Humans have many ways in which to manage their own reproduction. They can choose to prevent or assist fertilisation f an egg by a sperm. (1)
The artificial control of the menstrual cycle in females has two main purposes:
Firstly as a contraceptive device by preventing ovulation and secondly as a fertility device by stimulating ovulation. (2)
All human societies have at one time or another developed mechanisms of birth control. The impact of too many children on the family, tribe, or population has led to methods as diverse as infanticide and the sophisticated pharmacology of the contraception. (4)
Contraception refers to the use of methods ort devices that prevent conception. There are many contraceptive methods available including physical barriers (such as condoms) that prevent egg and sperm ever meeting. The most effective methods involve chemical interference in the normal female cycle so that egg production is inhibited. (1)
Hormonal methods of birth control appear in many different forms and are extremely popular. These include oral contraceptives, injections and implants skin patches.
Combined oral contraceptives (Ocs)
Hormones direct the process of ovulation. Oestrogen and progesterone are 2 hormones that direct many of the processes surrounding the menstrual cycle. Artificial analogues of these have proven an efficient form of birth control. To prevent pregnancy a woman takes a pill daily which contains both these hormones. This is the combination pill or simply “the pill”. The oestrogen works by preventing an egg of being released from the ovaries most of the time. Both the oestrogen and progesterone make the uterus a hostile environment for an embryo by causing a thinning of the uterus lining. (3)
Pros and cons of hormonal contraception
High reliability is a major advantage of hormonal contraception. The risk of accidental pregnancy is less than 3 %. The hormones make for lighter and more regular menstrual periods, and reduce the cramps associated with periods. They also lower the statistical risk of tubal pregnancy, pelvic infections and ovarian and endometrial cancer. Ocs gives more sexual freedom and also acne improvements. (6)
However there are many disadvantages and complications of Ocs
Common side effects. Oestrogen and progesterone have different side effects. Symptoms of serious problems include severe abdominal pain, chest pain, unusual headaches, visual disturbances or severe pain or swelling in the legs.
Effects on heart and circulation. Osc pose some serious risks when they first were introduced and oestrogen and progestin levels were high. Such complications include blood cloths, heart attack, stroke, pulmonary embolism and Hypertension.
A number of studies have reported a strong association between cervical cancer and long-term use of Ocs. Most known risk factors for breast cancer are attributable to some form of oestrogen overexposure (5)
Family planning and the use of contraception have arisen ethical issues within different countries. More and more people in targeted countries are coming to realise that family planning is not in their best interest, and that the conspicuous anti-fertility devices and drugs are comparable to landmines in a demographic war.
Over the past 4 years a backlash has been building against western “birth control imperialism”. Opposite to population control programmes on the part of Islamic leaders in Pakistan, for instance, has dramatically slowed the efforts of family planning. (7)
On the other hand millions of women in developing countries who would prefer to postpone or avoid pregnancy find the use of contraception useful. These women have an “unmet need” for contraception. By reducing obstacles to the use of contraception, family planning has been successful in addressing unmet need. Programs’ principle methods for addressing this need have included emphasizing voluntary acceptance of contraception. (8)
Over the past 20 years, fertility problems have increased dramatically. About 1 in 6 couples are infertile due to physical or physiological conditions preventing gamete production or fertilisation. Blocked oviducts are the leading cause of infertility in females. Low sperm count; low motility or blocked ducts are common causes of male infertility. More and more couples are turning to fertility treatments to help them have a family.
Hormone therapy can cause increased egg production and surgery can open blocked ducts. (9)
The most common non-surgical method to treat infertile patient is controlled ovarian hyperstimulation/intrauterine insemination (COH/IUI)
Ovulation is the process by which a mature follicle bursts and releases an egg. The egg is then picked up by the fallopian tube.
There are numerous ways for controlled ovarian hyperstimulation to be carried out.
The most widespread protocols involve the use of Gonadotropins and Clomiphene Citrate.
Clomiphene Citrate (Clomid, Serophene)
This drug is competitive inhibitor of oestrogen. It blocks oestrogen receptors in a part of the brain called the hypothalamus, which causes the hypothalamus to signal the pituitary gland to release more FSH and LH into the bloodstream. The increased levels of FSH lead to the development of the follicle and egg which secretes more oestrogen into the bloodstream.
About a week after the hypothalamus receptors are no longer blocked and thus trigger an LH surge that triggers ovulation 14 days before the end of the cycle. (10)
Disadvantages of using fertility drugs
Fertility drugs are occasionally responsible for multiple births. While clomipfene citrate only rarely results in pregnancy with more than twins, hMG and FSH carry a greater risk of causing multiple births. Because these drugs are given continuously, they constantly stimulate the ovaries to develop mature eggs.
About 15% to 25% of FSH cycles result in multiple pregnancies. As a rule, the greater the number of foetuses, the higher the risk of premature labour. Babies born prematurely are at increased risk for a number of medical problems.
Some studies have suggested a link between fertility drugs and an increased long-term risk of developing ovarian cancer.
If too many babies are conceived, the removal of one or more foetuses (multiple pregnancy reduction) can aid survival of the remaining foetuses. However, this presents serious emotional and ethical challenges for many people. (11)
Having looked at the facts concerning the use of hormones to prevent or assist pregnancy in females, I find it hard to decide if I’m “against” or “for” the use of hormones by humans to control the female sexual cycle, because each side of the argument has its positive and negative effects and applications.