the
correct option from the statements given below:
(i) They are introduced into the uterus
(ii) They are placed to cover the cervical region
(iii) They act as physical barriers for sperm entry
(iv) They act as spermicidal agents
(a) i and ii
(b) i and iii
(c) i, ii and iii
(d) iii and iv
14.A procedure that finds use in testing for genetic disorders, but is also
misused for female foeticide is:
(a) Lactational amenorrhea
(b) Amniocentesis
(c) Artificial insemination
(d) Parturition
➢ Very Short Question:
1. Give the term for prenatal diagnostic technique aimed to know the
sex of developing foetus and to detect congenital disorders.
2. After a successful in vitro fertilisation, the fertilised egg begins to divide.
Where is this egg transferred before it reaches the 8-celled stage and
what is this technique called?
3. Give the term for rapid population growth.
4. Name the fluid from which foetal cells are extracted for chromosomal
analysis.
5. Give technical name of female used to bring up in vitro fertilized egg to
maturity.
6. Name the oral contraceptive developed by CDRI, Lucknow.
7. What is the WHO’s interpretation of reproductive health?
8. Why has the Government imposed a statutory ban on amniocentesis?
9. Expand MTP and ICSI.
10. What is lactational amenorrhoea?
➢ Short Questions:
1. What are implants? How do they help in preventing fertilisation?
2. Briefly explain two natural barriers for birth control.
3. Enlist any four possible reasons for infertility in human beings.
4. What does GIFT represent?
5. How does Cu- T act as a contraceptive?
6. Mention any four probable reasons for the rapid rise of population in our
country?
7. Identify the device used for the following methods of birth control:
Barrier, IUD, Surgical technique and Administering hormone.
8. What are STDs? Mention any two of it.
➢ Long Questions:
1. Suggest the aspects of reproductive health that need to be given special
attention in the present scenario.
2. Briefly give an account of various intra-uterine contraceptive (IUD)
measures. What are their advantages? How do they function?
3. What are the measures one has to take to prevent contracting STDs?
➢ Assertion and Reason Questions:
1) For two statements are given-one labelled Assertion and the other
labelled Reason. Select the correct answer to these questions from the
codes (a), (b), (c) and (d) as given below.
a) Both assertion and reason are true, and reason is the correct
explanation of assertion.
b) Both assertion and reason are true, but reason is not the
correct explanation of assertion.
c) Assertion is true, but reason is false.
d) Both assertion and reason are false.
Assertion: Generally, a woman does not conceive during the lactation
period.
Reason: The hormone 'prolactin' initiates and maintains lactation in a
postpartum woman.
2) For two statements are given-one labelled Assertion and the other
labelled Reason. Select the correct answer to these questions from the
codes (a), (b), (c) and (d) as given below.
a. Both assertion and reason are true, and reason is the correct
explanation of assertion.
b. Both assertion and reason are true, but reason is not the
correct explanation of assertion.
c. Assertion is true, but reason is false.
d. Both assertion and reason are false.
Assertion: In GIFT, fertilisation takes place in vivo.
Reason: The results of GIFT are less better than in vitro fertilisation.
➢ Case Study Questions:
1. Read the following and answer any four questions from (i) to (v) given
below:
A woman unable to conceive after many years of regular unprotected coitus
went to specialised infertility clinic. On complete examination, woman was
found to be normal, while male partner was diagnosed with infertility. Male
partner is unable to copulate the female.
Couple was advised to opt for assisted reproductive technology (ART).
(i) Which ART could have been useful for this couple?
a. ZIFT
b. IUT
c. AI
d. GIFT
(ii) In which of the following infertility issues could this technique be used?
a. Anovulation.
b. Oligospermia.
c. Low fructose content in seminal fluid.
d. All of these.
(iii) Which among the following techniques is useful to conceive when there
is very low sperm count?
a. GIFT
b. Test-tube baby
c. IUT
d. JCSI
(iv) Assertion: Artificial insemination (AI) is intra-uterine insemination.
Reason: In Al, sperms collected from donor are introduced into the
uterus.
a. Both assertion and reason are true, and reason is the correct
 explanation of assertion.
b. Both assertion and reason are true, but reason is not the
correct explanation of assertion.
c. Assertion is true, but reason is false.
d. Both assertion and reason are false
(v) Success rate of artificial insemination technique is:
a. 20-40%
b. 60-70%
c. 40-50%
d. 5-7%
2. Read the following and answer any four questions from (i) to (v) given
below:
Oral administration of small doses of hormones is contraceptive method
used by the females. They are used in the form of tablets and hence called
the pills. The oral pills are two types; mini pills and combined pills.
(i) Mini pills
contain:
a. Estrogen only.
b. Progestin only.
c. Combination of progesterone-estrogen.
d. Inhibin.
(ii) How do hormonal pills prevent pregnancy?
a. By phagocytosing the sperms.
b. By inhibiting ovulation.
c. By preventing sperms from entering the vagina.
d. All of these.
(iii) Pill containing non-steroidal preparation, centchroman is:
a. Mala D.
b. Mala N.
c. I-Pill.
d. Saheli.
(iv) Which among the following is incorrect for oral contraceptives?
a. Oral pills alter the uterine endometrium and make it unsuitable for
implantation.
b. Oral pills have to be taken daily for 7 days starting within first five
days of menstrual cycle.
c. Oral pills increase the risk of intravascular clotting.
d. Oral pills contain either progestin alone or combination of
progestogen and estrogen.
(v) Assertion: Mala D, a combined contraceptive pill, have to be taken daily
without a break.
Reason: Mala D contains synthetic progesterone and estrogen.
a. Both assertion and reason are true, and reason is the correct
explanation of assertion.
b. Both assertion and reason are true, but reason is not the
correct explanation of assertion.
c. Assertion is true, but reason is false.
d. Both assertion and reason are false.
 ✓ Answer Key-
➢ Multiple Choice
Answers:
1. (c) ICSI
2. (c) Not cause significant change in growth rate
3. (a) Suppression of gonadotropins
4. (d) i, ii, iii and iv
5. (a) 1950s
6. (a) 72 hrs of coitus
7. (b) lUDs increase phagocytosis reaction in the uterus
8. (c) i and iv
9. (b) AIDS
10. (d) All of the above.
11. (b) Zygote is collected from a female donor and transferred to the
fallopian tube
12. (c) Vasectomy
13. (c) i, ii and iii
14. (b) Amniocentesis
➢ Very Short Answers:
1. Amniocentesis.
2. Fallopian tube; Zygote intra fallopian transfer (ZIFT)
3. Population explosion.
4. Amniotic fluid.
5. Surrogate mother.
6. Saheli
7. WHO defines reproductive health as total well being in all respects
of reproduction including physical, emotional, behavioural and
social.
8. The Government has banned amniocentesis to check on the
incidences of female foeticides.
9. MTP: Medical Termination of
Pregnancy. ICSI: Intra
Cytoplasmic Sperm Injection.
10. It refers to absence of menstruation during period of intense lactation.
➢ Short Answer:
1. The structures which contain hormones like progesterone and
estrogen and are placed under the skin.
2. Periodic abstinence couple should avoid coitus from 10th to 17th
day of menstrual cycle. Coitus interruptus Male partner withdraws his
penis from the vagina just before ejaculation of semen.
3. Physical, congenital disease, Drugs, Immunological and even
psychological (any four).
4. It is the introduction of two unfertilized oocytes and several sperms into
the fallopian tube of a woman desirous to be a mother through
laproscope. The eggs may be hers or a donor’s. The sperms may be of
her husband’s or of a donor. Fertilisation occurs in vivo and the
development of the foetus takes place through natural process.
5. It is an intrauterine device having ionized copper. The copper diffuses
into the uterus and brings about the release of toxic cytokines. They
inhibit sperm motility and therefore fertilization of ovum.
6. The probable reasons could be:
 Steady decline in the death rate due to improved health services.
 Early marriages especially in certain rural areas.
 Lack of education among the poor and they fail to understand the ill
effects of a large family.
 Longer life span.
7. Barrier: Condom, IUD: Copper –T, Surgical technique:
Vasectomy or Tubectomy, Administering Hormone : Oral Pill.
8. Diseases or infections transmitted through sexual intercourse are
collectively called Sexually Transmitted Diseases or STDs. Ex:
Syphilis and Gonorrhoea.
➢ Long Answer:
1. Conferring upon the demands of the present situation of our
country, the following aspects of reproductive health should be
given special attention:
i. Control of the human population.
ii. Creation of awareness about reproduction-related aspects among
people including sex education to the students.
iii. Implementation of various action plans to attain reproductive
health and building a reproductively healthy society.
iv. Continued research on reproduction-related areas.
 v. Providing medical assistance and care to people especially during
pregnancy, delivery, STDs, abortions, contraception, menstrual
problems, infertility, etc.
vi. Measures of birth control.
2. Different types of lUDs are presently available such as the non-
medicated lUDs (e.g. Lippes loop), copper releasing IUDs (CUT, CU 7,
Multiload 375), and the hormone-releasing ones (Progestasert, LNG-20).
Functions. lUDs increase phagocytosis of sperms within the uterus and
the Cu ions released by some suppress sperm motility and the fertilizing
capacity of the sperms. The hormone-releasing lUDs, in addition, make
the uterus unsuitable for implantation and the cervix hostile to the
sperms. Advantages. LEDs are ideal contraceptives for females who
want to delay pregnancy and/or space children. It is one of the most
widely accepted methods of contraception in India.
3. STDs are sexually transmitted diseases that are transmitted from an
infected person to a normal person through sexual intercourse. STDs
are a major threat to a healthy society and can be prevented by
adopting the following practices:
i. Avoidance of sex with multiple partners.
ii. Avoidance of sex with unknown partners.
iii. Complete abstinence from sex with infected individuals.
iv. Use of condoms during sexual intercourse.
v. In case of doubt, a qualified doctor should be consulted.
➢ Assertion and Reason Answers:
1) (b) Both assertion and reason are true, but reason is not the
correct explanation of assertion.
Explanation:
Milk secretion is maintained as long as breast feeding, and hence hormone
production continues. A woman does not conceive during the lactation
period because lactation stimulates prolactin secretion and there is
evidence that prolactin inhibits GnRH secretion, and antagonises the
action of gonadotrophins on the ovaries. Ovulation is inhibited, and the
ovaries are inactive, so estrogen and progesterone output falls to low
levels. Thus, during lactation a woman does not conceive. Only 5-10%
chances are there during lactation period. This can also be interpreted as
mechanism devised by nature so that mother can look after the new
born child by providing it with milk.
2) (c) Assertion is true, but reason is false.
Explanation:
GIFT is a more expensive and invasive procedure than IVF (in vitro
fertilisation) but its results are better than IVF.
➢ Case Study Answers:
1.
(i) (c) AI
Explanation:
Artificial Insemination (AI) is done in infertility cases, either due to inability
of male partner to copulate the female or due to very low sperm count in
the semen of male partner.
(ii) (b) Oligospermia.
Explanation:
Oligospermia is very low sperm count.
(iii) (d) JCSI
Explanation:
ICSI is intra cytoplasmic sperm injection.
(iv) (a) Both assertion and reason are true, and reason is the
correct explanation of assertion.
(v) (a) 20-40%
2.
(i) (b) Progestin only.
Explanation:
Mini pills contain progestin only, with no estrogen.
(ii) (b) By inhibiting ovulation.
Explanation:
Oral contraceptive pills inhibit ovulation and implantation.
(iii) (d) Saheli.
Explanation:
Saheli contains non-steroidal preparation called centchroman.
(iv) (b) Oral pills have to be taken daily for 7 days starting within
first five days of menstrual cycle.
Explanation:
Oral pills have to be taken daily for 21 days starting within first five
days of menstrual cycle.
(v) (b) Both assertion and reason are true, but reason is not the
correct explanation of assertion.