Natural Methods (Fertility Awareness Methods)

After ovulation, the human ovum is susceptible for fertilization for 24 hrs. After an intercourse, sperms can live up to 5 days, but they fertilize only about in 3 days. The most fertile period for woman is from 10th to 18th days, provided cycle is of 28 days. Coitus should be avoided during this fertile period.

Rhythm (Calendar) Method

Avoid intercourse between 7 to 21 days of menstrual cycle. This method has a high failure rate.

Basal Body Temperature Method

  • After ovulation, level of progesterone rises, which increases the body temperature (0.2-0.4 °C)
  • The woman should record her temperature every day before getting up from the bed in morning &before washing or taking any food. The thermometer should be kept under tongue for 5 minutes.


  • The end of preovulatory safe period cannot be detected. Couples are instructed to avoid intercourse during entire preovulatory & ovulatory periods and advised to meet 3 days after temperature rises
  • Cold, fever gives false information

Cervical Mucus Method

In preovulatory period, cervical mucus is found scanty & thick. At the time of ovulation, it becomes profuse, watery & slippery, which can be stretched between two fingers. This persists for about three days. These days are ‘wet days’; last day is called ‘peak day’. The couple should avoid sex until 4th day after ‘peak day’.


Not suitable for those with abnormal vaginal discharge

Symptothermal Method

This method is based on observation of basal body temperature, cervical mucus method & other manifestations of fertile period such as mid-cycle pain, mid-cycle spotting.

Barrier Methods

Male Condom

  • Silicon is used to produce semi-dry, pre-lubricated forms. They are supplied under various brand names of ‘Nirodh’, Nirodh Deluxe’ & ‘Nirodh Lubricated’.
  • Non-latex forms made of polyurethane have longer self-life.
  • Need no prescription
  • Suitable during lactation
  • Old age, infrequent coitus & premature ejaculation
  • Prevents sexually transmitted diseases (HIV, Syphilis, Gonorrhea)
  • During pregnancy, protects against amniotic fluid infections
  • Latex produces hyper-sensitization
  • Failure rate is high
  • Storage & disposal problems
  • Reduces sexual pleasures
Failure Rate

Average failure rate is 12%, but can be limited only to 3% when correctly & consistently used

Female Condoms

  • Trade name – ‘Femidom’ or ‘Reality’
  • Made up of polyurethane
  • Pre-lubricated with silicon-based lubricant (dimethicone)
  • Outer ring covers vulva & an inner ring is introduced in vagina.
  • Women controlled method
  • Prevents HIV & other sexually transmitted diseases

They are divided in three categories

  • Inert IUD-Lippes Loop: They are mostly abandoned these days
  • Copper-relating IUD: Copper 7, copper T-200, multiload copper 250, multiload copper 375, copper T 380Ag, copper T 380 S, Nova T, Copper T220C
  • Hormone-releasing IUD: Progestasert (Progesterone IUD), LNG-IUD (Mirena LNG-20), Cu-T 200, multiload copper 250, Cu-T 380 Ag; Mirena are widely used nowadays.


  • Requires only one-time motivation
  • No interference with intercourse
  • No systemic side effects
  • Return of fertility following its removal as immediate


  • Needs trained personnel for insertion
  • Some women cannot tolerate due to complications like ‘bleeding, pain, vaginal discharge & mild infection’
  • Expulsions occur sometimes unknowingly
  • Cu-T38Ag -0.6%
  • Mirena-0.1%
  • Reduction in blood loss in menorrhagia
  • Decrease in size of fibroids
  • Decreased pain in endometriosis & adenomyosis

Oral Contraceptives


(A) Combined Pills

(B) Progesterone – only Pills or Mini Pills

(A) Combined Pills:

1. Monophasic Pills:

Low-dose (std-dose) pills

  • Overal – L, Mala – D, Mala – N
  • (Ethinyl estradiol – 0.03mg, levonorgestrel-0.15mg)
  • Novelon (ethinyl estradiol – 0.03mg, desogestrel – 0.15mg)
  • Return of fertility following its removal as immediate

Very-low dose pills

  • Femilon (EE-0.02mg, desogestrel – 0.15mg)
2. Multiphasic Pills:
  • (biphasic & triphasic pills)
  • Triquilar (EE-00.3mg/levonorgestrel – 0.05mg for 6 days
  • EE-0.04mg/Levonorgestrel – 0.75mg for 5 days
  • EE – 0.03mg/levonorgestrel – 0.125 mg for 10 days

(B) Progesterone – only Pills or Mini Pills

Cerazette (Desogestrel – 0.075mg)

  • Regularizes menstrual cycles
  • Cures menorrhagia, premenstrual tension, dysmenorrhea, irregular bleeding
  • Protection against endometrial & ovarian cancer
  • Protection against benign breast disease & ovarian functional cysts
  • Nausea, vomiting & lack of appetite
  • Breast heaviness & tenderness
  • Increased vaginal discharge
  • Weight gain
  • Headache & migraine

All these side-effects do not occur with very low-dose OC pills. Low-dose pills also increase chances of ischemic stroke, venous thromboembolism, altered coagulation & lipid profile, cholestatic jaundice

Non-oral Hormonal Contraceptives

(A)Hormone-releasing IUDs:

  • Progestasert
  • LNG – 20 or Mirena

(B) Injectable contraceptives:

Progesterone– only:
  • Depot medroxyprogesterone acetate (Depo-provera)
  • Norethisterone enanthate (NET EN)
  • DMPA (25 mg) + estradiol : Cypionate (5mg) [Cyclofem]
  • NET EN (50mg)+estradiol: Valerate (5mg) [Mesigna]

(C) Contraceptive Implants:

  • Norplant (six capsules of levonorgestrel)
  • Implanon (single load device of 3-keto desogestrel)
  • LNG rod or Jadelle (Silastic – covered rods of levonorgestrel)

(D) Vaginal Rings:

  • LNG ring
  • Vaginal combined ring
  • Vaginal progesterone ring

(E) Transdermal Patches:

  • Depo-Provera (150 mg DMPA)
  • It is administered intramuscularly in buttocks every 3 months
  • Convenient use
  • No pain & bleeding as with IUD
  • No estrogenic side effects as with OC pills
  • Suitable for lactating women
  • Cures menorrhagia & dysmenorrhea
  • Weight gain
  • Irregular bleeding sometimes amenorrhea
  • Delay of several months in return of fertility after stopping
  • Breast & mood changes
  • Hair loss
Failure Rate
  • 0.2%-0.4%
  • Transdermal Patch (Ortho-evra)
  • Contains 0.02mg EE+150µgnorelgestromin
  • Patch is changed weekly for 3 weeks followed by patch-free week
  • Applied on dry skin on buttocks, lower abdomen, upper outer arm or upper body; not on breasts
  • Growth of baby: Ovulation takes place at around 14th day. Ovum & sperm will form zygote. It rapidly multiplies & implants in uterus at around 21st day)
Week 4:

Yolk sac & amniotic cavity, which will envelop and baby is developing in three specialized layers of cells: outer, middle & inner layer

Week 5:
  • From the outer layer, the neural tube forms;eventually brain & spinal cord
  • From the middle layer, blood vessels are formed
Week 6:
  • Heart starts beating
  • Brain develops in three parts: forebrain, midbrain & hindbrain
  • Facial features – eyes, ears & mouth are starting to form; limb buds & digestive system are beginning to develop.
Week 7:
  • Heart has developed the right & left chambers
  • Nostrils are visible
  • Esophagus & trachea are differentiating into separate tubes with lungs positioned on either side
Week 8:
  • The sex organs are forming
  • The 4-chamber heart, arteries & veins are developing
Week 9:
  • All major organs & nerves have formed
  • Eyelids, fingers & toes begin to develop
Week 10:

Cartilage, bones of skeleton & external genitalia continue to develop

Week 11:
  • Baby is graduated from embryo to foetus. The liver, intestine, brain and lungs begin to function. External genitalia have developed into a clitoris & labia majora (or penis)
  • Fingernails & toenails will begin to emerge.
Week 12:
  • Baby develops an ability to swallow, breathe and discharge amniotic fluid. Placenta is fully formed.
  • Joint & muscle developments allow movements
Week 13:

Vocal cords are beginning to develop. The baby develops some serious reflexes in there, kicking, jerking his arms around and sorts

Week 14:

Baby is able to suck the thumb. You may feel some fluttering movements like ‘butterfly wings’.

Week 15:

Blood vessels can be seen under thin skin & baby is covered with fine, fuzzy hairs called lanugo.

Week 16:
  • Baby may also start getting hiccups
  • Eyes, which were spaced wide, have migrated closer. Her eyes can make side-to-side movements. Backbone becomes stronger, so she can straighter her neck.
Week 17:
  • Meconium also begins to collect in her colon
  • Baby develops eyebrows & scalp hairs
Week 18:
  • Hardening of bone (ossification) occurs (legs & inner ear)
  • Baby will begin to hear
Week 19:

Baby’s skin becomes covered with white cheesy layer called Vernix Caseosa

Week 20:

Baby girl has developed her uterus, ovaries. Skin develops in layers (epidermis, dermis & subcutaneous fat) By this week, all women are able to feel foetal movements

Week 21:

Baby’s bone marrow is beginning to produce blood cells. Her liver & spleen have been handling this job so far.

Week 22:

Baby boy’s testes begin to descend from abdomen. Taste buds in tongue & nerve ending for touch starts developing

Week 23:
  • Baby is practicing inhalation & exhaustion
  • Pancreas also starts developing surfactant, which will enable lungs to expand
Week 24:
  • If baby is born this week, she will have chances of 50/50 percent of survival
  • She is 15inches long
Week 25:

She can curl his fingers in fist & baby is able to hear loud sounds

Week 26, 27, 28:

Brain surface is beginning to form its characteristic grooves

Week 29:

Around this time, baby is kicking & jabbing you all the night & seems to sleep all around the day

Week 30:

Baby is 17inches long between now and 37 weeks. She will gain about a half pound per week. You may notice bouts of baby hiccups.

Week 31:

Baby is nearly 18 inches long. Her iris of eye will respond by contracting to change between dark & light.

Week 32:

Foetal movements are beginning to lessen around this time, as it becomes bigger & getting crowded inside the uterus. Lanugo hairs begin to fall around this week.

Week 33:

By this week, she may settle into a position. She will be born in either head down or breech

Week 34:

Total length is about 19¾ inches

Week 35:

You should count foetal movements every day. Body fat accumulates nowadays. In facts, during last six weeks of pregnancy, your baby could gain several pounds.

Week 36:

Baby develops strong sucking muscles. Due to an accumulation of fat, wrinkly skin becomes smoother & cheeks become chubby.

Week 37:

At this stage, baby is gaining about a half an ounce each day

Week 38+39:

Her total length is 21½ inches. Fingernails have grown past her fingertips. Placenta continues to supply antibodies.

Week 40:

Around this time, your pretty & healthy baby would have arrived.