MODULE 1.

INTRODUCTION TO REPRODUCTIVE HEALTH

LEARNING OUTCOME
In this module, you will learn about the reproductive health. After completing this
module, you are expected to:

• Discuss the basic components of reproductive health

• Determine the effect of the environment to reproductive health

LEARNING CONTENT

1. REPRODUCTIVE HEALTH
➢ Reproductive processes, functions, and systems at all stages of life
➢ Freedom to make decisions regarding a healthy sex life
➢ Access to appropriate reproductive health services

The WHO defines reproductive health as a state of complete physical, mental

and social well-being, and not merely the absence of reproductive disease or
infirmity.

Republic Act 10354: The Responsible Parenthood and Reproductive Health

Act of 2012*

An Act providing for a National Policy on Responsible Parenthood and

Reproductive Health

• The State likewise guarantees universal access to medically-safe, non-

abortifacient, , effective, legal, affordable, and quality reproductive health
care services, methods, devices, supplies which do not prevent the
implantation of a fertilized ovum as determined by the Food and Drug
Administration (FDA) and relevant information and education thereon
according to the priority needs of women, children and other
underprivileged sectors, giving preferential access to those identified
through the National Household Targeting System for Poverty Reduction
(NHTS-PR) and other government measures of identifying
marginalization, who shall be voluntary beneficiaries of reproductive health
care, services and supplies for free.

• The State shall eradicate discriminatory practices, laws and policies that
infringe on a person’s exercise of reproductive health rights.

ELOI ROSALES ATIENZA, RN,MAN 1

 • The State shall also promote openness to life; Provided, that parents bring
forth to the world only those children whom they can raise in a truly
humane way.

• The State shall respect individuals’ preferences and choice of family

planning methods that are in accordance with their religious convictions
and cultural beliefs, taking into consideration the State’s obligations under
various human rights instruments;

• Active participation by nongovernment organizations (NGOs), women’s

and people’s organizations, civil society, faith-based organizations, the
religious sector and communities is crucial to ensure that reproductive
health and population and development policies, plans, and programs will
address the priority needs of women, the poor, and the marginalized;

• While this Act recognizes that abortion is illegal and punishable by law, the
government shall ensure that all women needing care for post-abortive
complications and all other complications arising from pregnancy, labor
and delivery and related issues shall be treated and counseled in a
humane, nonjudgmental and compassionate manner in accordance with
law and medical ethics;

• Each family shall have the right to determine its ideal family size:
Provided, however, That the State shall equip each parent with the
necessary information on all aspects of family life, including reproductive
health and responsible parenthood, in order to make that determination;

Definition of terms

Abortifacient refers to any drug or device that induces abortion or the

destruction of a fetus inside the mother’s womb or the prevention of the
fertilized ovum to reach and be implanted in the mother’s womb upon
determination of the FDA.

Adolescent refers to young people between the ages of ten (10) to nineteen
(19) years who are in transition from childhood to adulthood.

Family planning refers to a program which enables couples and individuals

to decide freely and responsibly the number and spacing of their children
and to have the information and means to do so, and to have access to a
full range of safe, affordable, effective, non-abortifacient modem natural and
artificial methods of planning pregnancy.

Reproductive health care is the constellation of methods, techniques and

services that contribute to reproductive health and well-being by preventing and
solving reproductive health problems.

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 ▪ refers to the access to a full range of methods, facilities,
services and supplies that contribute to reproductive health and
well-being by addressing reproductive health-related
problems.

Reproduction – biological process where a new individual is produced.

Responsible Parenthood – the will and the ability to respond to the needs and
aspirations of the family and children.

Reproductive health involves all of the reproductive processes, functions and

systems at all stages of human life.
• This definition implies that people are able to have a 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.
• Men and women have the right to be informed and to have access to
safe, effective, affordable and acceptable methods of family planning
of their choice that are not against the law.
• Furthermore, men and women should have access to appropriate
health care services that will enable women to go safely through
pregnancy and childbirth, as well as to provide couples with the best
chance of having a healthy infant.

• Reproductive health is a universal concern, but is of special

importance for women particularly during the reproductive years.

• However, men also demand specific reproductive health needs and

have particular responsibilities in terms of women's reproductive
health because of their decision-making powers in some
reproductive health matters.

• Reproductive health is a fundamental component of an individual’s

overall health status and a central determinant of quality

1.1 Reproductive Health

Right to a satisfying and safe sex life with the freedom to decide to reproduce and
how often to do so
➢ Safe, effective, affordable access to family planning methods
➢ Access to appropriate reproductive health services

The WHO’s definition of reproductive health specifically highlights the importance

of an individual’s right to maintain their own sexual health status.

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Sexual health is the integration of emotional, intellectual, and social aspects of
sexual being in order to positively enrich personality, communication, relationships
and love. The three fundamental principles of sexual health are:

1. Capacity to enjoy and control sexual and reproductive behavior;

2. Freedom from shame, guilt, fear, and other psychological factors that may
impair sexual relationships; and
3. Freedom from organic disorder or disease that interferes with sexual and
reproductive function. Reproductive health further implies the right to
satisfying and safe sex life.

Reproductive health should also be understood in the context of healthy

relationships in which there is an understanding of the balance between fulfillment
and risk. Reproductive health contributes enormously to physical and psychosocial
comfort and closeness between individuals. Poor reproductive health is frequently
associated with disease, abuse, exploitation, unwanted pregnancy, and death.

1.2 The Life Cycle Perspective

➢ Individual reproductive health needs differ at each stage of life
➢ Reproductive health status may reflect cumulative effects and experiences
that occurred in earlier life phases

Reproductive health is important for healthy

social, economic, and human development

Reproductive health is a crucial feature of healthy human development and of

general health. It may be a reflection of a healthy childhood, is crucial during
adolescence, and sets the stage for health in adulthood and beyond the
reproductive years for both men and women.

➢ Reproductive life span does not begin with sexual development at puberty
and end at menopause for a woman or when a man is no longer likely to
have children. Rather, it follows throughout an individual’s life cycle and
remains important in many different phases of development and maturation.

➢ At each stage of life, individual reproductive health needs may differ.

However, there is a cumulative effect across the life course, and each phase
has important implications for future well-being.

➢ An inability to deal with reproductive health problems at any stage in life

may set the scene for later health problems. This is known as the life cycle
perspective for reproductive health.

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1.3 Maintaining Reproductive Health
➢ Engaging in healthy behaviors
➢ Appropriate access to health care
➢ Condition of immediate environment
• Natural, physical, socio-economic, political, others

❖ Healthy reproductive systems, processes, and function are imperative

components of adequate overall health. However, many internal as well as
external factors may challenge an individual's ability to maintain
reproductive health.
❖ It is important to keep in mind that reproductive health status may be
determined by occurrences and exposures from in utero development until
the final stages of life.
❖ Numerous factors directly effect how well an individual maintains his or her
reproductive health status. While some factors may be pre-determined,
such as genetic susceptibility to a particular disorder or disease, other
factors that relate to the maintenance of reproductive health may be
behavioral and involve an individual's participation in risky practices.

Furthermore, the environment in which an individual lives, both natural and

physical, may present important risk that may directly influence reproductive
health. For instance, some occupational exposures (e.g works with hazardous
pesticides) can have adverse effects in reproductive life.

1.4 Reproductive Health Issues During and After Pregnancy

➢ Congenital anomalies - all structural, functional, and genetic abnormalities
diagnosed at birth or in the neonatal period
➢ Ectopic pregnancy - when implantation occurs outside the uterus
➢ Fetal death (stillbirth) - death prior to the complete birth after 20 weeks of
gestation. Evidenced by lack of vital life signs Spontaneous abortion
(miscarriage) - spontaneous loss of a pregnancy that occurs before 20
weeks of gestational age

There are specific reproductive health problems that directly describe the health of
an early pregnancy or the development of the fetus in utero.

The World Health Organization describes the term congenital abnormalities as all
structural, functional, and genetic abnormalities diagnosed in aborted fetuses, at
birth or in the neonatal period. Congenital abnormalities are sometimes known as
birth defects.

An ectopic pregnancy describes a complication in the early stages of pregnancy

when a fertilized egg is implanted in an area outside of the uterine cavity. A majority

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of ectopic pregnancies occur in the fallopian tube, but may also occur in the cervix,
ovary, or abdomen. If not treated properly, an ectopic pregnancy may be life
threatening for the woman.

Fetal death (commonly known as a stillbirth) occurs when an infant does not
survive complete expulsion from the mother or after twenty completed weeks of
gestational age. Death is evidenced by a lack of vital signs following separation
from the womb, for example, lack of fetal breath, heartbeat, umbilical cord
pulsation, or definite movement of voluntary muscles.

2. Reproductive Health and the Environment

➢ Focuses on exposure to contaminants found in the environment, specifically
during critical periods of development.
➢ All the physical, chemical, biological and social factors that may affect the
origin, growth, development and survival of a person in a given setting.
Examples include:
✓ Specific synthetic chemicals
✓ Some metals
✓ Air pollutants

Reproductive health and the environment focuses on exposures to environmental

contaminants during critical periods of human development. These periods are
directly related to reproductive health throughout the life course, including the
period before conception, at conception, fertility, pregnancy, child and
adolescent development, and adult health. Exposures to different
environmental contaminants may influence reproductive health status
through the process of epigenetics. Environmental toxicants may potentially
induce effects in human reproductive processes. However, the extent of this
hypothesis must be supported through greater levels of research.

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2.1 Role of environmental contaminants on reproductive health

Dose
Time

Exposure

Risk

Intrinsic
Properties
Nature

The diagram shows that the dose and the time of the exposure, as well as
the "danger" posed by the properties and toxicity of the environmental factor
determine the risk for health.

Recent high doses

intake via lungs,
skin or oral
ingestion

Exposure Risk Danger

Acute effects
(e.g pesticide)
Colinergic crisis Acute
Gastrointestinal
Respiratory Toxicity
Skin
General:
Migraine
Nausea

The diagram shows that the dose and the time of the exposure (in this case
we take the example of pesticide ingestion) as well as the "danger" posed

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 by the properties and toxicity of the environmental factor determine the risk
for health.

Repeated low
doses
Occupational
setting and
environment

Exposure Risk Danger

CHRONIC EFFECTS
Respiratory Skin
Neurological Cancer
Reproductive CHRONIC
TOXICITY
genotoxicity
endocrine
disruption
immunotoxicity

In the case of repeated low doses in the occupational setting, of pesticides for
instance, the toxicity is chronic and might affect the regulations/metabolism of
genes and the immune, endocrine and other systems. The effects are chronic and
might only be visible after a latency period.

LEARNING ACTIVITIES

1. Identify the environmental factors that can affect the reproductive health.
2. Read researches on reproductive health and environment. Explain and share
your views on the issue of whether the environment really affects the
reproductive health.
3. Explain the role of environmental contaminants on reproductive health

FLEXIBLE TEACHING LEARNING ACTIVITY MODALITY (FTLM) ADAPTED

• Modular
• Messenger
• Google class
• Zoom
• Edmodo

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ASSESTMENT TASK

1. Define the following related terms

• Reproductive health
• Reproduction
• Responsible parenthood
• Fetal death
• Ectopic pregnancy
• Congenital anomalies

2. Give the factors that affect reproductive health

3. State the three reproductive health issues during and after pregnancy

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MODULE 2. DEVELOPMENT AND FUNCTIONS OF HUMAN REPRODUCTIVE
SYSTEM

LEARNING OUTCOME

In this module, you will learn about the development and functions of human
reproductive system. After completing this module, you are expected to:

• Compare and contrast the parts and functions of the male and female
reproductive system
• Describe the flow of male and female reproductive hormones
• Discuss the ovarian and menstrual cycle
• State the parts and functions of mammary glands and its hormones

LEARNING CONTENT

Overview of the Male and Female Reproductive System

The reproductive system or genital system is a set of organs within an organism
that work together to produce offspring. Many non-living substances, such as
fluids, hormones, and pheromones, are important accessories to the reproductive
system. The reproductive system is a collection of internal and external organs in
both males and females that work.

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 Figure 1. Male and Female Reproductive System
1. Male Reproductive System
• The male reproductive system is specialized for the production of male
gametes and their transportation to the female reproductive tract that is
mediated by supporting fluids and the production of testosterone.

1.1 External structures

1. Penis
• The penis is the male organ of copulation and urination
• A male organ which is upfront during sexual intercourse
• The penis consists of three parts; namely, the root, the body, and the glans.
It is important to note that, the glans or penis head is covered with a movable
layer of skin. This is called the foreskin and is sometimes detached under a
procedure termed as circumcision.
• Prepuce or foreskin: it is a fold of retractable skin covering the glans and
which is removed during circumcision. In some cases the prepuce is too
tight and cannot be retracted over the glans, this condition is called
phimosis.
• Urethral meatus: it is the slit-like opening located at the tip of the penis which
serves as passageway of both semen and urine.

2 Scrotum
• The scrotum is the loose sac-like skin bag that hangs below the penis. This
part of the male reproductive system holds the testes or testicles, along with
many blood vessels and nerves. Scrotum behaves like a temperature
control system in regard to the testes. In order to achieve normal sperm
development, it is necessary that the temperature of the testes should be
somewhat cooler than the body temperature.

3. Testes or Testicles
• Testicles are oval organs which are almost the size of bigger olives that are
present within the scrotum. These are secured at all ends by a structure
termed as a spermatic cord. Usually, most men have two tests.
• The primary function of the testes is to make testosterone and generate
sperm. In the interior of the testes, you will find seminiferous tubules, which
are coiled tube masses. The function of these tubes is to produce sperm
cells.

2.1 Internal Structures

1. Epididymis
• It is a coiled tube that is long and is placed on the rear of each testicle. The
function of Epididymis is to store and transport sperm cells that are created
in the testes.

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2. Ejaculatory Ducts
• The ducts are formed due to the union of the seminal vesicles and vas
deferens. Ejaculatory ducts get unfilled into the urethra

Figure 2. Male Reproductive System

3. Seminal Vesicles
• These are sac-like pouches which are linked to the vas deferens close to
the bladder base. The fluid contained in the seminal vesicles is responsible
for making up the maximum volume of a male’s ejaculatory fluid.

4. Prostate Gland
• It is a walnut-sized assembly which is present under the urinary bladder.
The function of the prostate gland is to contribute additional fluid for
ejaculation.

5. Bulbourethral Gland
• You can call them as pea-sized structures that are present on the edges of
the urethra right beneath the prostate gland. The bulbourethral gland
produces a slippery, clear fluid which empties into the urethra.

6. Urethra
• It is a tube that carries urine starting from the bladder to travel outside the
body. Considering males, the additional purpose of ejaculating semen at
the time of orgasm is managed by the urethra. Whenever the penis gets
erect at the time of sex, the urine flow is blocked by the urethra.

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7. Vas Deferens
• Vas deferens is basically a muscular, long tube that initiates from the
epididymis and travels to the pelvic cavity. Transportation of mature sperm
is managed by vas deferens that leads to the urethra.

2. Male Reproductive Hormone

Testosterone is a male sex hormone that plays an important role in sexual and
reproductive development. They are responsible for the sex drives of men and
affect their reproductive abilities as well.

Testosterone belongs to a class of male hormones called androgens, which are

sometimes called steroids or anabolic steroids. In men, testosterone is produced
mainly in the testes, with a small amount made in the adrenal glands. The brain's
hypothalamus and pituitary gland control testosterone production. The
hypothalamus instructs the pituitary gland on how much testosterone to produce,
and the pituitary gland passes the message on to the testes. The communications
happen through chemicals and hormones in the bloodstream.

2.1 Important Hormones in the Male Reproductive System

The most important hormones involved in the male reproductive system are listed
below and also from where it is been secreted and produced.
• Gonadotropin-Releasing Hormone (GnRH) is secreted from the
hypothalamus,
• Follicle-Stimulating Hormone (FSH), and Luteinizing Hormone (LH) is
produced by the anterior portion of the pituitary gland,
• The gonads produce Estrogen (Estradiol) and Testosterone.
• The Hypothalamic-Pituitary Gonadal Axis (HPG) refers to the
hypothalamus, pituitary, and gonadal glands and it plays a critical role in the
development and regulation for the various body systems, such as
reproductive and immune systems.

2.2 The Important Functions of Testosterone

Testosterone has numerous important functions throughout the body.
1. Plays a role in reproduction and maintenance of bone and muscle strength
2. Develops the public and private hair
3. Develops growth of the penis and testes
4. Changes or deepening of the voice
5. Promotes strength and endurance
6. Promotes development of the body

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 Figure 3. Hormonal regulation of the male reproductive system

4. Female Reproductive System

The female reproductive system consists of the external genital organs and
internal genital organs. The breasts are sometimes considered part of the
reproductive system. However, other parts of the body also affect the development
and functioning of the reproductive system. They include the following:
• Hypothalamus (an area of the brain)
• Pituitary gland (located at the base of the brain, directly below the
hypothalamus)
• Adrenal glands (located on top of the kidneys)

The hypothalamus orchestrates the interactions among the genital organs,

pituitary gland, and adrenal glands to regulate the female reproductive system (see
figure Major Endocrine Glands). These parts of the body interact with each other
by releasing hormones. Hormones are chemical messengers that control and
coordinate activities in the body. The hypothalamus produces gonadotropin-
releasing hormone, which stimulates the pituitary gland to produce luteinizing
hormone and follicle-stimulating hormone. These hormones stimulate the ovaries
to produce the female sex hormones, estrogen and progesterone, and some male
sex hormones (androgens). (Male sex hormones stimulate the growth of pubic and
underarm hair at puberty and maintain muscle mass in girls as well as boys.) After

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childbirth, the hypothalamus signals the pituitary gland to produce prolactin, a
hormone that stimulates milk production.

4.1 External Organs (Pudendum or vulva)

The external genitalia lies outside the true pelvis, clitoris, urethral (urinary) meatus,
labia majora and minora, vestibule, greater vestibular (Bartholin) glands, Skene
glands, and periurethral area.
The function of the external female reproductive structures (the genitals) is twofold:
To enable sperm to enter the body and to protect the internal genital organs from
infectious organisms. The main external structures of the female reproductive
system include:

1. Mons Pubis
• The soft mound at the front of the vulva, the mons pubis, is formed by fatty
tissue covering the pubic bone. After the onset of puberty, the mons pubis
and the labia majora become covered by pubic hair. This hair sometimes
extends to the inner thighs and perineum, but the density, texture, color,
and extent of pubic hair coverage vary considerably due to both individual
variation and cultural practices of hair modification or removal.

2. Labia majora
• The labia majora enclose and protect the other external reproductive
organs. Literally translated as "large lips," the labia majora are relatively
large and fleshy and are comparable to the scrotum in males. The labia
majora contain sweat and oil-secreting glands. After puberty, the labia
majora are covered with hair.

4.1.3 Labia minora

• Literally translated as "small lips," the labia minora can be very small or up
to 2 inches wide. They lie just inside the labia majora and surround the
openings to the vagina (the canal that joins the lower part of the uterus to
the outside of the body) and urethra (the tube that carries urine from the
bladder to the outside of the body).

4.1.4 Bartholin's glands

• These glands are located beside the vaginal opening and produce a fluid
(mucus) secretion.

4.1.5 Clitoris
• The two labia minora meet at the clitoris, a small, sensitive protrusion that
is comparable to the penis in males. The clitoris is covered by a fold of skin,
called the prepuce, which is similar to the foreskin at the end of the penis.
Like the penis, the clitoris is very sensitive to stimulation and can become
erect.

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4.1.6 Perineum
• The region between the genitals and the anus, including the perineal body
and surrounding structures. A perineal tear often occur in childbirth with
first-time deliveries, but the massage.

4.1.7 Prepuce
• The clitoral hood, normally covers and protects the clitoris; however, in
women exposed. The clitoral hood is the female equivalent of the male
foreskin and may be partially hidden inside of the pudendal cleft.

Figure 3. External Reproductive Organ

4.1.8 Urethral opening (meatus)

• Is located below the clitoris and just in front of the vagina. This is where urine
passes from the urinary bladder.

4.1.9 Opening of the vagina

• Is located at the bottom of the vulval vestibule toward the perineum.
• The term introits is more technically correct than “opening,” since the vagina
is usually collapsed, with the opening closed unless something is inserted.
• The introitus is sometimes partly covered by a membrane called the hymen.
The hymen will rupture during the first episode of vigorous sex, and the blood
produced by this rupture has been traditionally seen as a sign of virginity.

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 Bartholin glands which produce a waxy, pheromone-containing substance,
the purpose of which is not yet fully known.

4.1.10 Hymen
• Is a thin membrane that surrounds the opening of the vagina. Hymens can
come in different shapes. The most common hymen is shaped like a half
moon. The hymen will rupture during the first episode of vigorous sex, and
the blood produced by this rupture has been traditionally seen as a sign of
virginity. However, the hymen may also rupture spontaneously during
exercise or be stretched by normal activities such as use of tampons.

Figure 4. Normal Hymen

4.2 Internal Female Organ

The internal reproductive organs in the female include:
1. Vagina
• The vagina is a canal that joins the cervix (the lower part of uterus) to the
outside of the body. It also is known as the birth canal

Functions
✓ Organ of copulation
✓ Serve as menstrual and birth canal

2. Uterus (womb)
• The uterus is a hollow, pear-shaped organ that is the home to a developing
fetus. The uterus is divided into two parts: the cervix, which is the lower part
that opens into the vagina, and the main body of the uterus, called the
corpus. The corpus can easily expand to hold a developing baby. A channel
through the cervix allows sperm to enter and menstrual blood to exit.

Functions
✓ Hosts the developing fetus
✓ Produces vaginal and uterine secretions
✓ Passes the anatomically male sperm through to the fallopian tubes

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3. Ovaries
• The ovaries are small, oval-shaped glands that are located on either side of
the uterus. The ovaries produce eggs and hormones. The ovary is an ovum-
producing reproductive organ, typically found in pairs as part of the
vertebrate female reproductive system. Ovaries in females are analogous
to testes in males in that both are gonads and endocrine glands. Ovaries
secrete both estrogen and progesterone. Estrogen is responsible for the
appearance of secondary sex characteristics of females at puberty and for
the maturation and maintenance of the reproductive organs in their mature
functional state. Progesterone functions with estrogen by promoting
menstrual cycle changes in the endometrium.

Functions
✓ Produce the anatomically female egg cells.
✓ Produce and secrete estrogen and progesterone

Oogenesis
• The ovaries are the site of gamete (egg cell, oocyte) production. The
developing egg cell (or oocyte) grows within the environment provided by
ovarian follicles. Follicles are composed of different types and number of
cells according to their maturation stage, which can be determined by their
size. When oocyte maturation is completed, a luteinizing hormone (LH)
surge secreted by the pituitary gland stimulates follicle rupture and oocyte
release.

• This oocyte development and release process is referred to as ovulation.

The follicle remains functional and transforms into a corpus luteum, which
secretes progesterone to prepare the uterus for possible embryo
implantation. Usually each ovary takes turns releasing eggs each month.
However, this alternating egg release is random. When one ovary is absent
or dysfunctional, the other ovary will continue to release eggs each month.

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 Figure 5. Female Internal Reproductive system

4. Fallopian tubes
• These are narrow tubes that are attached to the upper part of the uterus
and serve as tunnels for the ova (egg cells) to travel from the ovaries to the
uterus. Conception, the fertilization of an egg by a sperm, normally occurs
in the fallopian tubes. The fertilized egg then moves to the uterus, where it
implants into the lining of the uterine wall. The lining of the fallopian tubes
are ciliated and have several segments, including the infundibulum,
ampulla, isthmus, and interstitial regions.

Functions
✓ Site of fertilization
✓ The Fallopian tube allows passage of the egg from the ovary to the
uterus

5. Hormonal Regulation of the Female Reproductive System

The hormones estrogen and progesterone. In this study module you will learn
much more about the role of these and other important hormones involved in the
regulation of the human menstrual cycle, the monthly production of mature ova
(eggs) by females of reproductive age, and the preparation of the uterus as a
welcoming environment for the start of a pregnancy.

5.1 Female Reproductive Hormones

As you will probably remember from your previous high school biology course, the
various functions of the body are regulated by the nervous system and the

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hormonal system. Both these systems are involved in controlling the activity of the
female reproductive system in a regular monthly series of events known as
the menstrual cycle, as we will now describe.

You should remember that a hormone is a signaling chemical produced in the

body, which circulates in the blood; different hormones control or regulate the
activity of different cells or organs. The functions of the five main hormones that
regulate the female reproductive system are described in below and their
interactions are illustrated.

5.2 Hormones Regulating the Female Reproductive System

1. Gonadotropin-releasing hormone (GnRH) is produced by a part of the brain
called the hypothalamus. When it circulates in the blood, it causes the release
of two important hormones from the pituitary gland in another specialized part
of the brain.

2. Follicle-stimulating hormone (FSH) is produced by the pituitary gland during

the first half of the menstrual cycle. It stimulates development of the maturing
ovarian follicle and controls ovum production in the female, and sperm production
in the male.

3. Luteinizing hormone (LH) is also produced by the pituitary gland in the brain.
It stimulates the ovaries to produce estrogen and progesterone. It
triggers ovulation (the release of a mature ovum from the ovary), and it
promotes the development of the corpus luteum.
Corpus luteum means ‘yellow body’, and after ovulation it develops in the ovary
from the enlarged ovarian follicle that released the ovum.
4. Estrogen is a female reproductive hormone, produced primarily by the ovaries
in the non-pregnant woman. It promotes the maturation and release of an ovum in
every menstrual cycle. It is also produced by the placenta during pregnancy.

5. Progesterone is produced by the corpus luteum in the ovary; its function is to

prepare the endometrium (lining of the uterus) for the reception and
development of the fertilized ovum. It also suppresses the production of
estrogen after ovulation has occurred.

5.3 Ovarian Cycle

The ovarian cycle refers to the monthly series of events in the ovaries, associated
with the maturation and release of an ovum, and the ‘just in case’ preparation for
its fertilization and implantation in the uterus. You may be wondering why the
regulation of the female reproductive system is so complicated. The reason is that
the ovarian cycle has to be initiated (switched on) and then suppressed (switched
off) in a precisely regulated sequence every month.

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 Figure 6. The ovarian and menstrual cycles of female reproduction are
regulated by hormones produced by the hypothalamus, pituitary,
and ovaries.

5.4 Menstrual Cycle

Menstruation/menses: The discharge of blood and other tissue after ovulation
when fertilization does not occur.

1. Purpose of Menstruation
• Maturity of ovum
• Renewal of uterine tissue bed

2. Characteristics
• Menarche – average 12-14 year (onset of menstruation)

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 • Interval – 28 days
• Duration 2-7days/4-5days
• Amount 30-80 ml
• Color – dark red (blood, mucus, endometrial cells, bacteria, leucocytes,
cellular debris)
• Bleeding – by vasospasm
• Factors that affect – emotions, illness, excessive fatigue, anxiety, rigorous
exercise, temperature and attitude

3. Uterine Cycle
1. Menstrual Phase: Day 1-6, estrogen low, cervical mucus scanty, viscous,
opaque, shading of endometrium.

Figure 7. Diagrammatic Representation of different Phases of Menstrual

Cycle along with changes occurring in Uterus, Pituitary & Ovarian
Hormones
2. Proliferative Phase: Day 7-14, endometrium and myometrium thickens,
ovulation occur
Cervical mucus is:
• Secretions are abundant
• Clear stretchy (Spinnbarkeit – elastic more than 5cm)
• Wet and slippery - much like a raw egg white
• During ovulation temperature at rise (0.3-0.6
• Mittelschmerz – is a one-sided, lower abdominal pain associated with
ovulation

22
3. Secretory/Luteal Phase: Day 15-26
• Estrogen drop, progesterone high
• Endometrium vascular
• Graafian follicle degenerates to become yellow body (corpus luteum –
secrete high progesterone
• Corpus luteum becomes corpus albicans which forms from the breakdown
of the corpus luteum when fertilization of the egg does not occur.

4. Ischemic Phase: Day 27-28

• Estrogen/progesterone decrease
• Spiral arteries –vasoconstriction
• Endometrium pale
• Blood vessels rupture
• If no fertilization, endometrium slough off

6. Mammary Gland
• It is a glandular, fibrous, adipose tissue: An accessory organ of reproduction,
situated over the pectoralis major muscles between the second and six ribs
and it is supported by Cowper’s ligaments
• It grows and develops from stimulation of secretion from hypothalamus,
anterior pituitary and ovaries
• This develop from ectodermic tissue
• Develop until a rise of in estrogen at puberty produces a marked increase in
size
• Glandular tissue undeveloped until a first pregnancy
• Boys may have a temporary increase in breast size (gynecomastia)
1. External Structures
1.1 Nipple or Mammary Papillae
✓ Anterior surface of each breast, made of smooth muscles (go into
erection when sucked or manually stimulated
✓ Has 15-20 openings connected to lactiferous ducts in which milk flows
out
1.2 Areola
✓ Pigmented and wrinkled skin that surround the nipple

1.3 Montgomery Tubercles

✓ Glands secrete oily substance that keeps areola and nipple lubricated
2. Internal Structure

23
 2.1 Milk glands are divided by connective tissue into 15-20lobes – divided into
several lobes
2.2 Lobules composed of clusters of acini cells
2.3 Acini cells milk secreting cells stimulated by prolactin hormone
2.4 Lactiferous ducts, ducts that serve as passageway of milk
2.5 Lactiferous sinus dilated portions of the ducts located behind the nipple that
serve as milk reservoir (ampulla portion of the ducts)

By stimulation – sensation send to posterior pituitary gland to release oxytocin.

Oxytocin constrict the milk gland cells and push milk forward into the ducts that
lead to the nipple. (Milk ejection). Prolactin is for milk production. Blood supply
(thoracic branches – internal mammary and intercostal arteries). Provide
nourishment to infant and transfer maternal bodies during breastfeeding.

Figure 6. Mammary Gland

3. Hormones that influence the Mammary Gland

• Estrogen stimulates the development of ductile structure of the breast
• Progesterone stimulates the development of the acinar structure of the
breast
• Human Placental Lactogen promotes development of breast during
pregnancy
• Oxytocin –Let down reflex this is inhibited by progesterone
• Prolactin stimulates milk production and inhibited by estrogen

24
LEARNING ACTIVITIES
Individual Activities
1. Draw the human reproductive system, identify and label parts and explain its
functions
a. Male and reproductive system
b. Female reproductive system (external and external)
2. Explain the purpose of the organs of the male reproductive system?
3. Define testosterone and enumerate the important hormones of the male
reproductive system and its functions.
4. Identify the hormones involved in menstrual cycle
5. Explain the flow of menstrual cycle
6. Describe the mammary glands

Supplemental Web links or resources

https://www.youtube.com/watch?v=Sr4recOxmNc&feature=share
https://www.youtube.com/watch?v=3Lt915LrWZw&feature
https://www.youtube.com/watch?v=VYSFNwTUkG0&feature=share

FLEXIBLE TEACHING LEARNING ACTIVITY MODALITY (FTLM) ADAPTED

• Modular
• Messenger
• Google class
• Zoom
• Teleducation

ASSESSMENT TASK

1. Give the four (4) female reproductive internal organs and state its functions.
2. Enumerate the three (3) purpose of male reproductive organs.
3. State the free (4) hormones regulating the female reproductive system
4. Identify and label the female external reproductive organs
5. Identify and label the male external and internal reproductive organs
6. State the parts and functions of mammary glands

25
Just to know if you understood the full content of this module after you have studied
it. Tick the box below where you are belong.

I need more help to learn I do not completely I understand the learning

this topic understand the topic today

______ ______ ______

REFERENCES
• https://bio.libretexts.org/Bookshelves/Human_Biology/Book%3A_Human_
Biology_(Wakim_and_Grewal)/22%3A_Reproductive_System/22.02%3A_
Introduction_to_the_Reproductive_System
• https://bio.libretexts.org/Bookshelves/Introductory_and_General_Biology/B
ook%3A_General_Biology_(Boundless)/43%3A_Animal_Reproduction_an
d_Development/43.4%3A_Hormonal_Control_of_Human_Reproduction/4
3.4A%3A_Male_Hormones
• https://bio.libretexts.org/Bookshelves/Introductory_and_General_Biology/B
ook%3A_General_Biology_(Boundless)/43%3A_Animal_Reproduction_an
d_Development/43.4%3A_Hormonal_Control_of_Human_Reproduction/4
3.4A%3A_Male_Hormones
• https://www.google.com/search?q=reproductive+hormones&rlz=1C1CHBF
_enPH736PH736&oq=reproductive+hormones&aqs=chrome..69i57j0l7.80
51j0j4&sourceid=chrome&ie=UTF-8
• https://courses.lumenlearning.com/wm-biology2/chapter/the-ovarian-cycle-
the-menstrual-cycle-and-
menopause/#:~:text=The%20ovarian%20cycle%20governs%20the,averag
e%20length%20of%2028%20days.
• https://www.sciencedaily.com/terms/mammary_gland.htm.

26
 MODULE 3. HUMAN ADULT REPRODUCTION

LEARNING OUTCOME

In this module, you will learn about the human reproduction. After completing this
module, you are expected to:

• Compare and contrast the different stages of sexual response cycle

• Discuss gametes formation and fertilization process
• Determine pregnancy, signs and symptoms and discomfort related to
pregnancy
• Demonstrate the development of embryo
• Evaluate genetic testing and prenatal testing
• Explain sexual differentiation
• Identify the different stages of puberty
• Discuss the physiology of menarche

1. Human Sexual Response

Definition of Terms
• Vasocongestion – Congestion of blood vessel
• Myotonia – Increase muscle tension

1.2 Phases of the Sexual Response Cycle

The sexual response cycle refers to the sequence of physical and emotional
changes that occur as a person becomes sexually aroused and participates in
sexually stimulating activities, including intercourse and masturbation. Knowing
how your body responds during each phase of the cycle can enhance your
relationship and help you pinpoint the cause of any sexual problems.

Figure 7. Sexual Response Cycle

27
The sexual response cycle has four phases: excitement, plateau, orgasm, and
resolution. Both men and women experience these phases, although the timing
usually is different, and enhance the sexual experience.

Phase 1: Excitement
General characteristics of the excitement phase, which can last from a few minutes
to several hours, include the following:
• Muscle tension increases.
• Heart rate quickens and breathing is accelerated.
• Skin may become flushed (blotches of redness appear on the chest and
back).
• Nipples become hardened or erect.
• Blood flow to the genitals increases, resulting in swelling of the woman's
clitoris and labia minora (inner lips), and erection of the man's penis.
• Vaginal lubrication begins.
• The woman's breasts become fuller and the vaginal walls begin to swell.
• The man's testicles swell, his scrotum tightens, and he begins secreting a
lubricating liquid.

Phase 2: Plateau
General characteristics of the plateau phase, which extends to the brink of orgasm,
include the following:

• The changes begun in phase 1 are intensified.

• The vagina continues to swell from increased blood flow, and the vaginal
walls turn a dark purple.
• The woman's clitoris becomes highly sensitive (may even be painful to
touch) and retracts under the clitoral hood to avoid direct stimulation from
the penis.
• The man's testicles tighten.
• Breathing, heart rate, and blood pressure continue to increase.
• Muscle spasms may begin in the feet, face, and hands.
• Muscle tension increases.

Phase 3: Orgasm
The orgasm is the climax of the sexual response cycle. It is the shortest of the
phases and generally lasts only a few seconds. General characteristics of this
phase include the following:

• Involuntary muscle contractions begin.

• Blood pressure, heart rate, and breathing are at their highest rates, with a
rapid intake of oxygen.
• Muscles in the feet spasm.
• There is a sudden, forceful release of sexual tension.

28
 • In women, the muscles of the vagina contract. The uterus also undergoes
rhythmic contractions.
• In men, rhythmic contractions of the muscles at the base of the penis result
in the ejaculation of semen.
• A rash, or "sex flush" may appear over the entire body.

Phase 4: Resolution
During resolution, the body slowly returns to its normal level of functioning, and
swelled and erect body parts return to their previous size and color. This phase is
marked by a general sense of well-being, enhanced intimacy and, often, fatigue.
Some women are capable of a rapid return to the orgasm phase with further sexual
stimulation and may experience multiple orgasms. Men need recovery time after
orgasm, called a refractory period, during which they cannot reach orgasm again. The
duration of the refractory period varies among men and usually lengthens with
advancing age.

2. Definition of Gametes
Gametes are the reproductive cells used during sexual reproduction to produce a
new organism called a zygote. The gametes in males and females are different.
The male gamete is called sperm. It is much smaller than the female gamete and
very mobile. It has a long tail, flagellum that allows it to move towards the female
gamete. The female gamete is called an egg or ova. It is much larger than the
sperm and is not made to move.
2.1 Formation of Gametes
Both the male and female gametes are formed during a process of cellular
reproduction called meiosis. During meiosis, the DNA is only replicated or copied
one time. However, the cells are divided into four separate cells. This means that
the new gamete cells have only half of the number of chromosomes as the other
cells. So, during meiosis, DNA or chromosomes are copied, then split into two cells
(with one full set of chromosomes each), then again split into two more cells,
leaving only half of the pairs of chromosomes in each new cell.
These new cells with only half of the chromosomes will mature into the gametes.
The gametes are haploid cells because they have only one set of chromosomes.
When they unite they will join their single sets of chromosomes to make a complete
set, and then they will be considered diploid cells. In the female, the eggs or ova
mature in the female's ovaries. The sperm will mature in the male's testes.

2.2 Fusion
During sexual reproduction, a male and female gamete will merge together to
form a new organism. The two haploid cells will fuse together to form a diploid cell
called a zygote. The zygote will undergo massive cellular reproduction and develop
into a new individual organism with half of the chromosomes from the mother and
half from the father.

29
3. Fertilization
Sperm are specially equipped with burrowing catalysts and mechanisms for
fertilizing an egg. The head region contains a cap-like covering called
an acrosome that contains enzymes that help the sperm cell penetrate the zona
pellucida, the outer covering of an egg cell membrane.
When a sperm reaches the egg cell membrane, its head fuses with the egg. This
triggers the release of substances that modify the zona pellucida to prevent any
other sperm from fertilizing the egg. This process is crucial as fertilization by
multiple sperm cells, or polyspermy, produces a zygote with extra chromosomes.
Polyspermy is lethal to a zygote.

3.1 Development
Upon fertilization, two haploid gametes become one diploid zygote. A human
zygote has 23 pairs of homologous chromosomes and 46 chromosomes total—
half from the mother and half from the father. The zygote continues to divide
by mitosis until a fully functional individual is formed. The biological sex of this
human is decided by the sex chromosomes it inherits.
A sperm cell may either have an X or Y sex chromosome, but an egg cell can only
have an X chromosome. A sperm cell with a Y sex chromosome results in a male
(XY) and a sperm cell.

Figure 8. Fertilization and implantation in humans

4. Pregnancy
4.1 Pregnancy/gestation, is the time during which one or more offspring develops
inside a woman.

30
 • Occurs when a sperm fertilizes an egg after it’s released from
the ovary during ovulation
• Fertilization and development of one or more offsprings, known as embryo or
fetus
• There can be multiple gestations, as in the case of twins or triplets

1. A fraternal twin pregnancy occurs when two eggs are released during
ovulation, and both eggs are fertilized
• Usually, only one egg is released during ovulation. However the ovaries
sometimes
release two eggs at once. It’s possible for both eggs to be fertilized by two
different sperm cells. In this case, you might become pregnant with twins.
• These twins will be known as fraternal twins (also called nonidentical twins).
Because they come from two separate egg cells and two separate sperm cells,
they won’t have the same DNA and might not look identical.
• Fertility treatments like IVF can increase the likelihood of multiple births,
according to Cleveland Clinic. This is because fertility treatments often involve
transferring more than one embryo to the uterus at a time to increase the
chances of pregnancy. Fertility drugs can also result in more than one egg being
released during ovulation.

2. An identical twin pregnancy occurs when the fertilized egg splits

• Sometimes, a single embryo splits after it’s been fertilized, resulting in identical
twins. Because both cells come from the exact same egg cell and sperm cell,
identical twins will have the same DNA, the same sex, and a nearly identical
appearance.

4.2 Signs and Symptoms of Pregnancy

• Presumptive Signs
✓ Amenorrhea
✓ Breast changes
✓ Urinary frequency
✓ Quickening
✓ Easy fatigability
✓ Leukorrhea
✓ Nausea and vomiting
✓ Chadwick’s sign
✓ Skin changes

• Probable Signs
✓ Hegar’s sign
✓ Uterine growth
✓ Ballottement
✓ Uterine soufflé
✓ Goodel’s sign
✓ Braxton Hick’s contractions
✓ Fetal outline

31
 ✓ Positive pregnancy test

• Positive Signs
✓ FHT
✓ Funic soufflé
✓ Fetal movement

4.3. Common Related Discomforts of Pregnancy

During your pregnancy you may have a number of annoying problems that are not
dangerous but may need some attention. These problems include cramps, urinary
frequency and incontinence, heartburn and indigestion, varicose veins, backache,
constipation, hemorrhoids and thrush.
Fortunately some simple changes can often relieve your symptoms. Always
contact your doctor or midwife if you have any concerns about these or any other
health problems during your pregnancy.

1. First Trimester
• Nausea and vomiting
• Urinary frequency
• Fatigue
• Breast tenderness
• Increased vaginal discharge
• Nasal stuffiness and nosebleed
• Ptyalism

2. Second Trimester
• Heart burn
• Ankle edema
• Varicose veins
• Hemorrhoids
• Constipation
• Backache
• Leg cramps

3. Third Trimester
• Faintness
• Dyspnea
• Flatulence
• Carpal tunnel syndrome

5. Embryo Development
After implantation occurs, the blastocyst is called an embryo. The embryonic
stage lasts through the eighth week following fertilization. During this time, the

32
embryo grows in size and becomes more complex. It develops specialized cells
and tissues and starts to form most organs.

33
 Figure 9 Fetal Development

Fetal Development (Weeks 9–38). Organ development is completed and body size
increases dramatically.

6. Genetic testing
Genetic testing is a type of medical test that identifies changes in chromosomes,
genes, or proteins. The results of a genetic test can confirm or rule out a suspected
genetic condition or help determine a person’s chance of developing or passing on
a genetic disorder.

6.1 Types of Genetic Testing during Pregnancy

1. Amniocentesis, take a sample of the amniotic fluid that surrounds a baby to
check for signs of problems such as chromosomal disorders, genetic problems,
and neural tube defects.
Examining a sample of the amniotic fluid lets doctors test things in the fluid, such
as cells shed by the fetus that contain genetic information

Second-trimester amniocentesis is most often used to identify:

• Down syndrome and other chromosome abnormalities
• Structural defects such as spina bifida
• Inherited metabolic disorders like PKU (phenylketonuria)

34
2. A chorionic villus sampling prenatal test checks cells from the placenta (which
are identical to cells from the fetus) to see if they have a chromosomal abnormality
(such as Down syndrome).
A CVS can be done from weeks 10 to 13 in a woman's pregnancy. It's a diagnostic
test rather than a screening test. That means that it can tell for sure whether a
baby will be born with a specific chromosomal disorder.

Figure 10. Amniocentesis Procedure

This test can be done two ways:
• Transcervical: Using ultrasound as a guide, a thin tube is passed from the
vagina into the cervix. Gentle suction removes a sample of tissue from the
chorionic villi.
• Transabdominal: A needle is inserted through the abdominal wall with
ultrasound guidance and a sample of the chorionic villi is removed.

35
 Figure Chorionic 11.Villus Sampling Procedure

7. Prenatal Testing
Prenatal testing consists of prenatal screening and prenatal diagnosis, which are
aspects of prenatal care that focus on detecting problems with the pregnancy as
early as possible.

When a woman is pregnant, prenatal tests give an information about the health of
mother and her baby. They help detect any problems that could affect him,
like birth defects or genetic diseases. The results can help you make the
best health care decisions before and after your child is born.

Prenatal tests are helpful, but it’s important to know how to interpret what they find.
A positive test result doesn’t always mean your baby will be born with a disorder.
You’ll want to talk with your doctor, midwife, or other health care provider about
what the tests mean and what you should do once you have the results.

7.1 Routine Prenatal Tests

• Ultrasound. This technology uses sound waves to make pictures of your
baby and your organ.
• Blood test
• Urinalysis

8. Sexual Differentiation and Development

Sexual differentiation, in human embryology, the process by which the male and
female sexual organs develop from neutral embryonic structures. The normal

36
human fetus of either sex has the potential to develop either male or female
organs, depending on genetic and hormonal influences.

In humans, each egg contains 23 chromosomes, of which 22 are autosomes and

1 is a female sex chromosome (the X chromosome). Each sperm also contains 23
chromosomes: 22 autosomes and either one female sex chromosome or one male
sex chromosome (the Y chromosome). An egg that has been fertilized has a full
complement of 46 chromosomes, of which two are sex chromosomes. Therefore,
genetic sex of the individual is determined at the time of fertilization; fertilized eggs
containing an XY sex chromosome complement are genetic males, whereas those
containing an XX sex chromosome complement are genetic females.

Every fetus contains structures that are capable of developing into either male or
female genitalia, and, regardless of the complement of sex chromosomes, all
developing embryos become feminized unless masculinizing influences come into
play at key times during gestation. In males, several testis-determining genes on
the Y chromosome direct the sexually undifferentiated (indeterminate)
embryonic gonads to develop as testes. The X chromosome also participates in
the differentiating process, because two X chromosomes are necessary for the
development of normal ovaries.

Two precursor organs exist in the fetus: the Wolffian duct,

which differentiates into the structures of the male genital tract, and the Müllerian
duct, the source of the female reproductive organs. During the third month of fetal
development, the Sertoli cells of the testes of XY fetuses begin to secrete a
substance called Müllerian inhibiting hormone. This causes the Müllerian ducts to
atrophy instead of develop into the oviducts (fallopian tubes) and uterus. In
addition, the Wolffian ducts are stimulated by testosterone to eventually develop
into the spermatic ducts (ductus deferens), ejaculatory ducts, and seminal
vesicles. If the fetal gonads do not secrete testosterone at the proper time, the
genitalia develop in the female direction regardless of whether testes or ovaries
are present. In normal female fetuses, no androgenic effects occur; the ovaries
develop along with the Müllerian ducts, while the Wolffian duct system
deteriorates. Sexual differentiation is completed at puberty, at which time the
reproductive system in both women and men is mature.

9. Puberty
Puberty is the time in life when a boy or girl becomes sexually mature. It is a
process that usually happens between ages 10 and 14 for girls and ages 12 and
16 for boys. It causes physical changes, and affects boys and girls differently.

James M. Tanner
• The Tanner Scale (also known as the tanner Stage) is a scale of physical
development in children, adolescents and adult. The scale defines physical
measurements of developmental based on external primary and secondary

37
 sex characteristics, such as the size of the breast, genitalia, testicular
volume of development of pubic and axillary hair. This scale was first
identified by James Tanner, a British pediatrician, and thus bears his name.

9.1The stages of Puberty: Development in Girls and Boys

Tanner stages in girls Age at the start Noticeable changes

Stage 1 After the 8th birthday None

Breast “buds” start to

Stage 2 From age 9–11 form; pubic hair starts to
form

Acne first appears;

armpit hair forms; height
Stage 3 After age 12
increases at its fastest
rate

Stage 4 Around age 13 First period arrives

Reproductive organs and

Stage 5 Around age 15 genitals are fully
developed

Tanner stages in boys Age at the start Noticeable changes

After the 9th or 10th

Stage 1 None
birthday

Stage 2 Around age 11 Pubic hair starts to form

Voice begins to change

Stage 3 Around age 13 or “crack”; muscles get
larger

Acne may appear; armpit

Stage 4 Around age 14
hair forms

Stage 5 Around age 15 Facial hair comes in

Table 1. Tanner Stages of Puberty

9.2 Problems can be encountered by both boys and girls during puberty
period

38
Acne
Acne can be a problem for both boys and girls. The changing hormones cause oils
to build up on the skin and clog pores. Your child can develop acne on the
face, back, or chest.
Some people have worse acne than others. If you have a family history of acne,
there’s a higher possibility your child will also experience acne.
Generally, you can treat acne by washing the affected areas regularly with a mild
soap. And there are also over-the-counter (OTC) creams and ointments to help
control breakouts. You may want to try some home remedies as well.
For more severe acne, you may consider taking your child to see
their pediatrician or a dermatologist. The doctor can recommend stronger
prescription treatments.

Body odor
Larger sweat glands also develop during puberty. To prevent body odor, talk to
your child about deodorant options and make sure they shower regularly,
especially after intense physical activity. Learn more about hygiene habits for kids
and teens.

Showing support
Puberty can be challenging for kids and parents. In addition to causing many
physical changes, hormones are also causing emotional changes. You may notice
your child is moody or behaving differently.
It’s important to react with patience and understanding. Your child may be feeling
insecure about their changing body, including their acne.
Talk about these changes and reassure your child it’s a normal part of maturing. If
something is particularly troubling, talk to your child’s doctor as well.

10. Physiology of Menarche

Menarche is the occurrence of a first menstrual period in the female adolescent.
Menstruation is the monthly shedding of the functional layer of the uterine
endometrial lining that occurs when ovulation is not followed by fertilization. It
occurs approximately every 28 days, with a range from every 21 to every 45 days.
The average age of onset of menarche is 12.4 years. Most menstrual periods last
between 3 and 7 days, and menses that last more than 10 days is considered
abnormal. Menarche signals maturation of the adolescent female body. It
commonly is associated with the ability to ovulate and reproduce. However, the
appearance of menarche does not guarantee either ovulation or fertility

Menarche occurs in the setting of a maturing hypothalamic-pituitary-ovarian (HPO)

axis. It relies on the following processes: normal hypothalamic and pituitary
function, normal female reproductive anatomy, normal nutrition, and the general
absence of other intervening chronic illness. It is a marker of normal female
reproductive health and wellness. Most females recognize menarche as their

39
body’s critical declaration of fertility. The absence of normal menstrual periods, not
related to pregnancy, is called amenorrhea. Primary amenorrhea is the complete
absence of any menstruation by 15 years of age. Secondary amenorrhea is the
cessation of menstruation for 3 months or more after it has started. In the first 2 to
3 years after the initial onset of menses, it is common for irregular cycles to occur,
with adolescents often having several months of missed menses. Many of these
irregular cycles may be nonovulatory due to poor early regulation of the hormonal
interactions between hypothalamic, pituitary, and gonadal hormones. Tracking
menstruation on a paper calendar or using a smartphone app can be helpful in
determining if menstrual periods are becoming more regular for adolescents and
also for predicting when ovulation is most likely to occur.

LEARNING ACTIVITIES
Individual Activities
1. Enumerate the stages of sexual response cycle and describe its stages
2. Discuss the gametes formation and fertilization process
3. State the signs and symptoms of pregnancy per semester
4. Illustrate and explain the milestones of embryo development
5. Explain the genetic and prenatal testing and its importance to pregnant women
6. Enumerate the stages of puberty and physical changes
7. Discuss the physiology of menarche

Supplemental Web links or resources

https://www.youtube.com/watch?v=DGyRD9HnXVs&feature=share
https://www.youtube.com/watch?v=VktZZEeGdSs&feature=share
https://www.youtube.com/watch?v=wCpg54vuEqA&feature=share
https://www.youtube.com/watch?v=PfRJe8Wxkew&feature=share
https://youtu.be/3HshQBrJbvg
https://youtu.be/rqVnyvfhld8

FLEXIBLE TEACHING LEARNING ACTIVITY MODALITY (FTLM) ADAPTED

• Modular
• Messenger
• Google class
• Zoom
• Teleducation

ASSESSMENT TASK

After reading this module and watched the link above, answer the following
questions:

40
1. Enumerate the stages of sexual response and explain the physiological changes
in its stages
2. Explain the fertilization process.
3. State the signs and symptoms of pregnancy per semester
4. Identify the common discomforts of pregnancy and enumerate recommended
interventions to relief discomforts.
5. Explain the week by week fetal development in the mother’s womb
6. What are the testing procedures used to determine genetic problems in
pregnancy
7. Identify the stages of puberty and physical changes within it.

Just to know if you understood the full content of this module after you have studied
it. Tick the box below where you are belong.

I need more help to learn I do not completely I understand the learning

this topic understand the topic today

______ ______ ______

REFERENCES

• https://www.youtube.com/watch?v=8RGRnCQNZWc
• https://www.youtube.com/watch?v=_5OvgQW6FG4
• 13.65: Embryo Growth and Development - Biology LibreTexts

41
MODULE 4. THE EFFECT OF AGING ON THE REPRODUCTIVE SYSTEM

LEARNING OUTCOME

In this module, you will learn about the different topics about the effect of aging
on the reproductive system. After completing this module, you are expected to:

• Determine the causes of menopause and andropause

• Differentiate the meaning of menopause and andropause
• Compare and contrast the signs of menopause and andropause
• Determine the complications of both menopause and andropause
• Discuss the treatment for menopause and andropause

LEARNING CONTENT

1. Menopause
1.1 Definition of Terms
1. Perimenopause this phase usually begins several years before
menopause, when your ovaries slowly make
less estrogen. Perimenopause lasts until menopause, the point at which your
ovaries stop releasing eggs.

2. Menopause is the time in a woman's life when her period stops. It usually
occurs naturally, most often after age 45. Menopause happens because the
woman's ovaries stop producing the hormones estrogen and progesterone.

3. Postmenopause these are the years after menopause. Menopausal

symptoms such as hot flashes usually ease. But health risks related to the loss
of estrogen increase as you get older.

1.2 Signs of Menopause

1. First signs
• A change in periods - shorter or longer, lighter or heavier, with more
or less time in between
• Hot flashes and/or night sweats
• Trouble sleeping
• Vaginal dryness
• Mood swings
• Trouble focusing
• Dry skin and eyes or mouth

2. Later symptoms
• Fatigue

42
 • Depression
• Crankiness
• Racing heart
• Headaches
• Joint and muscle aches and pains
• Weight gain
• Hair loss
• Changes in libido (sex drive)

1.3 Causes of Menopause

• Natural decline of reproductive hormones. As you approach your late 30s,
your ovaries start making less estrogen and progesterone — the hormones
that regulate menstruation — and your fertility declines. In your 40s, your
menstrual periods may become longer or shorter, heavier or lighter, and more
or less frequent, until eventually — on average, by age 51 — your ovaries
stop producing eggs, and you have no more periods.

• Hysterectomy. A hysterectomy that removes your uterus but not your

ovaries usually doesn't cause immediate menopause. Although you no longer
have periods, your ovaries still release eggs and produce estrogen and
progesterone. But surgery that removes both your uterus and your ovaries
(total hysterectomy and bilateral oophorectomy) does cause immediate
menopause. Your periods stop immediately, and you're likely to have hot
flashes and other menopausal signs and symptoms, which can be severe, as
these hormonal changes occur abruptly rather than over several years.

• Chemotherapy and radiation therapy. These cancer therapies can induce

menopause, causing symptoms such as hot flashes during or shortly after the
course of treatment. The halt to menstruation (and fertility) is not always
permanent following chemotherapy, so birth control measures may still be
desired.

• Primary ovarian insufficiency. About 1 percent of women experience

menopause before age 40 (premature menopause). Menopause may result
from primary ovarian insufficiency — when your ovaries fail to produce normal
levels of reproductive hormones — stemming from genetic factors or
autoimmune disease. But often no cause can be found. For these women,
hormone therapy is typically recommended at least until the natural age of
menopause in order to protect the brain, heart and bones.

1.4 Complications
After menopause, your risk of certain medical conditions increases. Examples
include:

• Heart and blood vessel (cardiovascular) disease. When your estrogen

levels decline, your risk of cardiovascular disease increases. Heart disease
is the leading cause of death in women as well as in men. So it's important to
get regular exercise, eat a healthy diet and maintain a normal weight. Ask

43
 your doctor for advice on how to protect your heart, such as how to reduce
your cholesterol or blood pressure if it's too high.

• Osteoporosis. This condition causes bones to become brittle and weak,

leading to an increased risk of fractures. During the first few years after
menopause, you may lose bone density at a rapid rate, increasing your risk
of osteoporosis. Postmenopausal women with osteoporosis are especially
susceptible to fractures of their spine, hips and wrists.

• Urinary incontinence. As the tissues of your vagina and urethra lose

elasticity, you may experience frequent, sudden, strong urges to urinate,
followed by an involuntary loss of urine (urge incontinence), or the loss of
urine with coughing, laughing or lifting (stress incontinence). You may have
urinary tract infections more often.
Strengthening pelvic floor muscles with Kegel exercises and using a topical
vaginal estrogen may help relieve symptoms of incontinence. Hormone
therapy may also be an effective treatment option for menopausal urinary
tract and vaginal changes which can result in urinary incontinence.

• Sexual function. Vaginal dryness from decreased moisture production and

loss of elasticity can cause discomfort and slight bleeding during sexual
intercourse. Also, decreased sensation may reduce your desire for sexual
activity (libido).
Water-based vaginal moisturizers and lubricants may help. If a vaginal
lubricant isn't enough, many women benefit from the use of local vaginal
estrogen treatment, available as a vaginal cream, tablet or ring.

• Weight gain. Many women gain weight during the menopausal transition and
after menopause because metabolism slows. You may need to eat less and
exercise more, just to maintain your current weight.

1.5. Diagnosis
There is no one test to diagnose menopause. Symptoms may indicate that
menopause is imminent but menopause can only be confirmed retrospectively
after periods have been absent for one year. Blood tests may be taken at to look
for indicators of menopause.

A change in bleeding patterns, particularly where periods become heavier, and an

absence of periods can indicate various medical conditions. It
is therefore advisable to consult a doctor before assuming that the changes are
menopausal symptoms. Also, if bleeding occurs after periods have been absent
for a year, a doctor should be consulted, as this is not considered normal.

1.6 Treatment
1. Menopausal Hormone Therapy (MHT)

44
 Menopausal Hormone Therapy (previously known for many years as Hormone
Replacement Therapy) involves replacing hormones previously produced by the
ovaries. It can be effective in relieving the symptoms of hot flushes, night sweats
and dryness of the vagina. MHT can also help to reduce the risk of osteoporosis
following menopause. Link to Menopausal Hormone Therapy for more
information.
2. Diet
Women need a higher intake of calcium and vitamin D after menopause to help
reduce the risk of osteoporosis. Excellent dietary sources of calcium include
low-fat dairy products (milk, cheese, yoghurt), nuts, dark green vegetables
(example: broccoli, spinach) and fish with bones in (example: sardines, salmon).
An intake of at least 1000mg of calcium daily is recommended for women after
menopause. Vitamin D, which helps the body to absorb calcium, is
manufactured by the skin after exposure to sunlight; small quantities are also
found in foods such as dairy products and eggs. If the diet contains insufficient
amounts of calcium and vitamin D, dietary supplements may be required. Eating
a healthy balanced diet that is low in fat and refined sugars, and maintaining a
healthy body weight, is recommended. Limiting alcohol and caffeine, and not
smoking, are also important.

3. Exercise
Regular weight-bearing exercise such as walking, dancing, tennis, aerobics and
golf helps in maintaining a healthy weight, fitness and general wellbeing.
Exercise also helps to decrease the risk of osteoporosis by strengthening the
bones and may assist in reducing the severity of menopausal symptoms such
as hot flushes. Specific pelvic floor exercises can help to reduce urinary
problems such as incontinence and pain on urination. Rest and stress reduction
also play an important role in managing menopause symptoms. Fatigue and
stress can worsen symptoms, so employing strategies to ensure adequate rest
is attained and stress is managed will assist in alleviating symptoms.

2. Andropause
Male menopause "is the more common term for andropause. It describes age-
related changes in male hormone levels. Male menopause involves a fall in
testosterone production in men aged 50 or older. It is often associated with
hypogonadism. Both conditions involve lowering testosterone levels and similar
symptoms. If you are a man, testosterone is a hormone produced in your testes. It
is more than the fuel of your sex drive. It also brings about changes during
adolescence, enhances your mental and physical energy, maintains your muscle
mass, controls your fight-or-flight response, and controls other key evolutionary
features.

2.1 Symptoms of Menopausal Men

Male menopause can cause physical, sexual, and psychological problems.
They usually get worse as you get older. They may include:

45
 • Low energy
• Sadness or sadness
• Reduced motivation
• Lowered self-confidence
• Difficulty concentrating
• Insomnia or difficulty sleeping
• Increased body fat
• Reduced muscle mass and feelings of physical weakness
• Gynecomastia, or development of breasts
• Reduced bone density
• Erectile dysfunction
• Decreased libido
• Infertility

2.3 Diagnosis and Treatment of Menopausal Men

Y our doctor may take a sample of your blood to test your testosterone levels.
Unless male menopause causes you severe discomfort or disruption in your
life, you are more likely to manage your symptoms without treatment. The
biggest barrier to treating menopausal men is to be able to talk to your doctor
about your symptoms. Many men are too scared or embarrassed to discuss
sexual topics with their doctors.

The most common type of treatment for male menopause symptoms is making
healthier lifestyle choices. For example, your doctor may advise you to:
• Eat a healthy diet
• Get regular exercise
• Get enough sleep
• Reduce your stress

These lifestyle habits can benefit all men. After using these habits, men who
experience menopausal symptoms of men may see a noticeable change in
their overall health. If you experience depression, your doctor may prescribe
antidepressant, therapy, and lifestyle changes. Hormone replacement therapy
is another treatment option. However, very controversial. Like the performance
enhancers of steroids, synthetic testosterone can have a detrimental effect. For
example, if you have prostate cancer, it can cause your cells to cancer. If your
doctor recommends hormone replacement therapy, weigh all the positives and
negatives before making your decision.

LEARNING ACTIVITIES
1. Define the related terms
• Menopause
• Pre-menopause

46
 • Andropause
• Hysterectomy

2. State the causes of menopause and andropause

3. Identify the complications of both menopause and andropause
4. Discuss treatment for menopause and andropause

Supplemental Web links or resources

https://www.youtube.com/watch?v=t3EO4jZRs8&feature=share
https://www.youtube.com/watch?v=hjBxRLhyd2l&feature=share

FLEXIBLE TEACHING LEARNING ACTIVITY MODALITY (FTLM) ADAPTED

• Modular
• Messenger
• Teleducation

ASSESSMENT TASK

1. Identify the causes of menopause and andropause

2. Explain the physiological changes in sexual life when you get older
3. Enumerate the signs and symptoms of menopause and andropause?
4. Identify the medical conditions brought about by menopause and andropause

Just to know if you understood the full content of this module after you have studied
it. Tick the box below where you are belong.

I need more help to learn I do not completely I understand the learning

this topic understand the topic today

______ ______ ______

REFERENCES
• Australasian Menopause Society (2018). Menopause basics (Web Page).
Healesville, Victoria: Australasian Menopause Society.

47
 • https://www.southerncross.co.nz/group/medical-library/menopause-signs-
symptoms-treatment
• https://www.southerncross.co.nz/group/medical-library/menopause-signs-
symptoms-treatment
• https://medbroadcast.com › condition › getcondition › andropause
• https:/www.womenshealth.gov › menopause › menopause-and-your-
health

MODULE 5 FAMILY PLANNING

LEARNING OUTCOME

In this module, you will learn about the different natural and artificial family
planning methods. After completing this module, you are expected to:

• Discuss the meaning of family planning and its importance to the family.
• Understand the different types of family planning methods
• Explain the advantages and disadvantages of the contraceptive methods

LEARNING CONTENT

1. Family Planning
Family planning is the information, means and methods that allow individuals to
decide if and when to have children. This includes a wide range of contraceptives
– including pills, implants, intrauterine devices, surgical procedures that limit fertility,
and barrier methods such as condoms – as well as non-invasive methods such as
the calendar method and abstinence. Family planning also includes information
about how to become pregnant when it is desirable, as well as treatment of
infertility.

Family Planning (FP) is having the desired number of children and when you
want to have them by using safe and effective modern methods. Proper birth
spacing is having children 3 to 5 years apart, which is best for the health of the
mother, her child, and the family.

Family planning saves lives

Contraceptives prevent unintended pregnancies, reduce the number of abortions,
and lower the incidence of death and disability related to complications of
pregnancy and childbirth. If all women in developing regions with an unmet need for
contraceptives were able to use modern methods, maternal deaths would be
reduced by a quarter and child deaths would decrease by as much as one fifth.

48
 Family planning empowers women
Access to contraceptive information is central to achieving gender equality. When
women and couples are empowered to plan whether and when to have children,
women are better enabled to complete their education; women’s autonomy within
their households is increased; and their earning power is improved. This
strengthens their economic security and well-being and that of their families.

1.1The Benefits of Using Family Planning

Family planning provides many benefits to mother, children, father, and the
family.

Mother
• Enables her to regain her health after delivery.
• Gives enough time and opportunity to love and provide attention to her
husband and children.
• Gives more time for her family and own personal advancement.
• When suffering from an illness, gives enough time for treatment and
recovery.

Children
• Healthy mothers produce healthy children.
• Will get all the attention, security, love, and care they deserve.

Father
• Lightens the burden and responsibility in supporting his family.
• Enables him to give his children their basic needs (food, shelter,
education, and better future).
• Gives him time for his family and own personal advancement.
• When suffering from an illness, gives enough time for treatment and
recovery.

2.1 Signs of Fertility

There are two main naturally occurring fertility signs that a woman can observe to
determine when she can or cannot become pregnant. These are:
✓ Changes in the cervical mucus: cervical mucus can be used to determine
the beginning and end of the fertile days.
✓ Changes in the basal body temperature: basal body temperature can be
used to determine when ovulation has passed and the fertile days have
ended.
✓ The first day of menstruation is the sign for keeping track of a woman’s
menstrual cycle.

2. Types of Contraceptive Methods

1. An IUD is a small object that goes inside your uterus.

49
The hormones or the copper stop the sperm reaching the egg. Sometimes,
sperm does reach the egg (fertilization) so the IUD stops the egg from attaching
to the wall of the uterus.

Figure 11. Intra Uterine Device

Most people notice some changes to their period.

With a copper IUD, your periods might be longer, heavier and more painful,
especially in the first few months. This usually gets better with time.

Advantages

• Long acting – it lasts for between 3 and 10 years depending on the type of
IUD
• Reversible – you can choose to have it taken out at any time. After that, you
will be able to get pregnant
• 99% effective – it works very well
• You don’t need to think about contraception every day
• Does not affect breastfeeding
• Does not get in the way of sex
• The copper IUD does not contain any hormones
• The copper IUD can also be used as emergency contraception

2. The implant or “the rods” are a type of long-acting reversible

contraception (LARC)
• More than 99% effective
• Works for up to 5 years
• ‘Fit and forget’ – you don’t need to do anything once it has been put in
• Your bleeding may change. If it is annoying there are pills to help
• You can choose when to have it taken out

The implant is made up of two small rods the size of a matchstick. The rods are
put under the skin in the inside of your arm. They slowly release a hormone called
progestogen. They work for up to 5 years. You can have them taken out whenever
you want.

50
Implants can stop your body from releasing an egg each month. They also thicken
the mucus in your cervix so sperm cannot get to an egg.

Figure 12. Implant

Advantages
• Long acting – it lasts for up to 5 years
• Reversible – you can choose to have it taken out at any time. After that, you
will be able to get pregnant again
• 99% effective – it works very well
• You don’t need to think about contraception every day
Studies show that implants do NOT cause any change in your weight, mood, sex
drive, or give you headaches.

Disadvantages
• You might have irregular periods or periods that last longer. This is quite
common in the first 6 months but it can last as long as you use the implant.
This can be annoying, but it’s not harmful and the implant will still work. If the
bleeding is a problem, you can get pills to help.
• You might have a sore or bruised arm after the implant is put in or taken out.
There is a small risk of infection
• Sometimes it’s not easy for the nurse or doctor to find the implant and you
might have to see someone else to take it out.

3. Hormonal contraceptives include the pill and the Depo Provera injection.
There are two types of pill:
1. Combined Oral contraceptive pill
• It is a pill you take every day to stop getting pregnant
• The combined pill contains the hormones estrogen and progestogen.
• Estrogen and progestogen stop eggs developing, so no egg is released
from the ovary.
• It is best to take this pill at the same time every day. You could set the
alarm on your phone to remind you.

51
If you are healthy and do not smoke you can keep taking the pill safely for many
years.
You should not use this pill if:
• You have had a heart attack, stroke or blood clot in your legs or lungs
• A family member has had a blood clot in their legs or lungs
• You are over 35 and smoke
• You are overweight
• You have migraines (very bad headaches)
• You use some types of medications or herbal remedies. The nurse or
doctor will talk to you about this.
• If you have your leg in plaster or you use a wheelchair.

Advantages
• Up to 99% effective
• Easy to use
• Doesn’t get in the way of sex
• You can choose to have lighter, less crampy periods or no period at all
• As soon as you stop taking the pill, you can get pregnant
• It reduces your risk of ovarian and endometrial (lining of the uterus) cancer
by 50%
• Some pills can help with pimples/acne.

Disadvantages
• You have to take it every day – even if you don’t have sex that day.
• You might have irregular bleeding in the first month or two. If the bleeding
continues, keep taking your pill but make an appointment to see a nurse or
doctor.
• You might get dark patches on your face.

2. The progestogen-only pill (POP) is a form of contraception

The POP is a pill taken to prevent pregnancy. The POP contains one hormone
- progestogen. It does not contain any estrogen.
POPs work mainly by thickening the mucus in the cervix so sperm can’t travel
through it. They also change the lining of the uterus so it is less likely to accept
a fertilized egg.

Advantages
• Easy to use - it is simple and convenient.
• Doesn’t interfere with sexual intercourse.
• Does not affect breastfeeding.
• Can be used by people of any age.

52
 • There are very few side effects. Research does not show that the POP
causes weight gain, depression or headaches.

Disadvantages
• The pill must be taken every day whether you have sexual intercourse on
that day or not. Some POPs need to be taken at the same time every day.
• This pill may change your periods. Some irregular bleeding may occur for a
few months after starting the pill. This does not mean the pill is less
effective as long as you have not missed pills. If the bleeding continues,
keep taking your pill but check with a nurse or doctor at one of our clinics.

4. The Depo Provera injection is a form of contraception

Depo Provera is a contraceptive injection containing progestogen. It is commonly
referred to as “the injection” or "DP".
Progestogen is similar to one of the hormones produced naturally in the ovaries.
The injection is given every 12 weeks.
• It prevents pregnancy by stopping the ovaries releasing an egg each month.
There are also changes to the lining of the uterus (endometrium).
• If you have your injections on time (every 12 weeks) it can be more than
99% effective.
• Your bleeding may be irregular or prolonged, especially in the first three to
six months. This is safe for your body and there are pills to stop this if it
happens.
• About 70% of people will have no periods after four injections. This is safe.

4.1 Advantages
• Almost 100% effective.
• Convenient.
• Lasts for 12 weeks.
• No daily pill taking.
• Doesn’t interfere with sexual intercourse.
• No one else needs to know you are using it.
• Reduces the risk of endometrial cancer (cancer of the lining of the uterus) by
80%.
• Helps if you have heavy or painful periods

4.2 Disadvantages
Once you have had an injection of Depo Provera, it lasts at least 12 weeks which
can be a nuisance if you experience a side effect.
It can cause irregular or prolonged bleeding. This is more common on first starting
to use Depo Provera and often improves with time.

5. Barrier methods stop sperm from entering the vagina. The two barrier
methods are:

53
The condom is a form of contraception. It also protects against sexually
transmissible infections (STIs). This page explains how a condom works and tells
you how to use it.

Figure 12. Male condom

A condom is a fine barrier which is rolled on to the penis before sex. It is used as
a barrier to stop sperm and infection passing between sexual partners. It is usually
made of rubber.
Condoms are used for vaginal, anal and oral sex.

5.1 Use Condoms

They help protect against pregnancy and sexually transmissible infections (STIs),
including HIV which can lead to AIDS. Partners share responsibility for safer sex
and contraception.
Most other methods of contraception don’t protect you against STIs, including HIV.
To protect yourself, use condoms as well.
Condoms are easy to get, are easy to use, have no side effects (unless you are
allergic to rubber) and help prevent cancer of the cervix.
Internal condoms are another type of condom. These are put inside the vagina.

5.2 How Safe Are Condoms

If used correctly every time you have sex, condoms provide very good protection
from pregnancy and infection.
When condoms are used correctly every time, the pregnancy rate is two out of 100
each year.
Typically however, 15 out of 100 will get pregnant each year when using condoms
as contraception.
Viruses such as HIV cannot pass through an unbroken rubber condom.

Studies Prove Safety of Condoms

Two studies prove the safety of condoms. The studies involved couples where one
person was HIV positive and the other was not infected.
The first study showed that if condoms were used correctly, none of the uninfected
partners got HIV. Where condoms were not used correctly, 10 out of every 100
partners became infected.

54
The second study showed that two out of 100 women became infected when
condoms were always used. Fifteen out of 100 women became infected if
condoms were not used every time.

5.3 Reduce Risk of STIs

Condoms are known to greatly reduce the risk of catching other STIs such as
chlamydia and gonorrhea.
Condoms also reduce the risk of syphilis, herpes and wart virus infection, but
sometimes skin not covered by the condom can become infected.

5.4 Condoms Slip or Break

• Not put on correctly.
• Torn by fingernails or teeth
• Not enough lubrication (wetness) during sexual intercourse.
• Wrong lubricant is used.
• Prolonged or very vigorous sexual intercourse.
• Penis goes soft before withdrawal.
• Condom slips off during withdrawal.
• Rubber loses its strength when condoms are kept in a warm place like a
glovebox or hip pocket.
• Rubber loses its strength because the condoms are past “use by” date.

6. Natural family planning Methods is a form of birth control that doesn't involve
pills or devices. As a result, you don't have side effects.
With these methods, you track your fertility, which is when you are most likely
to get pregnant.
Usually, a woman releases an egg from her ovaries at about the same time each
month. That’s called ovulation. The egg moves through the fallopian tubes toward
the uterus. An unfertilized egg can live up to 24 hours.
Most women are fertile for about 6 days each month -- 5 before ovulation and the
day of ovulation. Natural family planning uses different methods to pinpoint those
fertility days.
Rhythm method. One of the oldest ways of natural family planning, this is based
simply on the calendar. A woman's normal menstrual cycle lasts between 28 and
32 days. Ovulation usually happens around day 14. So you would avoid
unprotected sex on days 8 through 19, since that’s when you’re most fertile.
Cervical mucus or ovulation method. Here, you track
the mucus your cervix makes. When you're ovulating, your mucus is clear,
stretchy, and wet, like raw egg whites. You write down what your mucus is like
each day so you know when you're ovulating.
Basal body temperature (BBT) method. Your temperature can rise between 0.5
and 1 degree when you ovulate and stay there until your next period. With this
method, you take your temperature before you get out of bed each morning, before

55
you have anything to eat or drink. BBT by itself isn't a good way to prevent
pregnancy because charting your temperature tells you when ovulation has
already happened.
Symptothermal method. With this, you combine several methods, usually BBT
and cervical mucus. Using more than one method can give you a better idea what's
going on in your body

LEARNING ACTIVITES
Individual activities

• Discuss the meaning of family planning and its importance to the family.
• Write the different types of family planning methods
• Explain the advantages and disadvantages of the contraceptive methods

Supplemental Web links or resources

https://www.youtube.com/watch?v=EcQSwtMR55E&feature=share

FLEXIBLE TEACHING LEARNING ACTIVITY MODALITY (FTLM) ADAPTED

• Modular
• Messenger
• Teleducation

ASSESSMENT TASK

1. Define family planning

2. Enumerate the types of natural and artificial family planning methods.
3. Give the benefits of family planning to the mother, father and children

Just to know if you understood the full content of this module after you have studied
it. Tick the box below where you are belong.

I need more help to learn I do not completely I understand the learning

this topic understand the topic today

______ ______

56
 ______

REFERENCES

• https://www.unfpa.org/family-planning
• https://www.doh.gov.ph/faqs/What-is-family-planning
• https://www.familyplanning.org.nz/advice/contraception/combined-oral-
contraceptive-pill

MODULE 6. SEXUALLY TRANSMITTED DISEASES

LEARNING OUTCOME

In this module, you will learn about the various sexually transmitted diseases.
After completing this module, you are expected to:

• Define sexually transmitted diseases

• Discuss the signs and symptoms of STDs
• Determine the treatment, side effects and pharmacologic actions of the
drug of choice

LEARNING CONTENT

The term sexually transmitted disease (STD) is used to refer to a condition

passed from one person to another through sexual contact.

Figure 13. Sexually Transmitted Diseases

57
1. Chlamydia
Chlamydia is a bacterial infection of your genital tract. Chlamydia may be difficult
to detect because early-stage infections often cause few or no signs and
symptoms. When they do occur, they usually start one to three weeks after you’ve
been exposed to chlamydia. Even when signs and symptoms occur, they’re often
mild and passing, making them easy to overlook. Causative agent is Chlamydia
trachomatis.

1.1 Signs and symptoms in women may include:

• Painful and burning sensation when urinating
• Lower abdominal pain
• Vaginal discharge in women
• Pain during sexual intercourse in women
• Bleeding between periods in women
1.2 Signs and symptoms in men may include:
• Discharge from the penis in men
• Testicular pain in men
• Burning or itching around the opening of the penis

Untreated Chlamydia can cause pelvic inflammatory disease (PID). Treatment is

antibiotics

2. Gonorrhea
Gonorrhea is a bacterial infection of your genital tract. It can also grow in your
mouth, throat, eyes and anus. The causative agent is Neisseria gonorrhoeae.
The first gonorrhea symptoms generally appear within 10 days after exposure.
However, some people may be infected for months before signs or symptoms
occur.

2.1 Signs and symptoms of gonorrhea may include:

• Thick, cloudy or bloody discharge from the penis or vagina
• Pain or burning sensation when urinating
• Heavy menstrual bleeding or bleeding between periods
• Painful, swollen testicles
• Painful bowel movements
• Anal itching

2.2 Treatment and Prevention

Is treated with antibiotics
• Ceftriaxone injected into the muscle

3. Trichomoniasis

58
Trichomoniasis is a common STI caused by a microscopic, one-celled parasite
called Trichomonas vaginalis. This organism spreads during sexual intercourse
with someone who already has the infection. Causative agent is the
trichomoniasis
The organism usually infects the urinary tract in men, but often causes no
symptoms. Trichomoniasis typically infects the vagina in women. When
trichomoniasis causes symptoms, they may appear within five to 28 days of
exposure and range from mild irritation to severe inflammation.

3.1 Signs and symptoms in women may include:

• Clear, white, greenish or yellowish vaginal discharge
• Strong vaginal odor
• Vaginal itching or irritation
• Pain during sexual intercourse
• Painful urination

3.2 Signs and symptoms in men may include:

• Testicular pain in men

• Itching or irritation inside the penis
• Discharge from the penis
• Burning after urination or ejaculation

3.3 Treatment
• Metronidazole

4. Human Immunodeficiency Virus

HIV is an infection with the human immunodeficiency virus. HIV interferes with your
body’s ability to fight off viruses, bacteria and fungi that cause illness, and it can
lead to AIDS, a chronic, life-threatening disease.
When first infected with HIV, you may have no symptoms. Some people develop
a flu-like illness, usually two to six weeks after being infected. Still, the only way
you know if you have HIV is to be tested.

4.1 Early Signs and Symptoms

Early HIV signs and symptoms may include:
• Fever
• Headache
• Sore throat
• Swollen lymph glands
• Rash
• Fatigue

59
These early signs and symptoms usually disappear within a week to a month and
are often mistaken for those of another viral infection. During this period, you’re
highly infectious. More-persistent or -severe symptoms of HIV infection may not
appear for 10 years or more after the initial infection.
As the virus continues to multiply and destroy immune cells, you may develop mild
infections or chronic signs and symptoms such as:
• Swollen lymph nodes — often one of the first signs of HIV infection
• Diarrhea
• Weight loss
• Fever
• Cough and shortness of breath

4.2 Late-Stage HIV Infection

Signs and symptoms of late-stage HIV infection include:
• Persistent, unexplained fatigue
• Soaking night sweats
• Shaking chills or fever higher than 100.4 F (38 C) for several weeks
• Swelling of lymph nodes for more than three months
• Chronic diarrhea
• Persistent headaches
• Unusual, opportunistic infections

5. Genital Herpes
Highly contagious, genital herpes is caused by a type of the herpes simplex virus
(HSV) that enters your body through small breaks in your skin or mucous
membranes. Most people with HSV never know they have it, because they have
no signs or symptoms or the signs and symptoms are so mild they go unnoticed.
When signs and symptoms are noticeable, the first episode is generally the worst.
Some people never have a second episode. Others, however, can have recurrent
episodes for decades. Causative agent is Herpes Simplex Virus

5.1 Signs and in men and women may include:

• Small red bumps, blisters (vesicles) or open sores (ulcers) in the genital, anal
and nearby areas
• Pain or itching around the genital area, buttocks and inner thighs
• Ulcers
• Scabs skin will crust over and form scabs as ulcer heal

The initial symptom of genital herpes usually is pain or itching, beginning within a
few weeks after exposure to an infected sexual partner. After several days, small
red bumps may appear. They then rupture, becoming ulcers that ooze or bleed.
Eventually, scabs form and the ulcers heal.

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In women, sores can erupt in the vaginal area, external genitals, buttocks, anus or
cervix. In men, sores can appear on the penis, scrotum, buttocks, anus or thighs,
or inside the tube from the bladder through the penis (urethra).
Ulcers can make urination painful. You may also have pain and tenderness in your
genital area until the infection clears. During an initial episode, you may have flu-
like signs and symptoms, such as a headache, muscle aches and fever, as well as
swollen lymph nodes in your groin.
In some cases, the infection can be active and contagious even when sores aren’t
present.

6. Human Papillomavirus (HPV) Infection and Genital Warts Symptoms

HPV infection is one of the most common types of STIs. Some forms put women
at high risk of cervical cancer. Other forms cause genital warts. HPV usually has
no signs or symptoms. The signs and symptoms of genital warts include:
• Small, flesh-colored or gray swellings in your genital area
• Several warts close together that take on a cauliflower shape
• Itching or discomfort in your genital area
• Bleeding with intercourse

Often, however, genital warts cause no symptoms. Genital warts may be as small
as 1 millimeter in diameter or may multiply into large clusters.
In women, genital warts can grow on the vulva, the walls of the vagina, the area
between the external genitals and the anus, and the cervix. In men, they may occur
on the tip or shaft of the penis, the scrotum, or the anus. Genital warts can also
develop in the mouth or throat of a person who has had oral sex with an infected
person.

7. Hepatitis Symptoms
Hepatitis A, hepatitis B and hepatitis C are all contagious viral infections that affect
your liver. Hepatitis B and C are the most serious of the three, but each can cause
your liver to become inflamed.
Some people never develop signs or symptoms. But for those who do, signs and
symptoms may occur several weeks after exposure and may include:
• Fatigue
• Nausea and vomiting
• Abdominal pain or discomfort, especially in the area of your liver on your right
side beneath your lower ribs
• Loss of appetite
• Fever
• Dark urine
• Muscle or joint pain
• Itching
• Yellowing of your skin and the whites of your eyes (jaundice)

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8. Syphilis Symptoms
Syphilis is a bacterial infection. The disease affects your genitals, skin and mucous
membranes, but it can also involve many other parts of your body, including your
brain and your heart.
The signs and symptoms of syphilis may occur in four stages — primary,
secondary, latent and tertiary. There’s also a condition known as congenital
syphilis, which occurs when a pregnant woman with syphilis passes the disease
to her unborn infant. Congenital syphilis can be disabling, even life-threatening, so
it’s important for a pregnant woman with syphilis to be treated.

Primary Syphilis
The first sign of syphilis, which may occur from 10 days to three months after
exposure, may be a small, painless sore (chancre) on the part of your body where
the infection was transmitted, usually your genitals, rectum, tongue or lips. A single
chancre is typical, but there may be multiple sores.
The sore typically heals without treatment, but the underlying disease remains and
may reappear in the second (secondary) or third (tertiary) stage.

Secondary Syphilis
Signs and symptoms of secondary syphilis may begin three to six weeks after the
chancre appears, and may include:
• Rash marked by red or reddish-brown, penny-sized sores over any area of your
body, including your palms and soles
• Fever
• Enlarged lymph nodes
• Fatigue and a vague feeling of discomfort
• Soreness and aching
These signs and symptoms may disappear without treatment within a few weeks
or repeatedly come and go for as long as a year.

Latent Syphilis
In some people, a period called latent syphilis — in which no symptoms are present
— may follow the secondary stage. Signs and symptoms may never return, or the
disease may progress to the tertiary stage.

Tertiary Syphilis
Without treatment, syphilis bacteria may spread, leading to serious internal organ
damage and death years after the original infection.
Some of the signs and symptoms of tertiary syphilis include:
• Lack of coordination
• Numbness
• Paralysis
• Blindness

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• Dementia

Neurosyphilis
At any stage, syphilis can affect the nervous system. Neurosyphilis may cause no
signs or symptoms, or it can cause:
• Headache
• Behavior changes
• Movement problems

If You Suspect You Have an STI, See Your Doctor

If you suspect you have these or other STIs or that you may have been exposed
to one, see your doctor for testing. Timely diagnosis and treatment are important
to avoid or delay more-severe, potentially life-threatening health problems and to
avoid infecting others.

Figure 14. Common Outpatient Treatments

2. Diagnosis
Laboratory tests can identify the cause and detect coinfections you might have
with the present of signs and symptoms of STDs.
• Blood tests – confirm the diagnosis of HIV or later stages of syphilis

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 • Urine samples
• Fluid sample – if the patient have open genital sores, your doctor may test
fluid and samples from the sores to diagnose the type of infection

LEARNING ACTIVITES
Individual activities
1. Determine the different types of STDs and state the signs and symptoms
2. Enumerate the specific causative agents of STDs
2. Identify the laboratory tests and treatment for STDs

Supplemental Web links or resources

https://www.youtube.com/watch?v=letH8skr02E&feature=share

FLEXIBLE TEACHING LEARNING ACTIVITY MODALITY (FTLM) ADAPTED

• Modular
• Messenger
• Teleducation

ASSESSMENT TASK
1. Enumerate the different sexually transmitted diseases
2. Give the causative agents of the specific sexually transmitted diseases
3. Give the signs and symptoms of specific STDs
4. Identify the drug of choice for treatment of the STDs
5. What is your view on STDs? Is it preventable? If it can be avoided, what can
you advise people who have this kind of diseases?

Just to know if you understood the full content of this module after you have studied
it. Tick the box below where you are belong.

I need more help to learn I do not completely I understand the learning

this understand the topic today

______ ______ ______

64
REFERENCES

https://medlineplus.gov › Health Topics

https://www.healthline.com › health › sexually-transmitted-diseases

MODULE 7. HUMAN INFERTILITY

LEARNING OUTCOME

In this module, you will learn about the infertility. After completing this module,
you are expected to:

• Define unassisted reproduction and infertility

• Determine the factors of infertility
• Discuss infertility, causes and factors
• Requirements for male and female fertility

LEARNING CONCENT

1. Unassisted Reproduction
In order to understand assisted reproduction and how it can help infertile couples,
it is important to understand how conception takes place naturally. For traditional
conception to occur, the man must ejaculate his semen, the fluid containing the
sperm, into the woman’s vagina around the time of ovulation, when her ovary
releases an egg. Ovulation is a complex event controlled by the pituitary gland,
which is located at the base of the brain. The pituitary gland releases follicle-
stimulating hormone (FSH), which stimulates follicles in one of the ovaries to begin
growing. The follicle produces the hormone estrogen and contains a maturing egg.
When an egg is mature, the pituitary gland sends a surge of luteinizing hormone
(LH) that causes the follicle to rupture and release (ovulate) a mature egg.

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Figure 15. Solid arrows indicate path sperm must travel to reach the egg. The
fertilized egg continues traveling through the fallopian tube to the uterus.
Following ovulation, the egg is picked up by one of the fallopian tubes.
Since fertilization usually takes place inside the fallopian tube, the man’s
sperm must be capable of swimming through the vagina and cervical mucus,
up the cervical canal into the uterus, and up into the fallopian tube, where it must
penetrate the egg in order to fertilize it. The fertilized egg continues traveling to the
uterus and implants in the uterine lining, where it continues to develop.
2. Infertility
Inability of a couple to conceive and reproduce. Also defined as the failure to
conceive after one year of regular intercourse without contraception. Infertility can
affect either male or female and can result from a number of causes. Normally
fertility depends on the production of a sufficient number of heathy, motile sperm
by the male, delivery of those cells into the vagina, successful passage of the
sperm through the uterus and into the fallopian tubes, and penetration of a normal
ovum by one of the sperm.

2.1 Types of Infertility

▪ Primary infertility – denotes couples who have never been able to conceive.
▪ Secondary infertility – indicates difficulty in conceiving after already having
conceived.
▪ Fecundity - the ability of a couple to conceive after a certain time of
attempting to become pregnant

2.2 Factors Affecting fertility

• Frequency of intercourse

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• Timing of intercourse
Intercourse just before ovulation maximizes the chance of pregnancy
✓ Sperm survives as long as 5 days in the female genital tract
✓ Ovum life expectancy is about 1 day if not fertilized
✓ Sperm should be available in the female genital tract at or shortly
before ovulation
• STIs and other infections
✓ Gonorrhea and chlamydia can cause:
In women (PID) major cause of tubal infertility and cervicitis
In men: Urethritis, epididymitis, accessory gland infection
mumps, leading to orchitis, may cause secondary testicular
atrophy
• Age of the woman
✓ After 40 the fertility rate decreases by 50% while the risk of
miscarriage increases
• Age of the man
✓ Increased age affects coital frequency and sexual function
• Nutrition
✓ For women, weight 10% to 15% below normal or obesity may lead
to less frequent ovulation and reduced fertility

• Factors that can contribute to fertility problems includes

✓ Toxic agents such as lead, toxic fumes and pesticides
✓ Smoking and alcohol
All these factors may cause
✓ In women: reduced conceptions and increased risk of fetal
wastage
✓ In men: reduced sex drive and sperm count

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2.3 Requirements for Female and Male Fertility
✓ Adequate sexual drive and sexual function
✓ Normal immunologic responses to accommodate sperm and conceptus
✓ Adequate nutrition and health status to maintain nutrition and oxygenation
of lacenta and fetus

2.4 Requerements for Male Fertility

• Normal spermatogenesis in order to fertilize egg:
✓ Sperm count
✓ Motility
✓ Biological structure and function
Normal ductal system to carry sperm from the testicles to the penis
• Ability to transmit sperm to vagina achieved through:
✓ Adequate sexual drive
✓ Ability to maintain erection
✓ Ability to achieved normal ejaculation
✓ Placement of ejaculate in vaginal vault

2.5 Causes of Female infertility

• Pelvic inflammatory diseases (PID) leading to blocked or damaged fallopian
tubes
✓ May interfere with fertilization and transport of egg
• Ovarian dysfunction resulting in absent or diminished egg production
• Local factors in the uterus and cervix
✓ May interfere with implantation and woman’s ability to carry
pregnancy to term
• Luteal phase defect
✓ Results in low production of progesterone
✓ May lead to early miscarriage
• Production of anti-sperm antibodies
✓ Can interfere with fertilization

2.6 Causes of male Infertility

• Conditions that affect quality or quantity of sperm may lead to infertility
• These conditions include
✓ Varicocele
✓ Primary testicular failure
✓ Accessory gland infection
✓ Idiomatic low sperm motility

2.7. Causes of infertility affecting both Partners

• Psychological
✓ Sexual behavior may reflect couple’s desire not to have children
• Immunological incompatibility

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 ✓ May cause sperm agglutination
• Unknown causes

2.8 Basic work up for Infertility

Evaluating both partners are essential
• Detailed history and physical examination for both
• Semen analysis
• Evidence of ovulation
• Evidence of fallopian tubes patency
• Post coital test

2.9 Fertility Evaluation Procedure

• Couple should be informed about:
✓ Different causes of infertility
✓ Tests and procedures required to make a diagnosis
✓ Various therapeutic possibilities
• Couple’s interview is conducted together as well as separately to obtain
confidential information

2.10 Fertility Evaluation

2.10.1 General and sexual history
• General history
✓ Occupation and background
✓ Use of tobacco, alcohol and drugs
✓ History of abdominal surgery earlier diseases or infections
• Sexual history
✓ Sexual disturbances or dysfunction
✓ Dyspareunia or erectile dysfunction
✓ Sexually transmitted infections

2.11 Obstetric and gynecological history

• Reproductive history
• Gynecological history
• Age at menarche
• Previous contraceptive use
• Previous testing and treatment for infertility

LEARNING ACTIVITES
Individual Activities
1. Define unassisted reproduction and infertility
2. Determine the factors of infertility
3. Discuss infertility, causes and factors

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4. Requirements for male and female fertility

Supplemental Web links or resources

https://www.youtube.com/watch?v=0ZCEEY0cecA&feature=share
https://www.youtube.com/watch?v=NQ3cS1q_rtl&feature=share

FLEXIBLE TEACHING LEARNING ACTIVITY MODALITY (FTLM) ADAPTED

• Modular
• Messenger
• Teleducation

ASSESSMENT TASK

1. Define unassisted reproduction and infertility

2. Identify the types of infertility
3. Enumerate the and causes factors of infertility
4. State the requirements of fertility

Just to know if you understood the full content of this module after you have studied
it. Tick the box below where you are belong.

I need more help to learn I do not completely I understand the learning

this understand the topic today

______ ______ ______

REFERENCES

• https://www.slideshare.net/ebwhs/infertility-6409342
• https://www.who.int/reproductivehealth/topics/infertility/definitions/en/

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MODULE 8. ASSISTED REPRODUCTIVE TECHNOLOGY

LEARNING OUTCOME

In this module, you will learn about the assisted reproductive technology. After
completing this module, you are expected to:

• Discuss the types of assisted reproductive technologies

• Determine the advantages and disadvantages of In Vitro Fertilization
• Dissect the ethical, legal and social issues impacted by assisted
reproductive technologies on religious perspectives

LEARNING CONTENT

1. The Assisted Reproduction Technology

A.1 Robert Geoffrey Edwards is an English physiologist and pioneer in
reproductive medicine and In-Vitro Fertilization. Along with surgeon Patrick
Steptoe, and the nurse Jean Purdy. Edwards successfully pioneered conception
through IVF, which led to the birth of Louise Brown on 25 July 1978.

1.2 Assisted reproductive technology (ART) is used to treat infertility. It includes

fertility treatments that handle both a woman's egg and a man's sperm. It works by
removing eggs from a woman's body. The eggs are then mixed with sperm to make
embryos. The embryos are then put back in the woman's body. In vitro fertilization
(IVF) is the most common and effective type of ART.

ART procedures sometimes use donor eggs, donor sperm, or previously frozen
embryos. It may also involve a surrogate or gestational carrier. A surrogate is a
woman who becomes pregnant with sperm from the male partner of the couple. A
gestational carrier becomes pregnant with an egg from the female partner and the
sperm from the male partner.

The most common complication of ART is a multiple pregnancy. It can be

prevented or minimized by limiting the number of embryos that are put into the
woman's body.

2. Types of Assisted Reproductive System

1. Ovulation induction (OI) can be used if a woman is not ovulating or not ovulating
regularly. It involves taking a hormone medication (tablets or injections) to
stimulate ovulation. The response to the hormones is monitored with ultrasound
and when the time is right, an injection is given to trigger ovulation (the release

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 of the egg). Timing intercourse to coincide with ovulation offers the chance of
pregnancy.

2. Artificial insemination, which is sometimes called intrauterine insemination (IUI),

involves insertion of the male partner’s (or a donor’s) sperm into a woman’s
uterus at or just before the time of ovulation. IUI can help couples with so called
unexplained infertility or couples where the male partner has minor sperm
abnormalities achieve pregnancy. You can use the Pregnancy Predictor
Tool to check if IUI is a suitable option for you.

IUI can be performed during a natural menstrual cycle, or in combination with

ovulation induction (OI) if the woman has irregular menstrual cycles. If a
pregnancy is not achieved after a few IUI attempts, IVF or ICSI may be needed.

3. In Vitro Fertilization, during IVF, the woman has hormone injections to stimulate
her ovaries to produce multiple eggs. When the eggs are mature they are
retrieved in an ultrasound-guided procedure under light anaesthetic. The eggs
and sperm from the male partner or a donor are placed in a culture dish in the
laboratory to allow the eggs to hopefully fertilize, so embryos can develop. Three
to five days later, if embryos have formed, one is placed into the woman's uterus
in a procedure called embryo transfer. If there is more than one embryo, they
can be frozen and used later if the first transfer is not successful. H (IVF)

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Figure 16. Single embryo transfer (transferring one at a time) is considered the
gold standard of practice in IVF to minimize the risk of multiple pregnancy which
are associated with high risk to both mother and babies
IVF is safe
In the hands of experts, IVF is a safe procedure and medical complications are
rare. But as with all medical procedures, there are some possible health effects for
women and men undergoing treatment and for children born as a result of
treatment.

4. Intracytoplasmic Sperm Injection (ICSI) is used for the same reasons as IVF,
but especially to overcome sperm problems. ICSI follows the same process as
IVF, except that ICSI involves the direct injection of a single sperm into each
egg to hopefully achieve fertilization.

Because it requires technically advanced equipment, there are additional costs

for ICSI. For couples with male factor infertility, ICSI is needed to fertilize the
eggs and give them a chance of having a baby. But, for couples who don’t have
male factor infertility, ICSI offers no advantage over IVF in terms of the chance
of having a baby.

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5. Intracytoplasmic morphologically selected sperm injection (IMSI) is a method
used in IVF to select a sperm so it can be injected into an egg. This is a variation
of ICSI or intracytoplasmic sperm injection which has been used for about 30
years to help couples overcome male factor problems. ICSI has greatly
improved birth rates for this group.

ICSI involves a scientist viewing sperm under a microscope with 200 times
magnification and selecting one to inject into the egg. The IMSI technique is a
variation of ICSI where a microscope with even higher magnification is used
(6,000 times). The reasoning for this is that it allows scientists to view more
detailed images of the sperm which may help them choose the ‘strongest’.

6. Donor sperm
There are many reasons why donor sperm, eggs or embryos may be needed.

Donor insemination (DI) may be used when:

• A male partner does not produce any sperm,

• A male partner does not produce normal sperm, or
• There is a high risk of a man passing on a genetic disease or abnormality
to a child.
Donor insemination can also be used by single women and women in same-sex
relationships. The process of donor insemination is the same as IUI. If the woman
also has an infertility problem, donor sperm can be used in IVF treatment.

Donor eggs
Treatment with donor eggs may be needed when:
• A woman doesn’t produce eggs or her eggs are of low quality. This may be
due to age or premature menopause (ovarian failure)
• A woman has experienced several miscarriages, or
• There is a high risk of the woman passing on a genetic disease or
abnormality to a child.
In these cases, the egg donor has hormone injections to produce several eggs.
When the eggs are mature, they are retrieved and sperm from the recipient's
partner or a donor is added to the eggs. Two to five days later, when embryos have
formed, one is inserted into the recipient woman’s uterus. In the two to three weeks
leading up to the embryo transfer, the recipient woman takes hormones to make
sure the lining in the uterus is ready for an embryo to implant. If a pregnancy is
confirmed, the hormone treatment continues for another 8-10 weeks.

Donor embryos
Donor embryos can be used if a person or couple requires both donor sperm and
donor eggs to achieve a pregnancy. Although rare, some people who have frozen
embryos that they don’t need choose to donate them for someone else to use. The

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recipient woman takes hormones in preparation for the embryo transfer and when
she is ready, embryos are thawed and transferred to her uterus.
7. Pre-Implantation Genetic Testing

There are two types of PGT

1. PGT for monogenic/single gene defects (PGT-M) is used to identify embryos
that are not affected by a ‘faulty’ gene that can lead to disease.

2. PGT for chromosomal structural rearrangements (PGT-SR) is used to identify

embryos that have an incorrect amount of genetic material.

PGT-M and PGT-SR are also known as pre-implantation genetic diagnosis

(PGD).
In PGT, embryos are generated through the process of IVF or ICSI and then a
few cells are removed from the embryo and screened for the genetic condition.
Embryos that are not affected by the genetic condition are then selected for
transfer to the woman's uterus.
Assisted reproductive treatment clinics in Victoria perform PGT to avoid a range
of conditions. If there is a disorder that you are particularly concerned about,
contact your clinic.

8. Surrogacy - A pregnancy may be carried by the egg donor (traditional surrogate)

or by another woman who has no genetic relationship to the baby
(gestational carrier). If the embryo is to be carried by a surrogate, pregnancy may
be achieved through insemination alone or through ART. The surrogate will
be biologically related to the child. If the embryo is to be carried by a
gestational carrier, the eggs are removed from the infertile woman, fertilized with
her partner’s sperm, and transferred into the gestational carrier’s uterus.
The gestational carrier will not be genetically related to the child. All
parties benefit from psychological and legal counseling before pursuing
surrogacy or a gestational carrier.
3. Advantages of IVF
1. IVF helps many patients who would be otherwise unable to
conceive. The ultimate advantage of IVF is achieving a successful
pregnancy and a healthy baby. IVF can make this a reality for people who
would be unable to have a baby otherwise.

2. Blocked tubes: For women with blocked or damaged fallopian tubes, IVF
provides the best opportunity of having a child using their own eggs.

3. Older patients/ patients with a low ovarian reserve: IVF can be used to
maximize the chance of older patients conceiving. At CREATE, we have
great experience with older women and those with low ovarian reserve. We
use Natural IVF to focus on quality of eggs, rather than quantity.

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4. Male infertility: Couples with a male infertility problem will have a much
higher chance of conceiving with IVF than conceiving naturally. We have a
number of laboratory techniques to facilitate this including intra-cytoplasmic
sperm injection (ICSI). We also have an experienced consultant urologist to
advice men with fertility problems.

5. Unexplained infertility: 1 in 6 couples will suffer fertility problems and

sometimes these remain undiagnosed after investigation. These patients
may benefit from intervention.

6. PCOS: Polycystic ovary syndrome is common condition in which there is a

hormone imbalance leading to irregular menstrual cycles. IVF has proved
very successful in patients with PCOS, who will not conceive with ovulation
induction.

7. Endometriosis: Patients with endometriosis, where parts of the womb lining

grow outside the womb, may like to try IVF, as it has proved successful in
this group.

8. Premature ovarian failure: Women with premature ovarian failure or

menopause can have IVF treatment using donor eggs, which typically has
high success rates.

9. It has been used for a long time and has a safe track record. The first
‘IVF baby’, Louise Brown, was born using natural IVF in 1978. Since then,
the technology has advanced, and techniques refined in order to create
safer and successful treatment. We use only the safest forms of IVF
with fewer drugs in order to reduce the risk of side effects such as Ovarian
Hyperstimulation Syndrome (OHSS).

10. IVF can be more successful than IUI and other forms of assisted
reproductive technology. IVF success rates have been increasing since
its conception, thanks to technological advances. Although IUI and other
forms of assisted reproduction technology can be successful for some
patients, on the whole they have not undergone the same level of
improvement, and do not currently have as high success rates. IUI with
donor sperm can however be a useful first option in single women and
same-sex couples.

11. It can help single women and same-sex couples. For single
women or same-sex couples who wish to have a child, IVF can provide a
great opportunity for helping them to become parents if IUI has not been

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 successful. IVF with donor sperm can help potential patients achieve this
goal.

12. IVF can help to diagnose fertilization problems. In some cases of

unexplained infertility, there could be a problem with fertilization. Cases
such as these may not be diagnosed until fertilization is attempted in the
laboratory. Although this would be a disappointing outcome, it is useful to
be able to uncover such problems so that solutions could be reached for
future treatment with ICSI.

13. Unused embryos can be donated to research or another couple. If you

are lucky enough to have embryos to spare, these can be used to help other
people and even save lives. With the permission of the biological parents,
unused embryos can be donated for research purposes, or to another
couple to enable them to have a child.

14. Embryos can be used to screen for inherited diseases. For individuals
who are known carriers of genetic disorders such as cystic fibrosis,
Huntington’s disease and muscular dystrophy, IVF with pre-implantation
genetic diagnosis (PGD) is one of the most reliable ways to ensure that a
child conceived will not suffer from the disorder. Pre-implantation genetic
screening (PGS) can improve the chances of a successful outcome, as it
screens embryos for chromosomal disorders such as Down’s syndrome.
Both of these techniques are available at our clinics.

4. Disadvantages of IVF
1. An IVF cycle may be unsuccessful. The success of IVF is not guaranteed,
and patients often have to undergo more than one cycle of treatment before
they are successful. This naturally varies woman to woman, and a fertility
specialist will be able to give a more accurate and personalized likelihood
of success. It is important to be realistic but positive about the chances of
success.

2. There may be associated side effects and risks. As a medical treatment,

IVF comes with a small chance of developing side effects, the most severe
of these being severe ovarian hyper-stimulation syndrome (OHSS).
Fortunately, the use of fewer or no drugs in natural and mild IVF cycles
means that the already small likelihood of developing unwanted risk of OHSS
is dramatically decreased or eliminated. CREATE Fertility takes the
possibility of side effects very seriously.

3. Multiple pregnancy. In IVF treatments, there is often more than one embryo
put back into the uterus, and this leads to a higher likelihood of multiple
pregnancy; around 20-30% of IVF pregnancies can result in multiple

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 pregnancies. Multiple pregnancies do carry associated health risks to mother
and baby: there is an increased chance of premature labor, miscarriage,
need for caesarean, stillbirth and infant health problems with multiple
pregnancies. It is important for all fertility clinics to have robust single embryo
transfer policies, to avoid the risks of multiple pregnancy. At CREATE, we
have a low multiple birth rate and focus on the reduction of multiple births.

4. There is a slightly higher chance of ectopic pregnancy. With IVF

treatment, the risk of an ectopic pregnancy doubles, to 1-3%, particularly in
women with damaged fallopian tubes.

5. There is evidence that high estrogen levels associated with high

stimulation IVF can increase the risk of prematurity and low birth
weight in babies. There is growing evidence that giving high stimulation
during IVF increases the chance that a baby is born prematurely and with
lower birth weight. This has been linked to long-term health problems for the
child. It is theorized that high estrogen levels can affect the intra-uterine
environment. With drug-free and low drug approaches, it has been observed
that babies born are more likely to be born at full term and with a higher birth
weight than those born through high stimulation IVF associated with high
estrogen levels. This is one of the reasons why we are committed to Natural
and Mild IVF, as we believe that the success of treatment is not just a live
birth, but is a healthy full term live birth.

6. IVF treatment can take an emotional/psychological toll. Going through

IVF treatment can be a highly emotive and stressful experience. For patients
undergoing treatment, it can be physically and emotionally demanding. For
partners it can be difficult to watch a loved-one go through a stressful
experience. It is important to priorities your psychological health, and this is
also good for the health of the body. Our short, lower-drug protocols should
help to minimize the amount of stress.

7. IVF treatment can be expensive. IVF treatment is not cheap, and after
paying for medication and blood tests, the costs can quickly mount up. It is
good to have a clear idea of the costs involved before starting treatment, and
to have your finances in order before beginning. With fewer drugs, the cost
of a cycle is reduced at CREATE Fertility.

8. Some patients may be concerned about ethical issues. The idea of

selecting some embryos and potentially discarding others may not sit well
with everybody. Before starting treatment, consider your own stance and
what you would be comfortable with. If you are uncomfortable with the
creation of multiple embryos, we can support your choice by using Natural

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 Cycle IVF, or by freezing additional eggs rather than fertilizing them to create
embryos.

5. Religious Perspectives on Assisted Reproductive Practice

The Ethics of In Vitro Fertilization
In vitro fertilization has been a source of moral, ethical, and religious controversy
since its development. Although members of all religious groups can be found on
both sides of the issues, the major opposition has come from the Roman Catholic
Church, which in 1987 issued a doctrinal statement opposing IVF on three
grounds:
1. The destruction of human embryos not used for implantation;
2. The possibility of in vitro fertilization by a donor other than the husband, thus
removing reproduction from the marital context;
3. The severing of an essential connection between the conjugal act and
procreation.

The Roman Catholic Church rejects assisted reproductive Technologies and

teaches that the only acceptable method of human reproduction is sexual
intercourse between husband and wife for the purpose of having a child to love
and care for (Congregation for the Doctrine of the Faith, 2008;Ford, 2008).
However, the Orthodox Church has deep reservations about IVF (Nikolaos, 2008),
a combination of the gametes of a wife and husband in vitro and the implantation
of the resulting embryo in the wife’s uterus does not absolutely prohibited.

Most Protestant dominations and Sunni Muslim authorities agree with the Roman
Catholic Church. However in opposing gamete donation. Judaism permits both IVF
and surrogacy if the gametes come from the husband and wife. (Nikolaos,
Schenker and et al 2008). Religious scholars debate under what circumstances
the donation of sperm or eggs might be acceptable (Schenker, 2005, Schenker
2008, Teman, 2010). Shia Muslims in Iran and Lebanon are, in contrast to Sunnis,
very permissive about ART. In Iran have allowed the donation of eggs and even
of sperm as well as the donation of in vitro fertilized embryos, and the use of
surrogate mothers (Afshrar, 1212, Aramesh, 2009).

Based on the various perspectives of different religions through researches you

can say that their beliefs are somewhat different. There is a belief in accordance
with the word of God found in the bible. (Luke 23:29) For behold the days are
coming in which they shall say, Blessed are the barren, and the wombs that never
bare, and the paps which never gave suck.

LEARNING ACTIVITIES

1. Define assisted reproductive technology

2. Enumerate and explain the types of ART
3. Compare and contrast the advantages and disadvantages of ART
4. Describe the beliefs of the different religious perspectives

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5. Determine the ethical and moral implications of ART

Supplemental Web links or resources

1. https://www.youtube.com/watch?v=004tbkwE8HA&feature=share
2. https://www.youtube.com/watch?v=VO56L2xDWy0&feature-share
3. https://www.youtube.com/watch?v=uHDzsO58iOo&feature=share

FLEXIBLE TEACHING LEARNING ACTIVITY MODALITY (FTLM) ADAPTED

• Modular
• Messenger
• Teleducation

ASSESSMENT TASK

1. Define what ART

2. Identify the types of ART
3. Give the advantages and disadvantages of specific type of ART
4. Discuss how the procedure of different types of ART are performed

Just to know if you understood the full content of this module after you have studied
it. Tick the box below where you are belong.

I need more help to learn I do not completely I understand the learning

this understand the topic today

______ ______ ______

REFERENCES

• https://www.britanica.com/science/infertility
• https://www.varta.org.au/information-support/assisted-reproductive-thical
treatment/types-assisted-reproductive-treatment
• https://www.researchgate.net/publication/7916810_Assisted_reproductive
_practice _Religious perspectives

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