What are the main contraceptive methods?

Contraceptive methods involve the whole range of measures used to prevent pregnancy. They may be reversible or irreversible.

The reversible ones can be divided into the following groups:

• Natural Methods: Based on the identification of the day of ovulation in order to avoid unprotected sex during these fertile days. The most well-known are the Billings method, based on the organoleptic characteristics of cervical fluid variables, and the Rhythm method, based on preventing sex from three days before until three days after ovulation in patients with regular cycles and established ovulation.
• Barrier Methods: This avoids contact between male and female gametes. The best known and used is the male condom, which prevents the deposit of sperm in the woman’s vagina. This method also protects the couple from the spread of sexually transmitted diseases, hepatitis, HIV, warts, etc, and its use is recommended for casual sexual relations and where there is no stable partner. There is also a female condom but its use is much less comfortable and less frequent.
• Hormonal Methods: This method uses exogenous hormones which produce anovulation. They can be taken orally in tablet form, transdermally via patches or with the use of a vaginal ring.
• Intrauterine devices (IUDs): This method places a polypropylene device inside the uterus, usually in the form of a T or an anchor, and generates endometrial atrophy and a decrease in menstrual bleeding via the use of copper which acts as a spermicide or a hormone which has a gestagenic effect.

Irreversible methods can be grouped as follows:

• Tubal ligation: This method is based on the occlusion of the fallopian tubes, preventing fertilisation or the mixing of male and female gametes. It can be performed through a minilaparotomy during a caesarean or more usually by laparoscopy, which requires general anaesthesia. The contraceptive effect is immediate.
• Vasectomy: This technique is performed under local anaesthesia on an outpatient basis, occluding the different conducts. Ejaculation occurs but of sperm-free seminal plasma and without any loss of sexual pleasure. It takes a period of between 2-3 months until the absence of sperm in the ejaculate can be confirmed.
• Essure: This is a spring-shaped implant about 4 cm long which is inserted into the fallopian tubes through the inside of the uterus. It is performed without any anaesthesia on an outpatient basis and through a hysteroscopy. The procedure requires about three months to produce fibrosis and tubal occlusion.

Patients who have undergone one of these irreversible contraceptive methods have the ability to achieve pregnancy with IVF treatment (tubal ligation and Essure) and testicular puncture (Vasectomy).