**SeqAnt 2012: Recent Developments in Next-Generation Sequencing Annotation**

Matthew Ezewudo, Promita Bose, Kajari Mondal, Viren Patel, Dhanya Ramachandran and Michael E. Zwick

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/53339


**Author details**

*Menstruation: 4/28.*

*ing to conceive.*

232 Family Planning

*Case 5: IUD.*

*oral contraception.*

*Menarche to the 14 years.*

*Planning: use a condom.*

*Case 6: Irreversible.*

*to metallic chromium. Menarche at age 12.*

**8. Conclusions**

impairments.

*Plan: Remove the implant, preconceptional counseling.*

*Personal and family history without interest.*

*Menstruation: 7/26, abundant since always.*

*Two vaginal births, 2 and 4 years ago. Menstruation: 4/27, are not very abundant.*

*The implant is palpable and removed successfully. We advise her to wait for her period before attempt-*

*Female 34 years old. She does not want more children at the moment, but she does not want irreversible contraception since she does not know if she will want children in the future. She does not want to take*

*The most appropriate method? In this case we could offer the administration of an IUD, since it is reversible, but can last up to 5 years. We explain her that there is no conclusive evidence that long-term use of IUD leads to impaired fertility. Many other factors influence fertility, like aging or smoking.*

*A 42-year-old woman who visits her doctor after a 7-day menstrual delay. Demand planning advice. Personal history: Hypothyroidism under treatment, varicose syndrome, smoking 15 cig / day. Intolerant*

*Planning: coitus interruptus, because her husband does not "tolerate" the condom. Gynecological*

*Which contraceptive method is the most appropriate? Given her age, having two children, the personal*

None of the contraceptive methods described (OCCs, POP, emergency contraception, implants, rings, Cu IUD or LNG IUD) is associated with impaired fertility. A temporary delay in fertility can occur with COCs, but this does not alter 1 year conception rates significantly. Injectable contraceptives are associated with delays in fertility buy not with fertility

*Two pregnancies and vaginal births, babies of 3900gr and 4100gr at 31 and 38 years.*

*Conduct to follow: pregnancy test is performed, being negative. Menstruation at 3 days.*

*history, for this couple the best method of contraception would be vasectomy or tubal ligation.*

*review less than 1 year ago with ultrasound and cytology, without alterations.*

Blanca Patricia Bautista Balbás1 \*, Luis Alfredo Bautista Balbás2 and Alicia Pouso Rivera3

### **References**

[7] Singh B, Meyers LA. Estimation of single-year-of-age counts of live births, fetal losses, abortions, and pregnant women for counties of Texas. BMC Research Notes. 2017 May 8;**10**(1):178. DOI: 10.1186/s13104-017-2496-x

[20] Grigg-Spall H. The Pill is Linked to Depression – And Doctors Can no Longer Ignore it. The Guardian, October 3, 2016. Website: https://www.theguardian.com/commentisfree/2016/oct/03/pill-linked-depression-doctors-hormonal-contraceptives [accessed:

Contraceptive Methods and the Subsequent Search for a Pregnancy

http://dx.doi.org/10.5772/intechopen.72525

235

[21] Petitti DB, Sidney S. Four decades of research on hormonal contraception. The Perma-

[22] WHO Guideline Development Group. Medical Elegibility Criteria for Contraceptive Use. World Health Organization; http://apps.who.int/iris/bitstream/10665/181468/1/

[23] Kannan S, Gowri S. Contradicting/negative results in clinical research: Why (do we get these)? Why not (get these published)? Where (to publish)? Perspectives in Clinical

[24] Summers L, Price RA. Preconception care. An opportunity to maximize health in preg-

[25] Deligdisch L. Hormonal pathology of the endometrium. Modern Pathology. 2000 Mar;

[26] Benagiano G, Pera A, Primiero FM. The endometrium and hormonal contraceptives.

[27] Nassaralla CL, Stanford JB, Daly KD, Schneider M, Schliep KC, Fehring RJ. Characteristics of the menstrual cycle after discontinuation of oral contraceptives. Journal of Women's

[28] Casper RF. It's time to pay attention to the endometrium. Fertility and Sterility. 2011

[29] Jernstrom H, Knutsson M, Olsson H. Temporary increase of FSH levels in healthy, nulliparous, young women after cessation of low-dose oral contraceptive use. Contraception.

[30] Balogh A, Ditrói F, Lampé LGLH. FSH, estradiol and progesterone levels after discontinuation of hormonal contraception. Acta Universitatis Palackianae Olomucensis Facul-

[31] Jukic AM, Weinberg CR, Baird DD, Wilcox AJ. Lifestyle and reproductive factors associated with follicular phase length. Journal of Women's Health (2002). 2007 Nov;

[32] Ismail MS, Serour GI, Torsten U, Weitzel H, Berlien HP. Elevated serum prolactin level with high-dose estrogen contraceptive pills. The European Journal of Contraception &

[33] Jemstrom H, Knutsson M, Taskila P, Olsson H. Plasma prolactin in relation to menstrual cycle phase, oral contraceptive use, arousal time and smoking habits. Contraception.

[34] Pardthaisong T, Gray RH. The return of fertility following discontinuation of oral con-

traceptives in Thailand. Fertility and Sterility. 1981 May;**35**(5):532-534

October 31, 2017]

**13**(3):285-294

Sep;**96**(3):519-521

1995 Jul;**52**(1):51-56

**16**(9):1340-1347

1992;**46**:543-548

tatis Medicae. 1981;**101**:95-101

Reproductive Health Care. 1998 Mar;**3**(1):45-50

nente Journal. 2005 Winter;**9**(1):29-34

Research. 2014 Oct;**5**(4):151-153

9789241549158\_eng.pdf [Accessed on October 30, 2017]

Human Reproduction. 2000 Jun;**15**(Suppl 1):101-118

nancy. Journal of Nurse-Midwifery. 1993 Jul-Aug;**38**(4):188-198

Health (2002). 2011 Feb;**20**(2):169-177. DOI: 10.1089/jwh.2010.2001

[20] Grigg-Spall H. The Pill is Linked to Depression – And Doctors Can no Longer Ignore it. The Guardian, October 3, 2016. Website: https://www.theguardian.com/commentisfree/2016/oct/03/pill-linked-depression-doctors-hormonal-contraceptives [accessed: October 31, 2017]

[7] Singh B, Meyers LA. Estimation of single-year-of-age counts of live births, fetal losses, abortions, and pregnant women for counties of Texas. BMC Research Notes. 2017 May

[8] Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Human Reproduction Update.

[9] Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. Lancet. 2012 Jun 9;**379**(9832):2162-

[10] Grimes DA, Lopez LM, O'Brien PA, Raymond EG. Progestin-only pills for contraception. Cochrane Database of Systematic Reviews. 2013 Nov 13;**11**:CD007541. DOI:

[11] American Congress of Obstetricians and Gynecologists. Long-Acting Reversible Contraception (LARC): IUD and Implant. FAQ184 (may 2016). Available from: https:// www.acog.org/Patients/FAQs/Long-Acting-Reversible-Contraception-LARC-IUD-and-

[12] Freeman S, Shulman LP. Considerations for the use of progestin-only contraceptives. Journal of the American Academy of Nurse Practitioners. 2010 Feb;**22**(2):81-91. DOI:

[13] National Collaborating Centre for Women's and Children's Health. Long-acting reversible contraception. Nice Clinical Guideline (Oct 2005, updated Sept 2014). National Institute for Health and Clinical Excelence. https://www.nice.org.uk/guidance/cg30

[14] Harlap S, Davies AM, Deutsch L, et al. The Jerusalem perinatal study cohort, 1964- 2005: Methods and a review of the main results. Paediatric and Perinatal Epidemiology.

[15] Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine copper T-380A contraceptive device. International Journal of Women's Health.

[16] Jones J, Mosher W, Daniels K. Current Contraceptive use in the United States, 2006-2010,

[17] Guttmacher Institute. Contraceptive Use in the United States. September 2016. Available

[18] Klerings I, Weinhandl AS, Thaler KJ. Information overload in healthcare: Too much of a good thing? Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen.

[19] Davey M. Push to Dispel Myths about Long-Lasting Contraception. The Guardian, September 26, 2017. Website: https://www.theguardian.com/society/2017/sep/26/push-

to-dispel-myths-about-long-lasting-contraception [Accessed: October 31, 2017]

from: www.guttmacher.orgNatl Health Stat Report. 2012 Oct 18;(60):1-25

8;**10**(1):178. DOI: 10.1186/s13104-017-2496-x

234 Family Planning

2172. DOI: 10.1016/S0140-6736(12)60820-4

10.1002/14651858.CD007541.pub3

Implant [Accessed on: 12-10-2017]

10.1111/j.1745-7599.2009.00473.x

(accessed on 30/10/2017)

2007;**21**(3):256-273

2010 Aug 9;**2**:211-220

and Changes in Patterns of use Since 1995

2015;**109**(4-5):285-290. DOI: 10.1016/j.zefq.2015.06.005

2014 Mar-Apr;**20**(2):250-261. DOI: 10.1093/humupd/dmt047

[35] Newton J, Curson R. Endocrine assessment of post-pill amenorrhoea. Proceedings of the Royal Society of Medicine. 1973 Jun;**66**(6):567-569

[50] Korver T, Klipping C, Heger-Mahn D, Duijkers I, van Osta G, Dieben T. Maintenance of ovulation inhibition with the 75 microg desogestrel-only contraceptive pill (Cerazette)

Contraceptive Methods and the Subsequent Search for a Pregnancy

http://dx.doi.org/10.5772/intechopen.72525

237

[51] WHO. Emergency Contraception Fact sheet. World Health Organization, updated June 2017. Website: http://www.who.int/mediacentre/factsheets/fs244/en/ [Accessed:

[52] Schreiber CA, Sober S, Ratcliffe S, Creinin MD. Ovulation resumption after medical abortion with mifepristone and misoprostol. Contraception. 2011 Sep;**84**(3):230-233.

[53] Rothman KJ. Fetal loss, twinning and birth weight after oral-contraceptive use. The New

[54] Murphy MF, Campbell MJ, Bone M. Is there an increased risk of twinning after discontinuation of the oral contraceptive pill? Journal of Epidemiology and Community

[55] Macourt DC, Stewart P, Zaki M. Multiple pregnancy and fetal abnormalities in association with oral contraceptive usage. The Australian & New Zealand Journal of Obstetrics

[56] Harlap S. Multiple births in former oral contraceptive users. British Journal of Obstetrics

[57] Lambalk CB, Boomsma DI, De Boer L, et al. Increased levels and pulsatility of folliclestimulating hormone in mothers of hereditary dizygotic twins. The Journal of Clinical

[58] Ford JH, MacCormac L. Pregnancy and lifestyle study: The long-term use of the contraceptive pill and the risk of age-related miscarriage. Human Reproduction. 1995 Jun;

[59] García-Enguídanos A, Martínez D, Calle ME, Luna S, Valero de Bernabé J, Domínguez-Rojas V. Long-term use of oral contraceptives increases the risk of miscarriage. Fertility

[60] Hahn KA, Hatch EE, Rothman KJ, Mikkelsen EM, Brogly SB, Sørensen HT, Riis AH, Wise LA. History of oral contraceptive use and risk of spontaneous abortion. Annals of

Epidemiology. 2015 Dec;**25**(12):936-941.e1. DOI: 10.1016/j.annepidem.2015.09.001

[61] Harlap S, Davies AM, Baras M. Complications of pregnancy and labor in former oral

[62] Mucci LA, Lagiou P, Hsieh CC, Tamimi R, Hellerstein S, Vatten L, Adami HO, Cnattingius S, Trichopoulos D. A prospective study of pregravid oral contraceptive use in relation to

[63] Hatch EE, Hahn KA, Mikkelsen EM, et al. Pre-gravid oral contraceptive use in relation to birth weight: A prospective cohort study. European Journal of Epidemiology. 2015

after scheduled 12-h delays in tablet intake. Contraception. 2005;**71**:8-13

November 1, 2017]

DOI: 10.1016/j.contraception.2011.01.013

Health. 1989 Sep;**43**(3):275-279

**10**(6):1397-1402

& Gynaecology. 1982 Feb;**22**(1):25-28

and Gynaecology. 1979 Jul;**86**(7):557-562

and Sterility. 2005 Jun;**83**(6):1864-1866

England Journal of Medicine. 1977 Sep 1;**297**(9):468-471

Endocrinology and Metabolism. 1998 Feb;**83**(2):481-486

contraceptive users. Contraception. 1981 Jul;**24**(1):1-13

Nov;**30**(11):1199-1208. DOI: 10.1007/s10654-015-0053-2

fetal growth. BJOG. 2004 Sep;**111**(9):989-995

[50] Korver T, Klipping C, Heger-Mahn D, Duijkers I, van Osta G, Dieben T. Maintenance of ovulation inhibition with the 75 microg desogestrel-only contraceptive pill (Cerazette) after scheduled 12-h delays in tablet intake. Contraception. 2005;**71**:8-13

[35] Newton J, Curson R. Endocrine assessment of post-pill amenorrhoea. Proceedings of the

[36] Barnhart KT, Schreiber CA. Return to fertility following discontinuation of oral contra-

[37] Hanson FW. Post oral contraceptive amenorrhea. California Medicine. 1972 Apr;

[38] Archer DF, Thomas RL. The fallacy of the postpill amenorrhea syndrome. Clinical

[39] Martin KA, Barbieri RL. Risks and Side Effects Associated with Estrogen-Progestin Sontraceptives. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.

[40] Vessey MP, Wright NH, McPherson K, Wiggins P. Fertility after stopping different methods of contraception. British Medical Journal. 1978 Feb 4;**1**(6108):265-267

[41] Doll H, Vessey M, Painter R. Return of fertility in nulliparous women after discontinuation of the intrauterine device: Comparison with women discontinuing other methods of contraception. BJOG : An International Journal of Obstetrics and Gynaecology. 2001

[42] Farrow A, Hull MG, Northstone K, et al. Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception. Human

[43] Weisberg E. Fertility after discontinuation of oral contraceptives. Clinical Reproduction

[44] Wiegratz I, Mittmann K, Dietrich H, Zimmermann T, Kuhl H. Fertility after discontinuation of treatment with an oral contraceptive containing 30 microg of ethinyl estradiol

[45] Mikkelsen EM, Riis AH, Wise LA, Hatch EE, Rothman KJ, Sørensen HT. Pre-gravid oral contraceptive use and time to pregnancy: A Danish prospective cohort study. Human

[46] Cronin M, Schellschmidt I, Dinger J.Rate of pregnancy after using drospirenone and other progestin-containing oral contraceptives. Obstetrics and Gynecology. 2009;**114**:616-622

[47] Hassan MA, Killick SR. Is previous use of hormonal contraception associated with a detrimental effect on subsequent fecundity? Human Reproduction. 2004 Feb;**19**(2):344-351

[48] Faculty of Sexual & Reproductive Healthcare. Clinical Effectiveness Unit. FSRH Guidance – Progestogen-only Pills. March 2015. Roycal College of Obstetricians & Ginaecologysts. Website: https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-

[49] Eckstein P, Whitby M, Fotherby K, Butler C, Mukherjee T, Burnett JBC, et al. Clinical and laboratory findings in a trial of norgestrel, a low-dose progestogen-only contraceptive.

and 2 mg of dienogest. Fertility and Sterility. 2006 Jun;**85**(6):1812-1819

Reproduction. 2013 May;**28**(5):1398-1405. DOI: 10.1093/humrep/det023

Royal Society of Medicine. 1973 Jun;**66**(6):567-569

**116**(4):55-56

236 Family Planning

Mar;**108**(3):304-314

ceptives. Fertility and Sterility. 2009 Mar;**91**(3):659-663

Obstetrics and Gynecology. 1981 Sep;**24**(3):943-950

uptodate.com [Accessed: October 20, 2017]

Reproduction. 2002 Oct;**17**(10):2754-2761

pop-mar-2015/ [Accessed: November 02, 2017]

BMJ. 1972;**3**:195-200

and Fertility. 1982 Dec;**1**(4):261-272

[64] Magidor S, Palti H, Harlap S, Baras M. Long-term follow-up of children whose mothers used oral contraceptives prior to conception. Contraception. 1984 Mar;**29**(3):203-214

[78] Chen S, Zhu R, Zhu H, et al. The prevalence and risk factors of preterm small-for-gestational-age infants: A population-based retrospective cohort study in rural Chinese popu-

Contraceptive Methods and the Subsequent Search for a Pregnancy

http://dx.doi.org/10.5772/intechopen.72525

239

[79] Chen A, Yuan W, Meirik O, Wang X, SZ W, Zhou L, Luo L, Gao E, Cheng Y. Mifepristoneinduced early abortion and outcome of subsequent wanted pregnancy. American Journal

[80] Kc S, Hemminki E, Gissler M, Virtanen SM, Klemetti R. Perinatal outcomes after induced termination of pregnancy by methods: A nationwide register-based study of first births in Finland 1996-2013. PLoS One. 2017 Sep 1;**12**(9):e0184078. DOI: 10.1371/journal.

[81] Strifert K. The link between oral contraceptive use and prevalence in autism spectrum

[82] Bahamondes L, Brache V, Meirik O, et al. A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with nonrandomized matched copper-intrauterine device controls. Human Reproduction. 2015

[83] American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice; Long-Acting Reversible Contraceptive Expert Work Group. Committee opinion no 672: Clinical challenges of long-acting reversible contraceptive methods. Obstetrics

and Gynecology. 2016 Sep;**128**(3):e69-e77. DOI: 10.1097/AOG.0000000000001644

[84] Singh M, Mansour D, Richardson D. Location and removal of non-palpable Implanon implants with the aid of ultrasound guidance. The Journal of Family Planning and

[85] Bennink HJ. The pharmacokinetics and pharmacodynamics of Implanon, a singlerod etonogestrel contraceptive implant. The European Journal of Contraception &

[86] Merck. Nexplanon Prescribing Information. Merck & Co., Inc. Website: http://www.merck. com/product/usa/pi\_circulars/n/nexplanon/nexplanon\_pi.pdf [Accessed: November 02,

[87] Bhatia P, Nangia S, Aggarwal S, Tewari C. Implanon: Subdermal single rod contraceptive implant. Journal of Obstetrics and Gynaecology of India. 2011 Aug;**61**(4):422-425.

[88] Kerns J, Darney P. Vaginal ring contraception. Contraception. 2011 Feb;**83**(2):107-115.

[89] Mulders TM, Dieben TO, Bennink HJ. Ovarian function with a novel combined contra-

[90] Merck. Nuvaring Prescribing Information. Merck & Co., Inc. Website: http://www.merck. com/product/usa/pi\_circulars/n/nuvaring/nuvaring\_pi.pdf [Accessed: November 02,

ceptive vaginal ring. Human Reproduction. 2002 Oct;**17**(10):2594-2599

lation. BMC Pregnancy and Childbirth. 2017 Jul 20;**17**(1):237

disorder. Medical Hypotheses. 2014 Dec;**83**(6):718-725

Reproductive Health Care. 2006 Jul;**32**(3):153-156

Reproductive Health Care. 2000 Sep;**5**(Suppl 2):12-20

DOI: 10.1007/s13224-011-0066-z

DOI: 10.1016/j.contraception.2010.07.008

of Epidemiology. 2004 Jul 15;**160**(2):110-117

pone.0184078

Nov;**30**(11):2527-2538

2017]

2017]

[78] Chen S, Zhu R, Zhu H, et al. The prevalence and risk factors of preterm small-for-gestational-age infants: A population-based retrospective cohort study in rural Chinese population. BMC Pregnancy and Childbirth. 2017 Jul 20;**17**(1):237

[64] Magidor S, Palti H, Harlap S, Baras M. Long-term follow-up of children whose mothers used oral contraceptives prior to conception. Contraception. 1984 Mar;**29**(3):203-214 [65] Herbst AL, Ulfelder H, Poskanzer DC. Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women. The New England

[66] NIH National Cancer Institute. Diethylstilbestrol (DES) and Cancer. NIH National Cancer Institute, rev Oct 5, 2011. From: https://www.cancer.gov/about-cancer/causes-

[67] CDC. DES Update: Health Care Providers. Centers for Disease Control and Prevention.

[68] Li DK, Daling JR, Mueller BA, Hickok DE, Fantel AG, Weiss NS. Oral contraceptive use after conception in relation to the risk of congenital urinary tract anomalies. Teratology.

[69] Wogelius P, Horváth-Puhó E, Pedersen L, Nørgaard M, Czeizel AE, Sørensen HT. Maternal use of oral contraceptives and risk of hypospadias - a population-based case-

[70] Nørgaard M, Wogelius P, Pedersen L, Rothman KJ, Sørensen HT. Maternal use of oral contraceptives during early pregnancy and risk of hypospadias in male offspring.

[71] Bracken MB. Oral contraception and congenital malformations in offspring: A review and meta-analysis of the prospective studies. Obstetrics and Gynecology. 1990 Sep;**76**(3 Pt 2):

[72] Charlton BM, Mølgaard-Nielsen D, Svanström H, Wohlfahrt J, Pasternak B, Melbye M. Maternal use of oral contraceptives and risk of birth defects in Denmark: Prospective,

[73] Harlap S, Shiono PH, Ramcharan S. Congenital abnormalities in the offspring of women who used oral and other contraceptives around the time of conception. International

[74] Waller DK, Gallaway MS, Taylor LG, et al. Use of oral contraceptives in pregnancy and major structural birth defects in offspring. Epidemiology. 2010 Mar;**21**(2):232-239. DOI:

[75] McCann M, Potter L. Progestin-only oral contraception: A comprehensive review. Con-

[76] Carmichael SL, Shaw GM, Laurent C, Croughan MS, Olney RS, Lammer EJ. Maternal progestin intake and risk of hypospadias. Archives of Pediatrics & Adolescent Medicine.

[77] Chen XK, Wen SW, Sun LM, Yang Q, Walker MC, Krewski D. Recent oral contraceptive use and adverse birth outcomes. European Journal of Obstetrics, Gynecology, and

Reproductive Biology. 2009 May;**144**(1):40-43. DOI: 10.1016/j.ejogrb.2008.12.016

prevention/risk/hormones/des-fact-sheet [accessed: 28-10-2017]

From: https://www.cdc.gov/des/hcp/index.html [Accessed: 28-10-2017]

control study. European Journal of Epidemiology. 2006;**21**(10):777-781

Journal of Medicine. 1971;**284**:878-881

1995 Jan;**51**(1):30-36

238 Family Planning

552-557

Urology. 2009 Sep;**74**(3):583-587

10.1097/EDE.0b013e3181c9fbb3

traception. 1994;**50**(6):S44-S49

2005 Oct;**159**(10):957-962

nationwide cohort study. BMJ. 2016 Jan;**352**:h6712

Journal of Fertility. 1985;**30**(2):39-47. [abstract]

[91] Bahamondes L, Bahamondes MV. New and emerging contraceptives: A state-of-the-art review. International Journal of Women's Health. 2014 Feb 19;**6**:221-234. DOI: 10.2147/ IJWH.S46811

[105] Fraser L. Contraceptive Coil can Lower Female Fertility. The Telegraph, 04-03-2001. Retrieved from http://www.telegraph.co.uk/news/uknews/1324945/Contraceptive-

Contraceptive Methods and the Subsequent Search for a Pregnancy

http://dx.doi.org/10.5772/intechopen.72525

241

[106] Wilson JC. A prospective New Zealand study of fertility after removal of copper intrauterine contraceptive devices for conception and because of complications: A four-year

study. American Journal of Obstetrics and Gynecology. 1989 Feb;**160**(2):391-396 [107] Price MJ, Ades AE, Soldan K, et al. The Natural History of Chlamydia Trachomatis Infection in Women: A Multi-Parameter Evidence Synthesis. Southampton (UK): NIHR Journals Library; 2016 Mar. (Health Technology Assessment, No. 20.22.) Chapter 9, Pelvic inflammatory disease and ectopic pregnancy. Available from: https://www.ncbi.

[108] Gray RH, Simpson JL, Kambic RT, et al. Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning.

[109] Harlap S, Baras M. Conception-waits in fertile women after stopping oral contracep-

[110] Belhadj H, Sivin I, Diaz S et al. Recovery of fertility after use of the levonorgestrel 20 mcg/d or Copper T 380 Ag intrauterine device. Contraception. 1986 Sep;**34**(3):261-267

[111] Skjeldestad FE, Bratt H. Return of fertility after use of IUDs (Nova-T, MLCu250 and

[112] Affandi B, Santoso SS, Djajadilaga, Hadisaputra W, Moeloek FA, Prihartono J, et al. Pregnancy after removal of Norplant implants contraceptive. Contraception. 1987;**36**:203-209

[113] Gupta BK, Gupta AN, Lyall S. Return of fertility in various types of IUD users.

[114] Sivin I, Stern J, Diaz S et al. Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices. American Journal of Obstetrics and Gynecology.

[115] Randić L, Haller H. Ectopic pregnancy among past IUD users. International Journal of

[116] Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrelreleasing intrauterine device and Nova-T. Contraception 1992;**46**:575-584

[117] Tadesse E. Return of fertility after an IUD removal for planned pregnancy: A six year

[118] Buckshee K, Chatterjee P, Dhall GI et al. Return of fertility following discontinuation of Norplant-II subdermal implants. ICMR Task Force on Hormonal Contraception.

prospective study. East African Medical Journal. 1996 Mar;**73**(3):169-171

American Journal of Obstetrics and Gynecology. 1995 May;**172**(5):1567-1572

tives. International Journal of Fertility. 1984;**29**(2):73-80

MLCu375). Advances in Contraception. 1987;**3**:139-145

International Journal of Fertility. 1989;**34**:123-125

Gynecology & Obstetrics. 1992 Aug;**38**(4):299-304 [abstract]

1992 Apr;**166**(4):1208-1213

Contraception. 1995 Apr;**51**(4):237-242

coil-can-lower-female-fertility.html [Accessed: October 30, 2017]

nlm.nih.gov/books/NBK350645/

[105] Fraser L. Contraceptive Coil can Lower Female Fertility. The Telegraph, 04-03-2001. Retrieved from http://www.telegraph.co.uk/news/uknews/1324945/Contraceptivecoil-can-lower-female-fertility.html [Accessed: October 30, 2017]

[91] Bahamondes L, Bahamondes MV. New and emerging contraceptives: A state-of-the-art review. International Journal of Women's Health. 2014 Feb 19;**6**:221-234. DOI: 10.2147/

[92] Pfizer Ltd. Depo-Provera 150mg/ml Injection Patient Information Leaflet. electronic Medicines Compendium, last updated December 13, 2016. Website: https://www.medi-

[93] Pardthaisong T. Return of fertility after use of the injectable contraceptive Depo Provera:

[94] Fotherby K, Yong-En S, Howard G, Elder MG, Muggeridge J. Return of ovulation and fertility in women . Using norethisterone oenanthate. Contraception. 1984 May;

[95] Bahamondes L, Lavín P, Ojeda G, Petta C, Diaz J, Maradiegue E, Monteiro I. Return of fertility after discontinuation of the once-a-month injectable contraceptive Cyclofem.

[96] Creinin MD. Intrauterine devices: Separating fact from fallacy. Medscape Women's

[97] Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: Biological bases of their mechanism of action. Contraception. 2007 Jun;**75**(6 Suppl):

[98] Randic L, Vlasic S, Matrljan I, Waszak CS. Return to fertility after IUD removal for

[99] Roepke CL, Schaff EA. Long tail strings: Impact of the Dalkon shield 40 years later. Open Journal of Obstetrics and Gynecology;**04**:996-1005. DOI: 10.4236/ojog.2014.416140

[100] Brody JE. The Contraception Conundrum: It's Not Just Birth Control Anymore. The New York Times. 1997, June 22. Retrieved from http://www.nytimes.com [Accessed:

[101] Hubacher D. Intrauterine devices & infection: Review of the literature. The Indian Journal

[102] Hubacher D, Grimes DA, Gemzell-Danielsson K. Pitfalls of research linking the intrauterine device to pelvic inflammatory disease. Obstetrics and Gynecology. 2013 May;

[103] Zhu H, Lei H, Huang W, Fu J, Wang Q, Shen L, Wang Q, Ruan J, Liu D, Song H, Hu L. Fertility in older women following removal of long-term intrauterine devices in the wake of a natural disaster. Contraception. 2013 Apr;**87**(4):416-420. DOI: 10.1016/j.

[104] Chapman J. Infertility Fears for Long-Term Coil Users. Daily Mail Online. Retrieved from http://www.dailymail.co.uk/health/article-28021/Infertility-fears-long-term-coil-

planned pregnancy. Contraception. 1985 Sep;**32**(3):253-259

of Medical Research. 2014 Nov;**140**(Suppl):S53-S57

Up-dated data analysis. Journal of Biosocial Science. 1984 Jan;**16**(1):23-34

cines.org.uk/emc/medicine/11127 [Accessed: October 31, 2017]

IJWH.S46811

240 Family Planning

**29**(5):447-455

S16-S30

October 30, 2017]

**121**(5):1091-1098

contraception.2012.11.002

users.html [Accessed: October 30, 2017]

Contraception. 1997 May;**55**(5):307-310

Health. 1996 Oct;**1**(10):4

[119] Zimmermann T, Dietrich H, Wisser KH, Hoffmann H. The efficacy and tolerability of Valette: A postmarketing surveillance study. Eur J Contracept Reprod Health Care. 1999 Sep;**4**(3):155-164

**Chapter 12**

Provisional chapter

**Postpartum Family Planning: Methods to Decrease**

DOI: 10.5772/intechopen.73534

Postpartum Family Planning: Methods to Decrease

Postpartum women are at high risk for unintended pregnancies and subsequent adverse perinatal outcomes often due to insufficient pregnancy intervals. There is a high burden of unmet family planning need caused by factors including inadequate education on postpartum contraception, limited access to healthcare professional in the immediate postpartum period, and lack of access to contraceptive options. This chapter will discuss the different contraceptive methods that can be utilized and their respective efficacies, venous thromboembolism (VTE) risk, and impact on lactation. Tubal ligation, lactation amenorrhea, barrier methods, the copper intrauterine device (IUD), and progestin-only pills (POP) have no clinically significant impact on VTE risk or lactation for the majority of women postpartum. Depot medroxyprogesterone acetate (DMPA) injection, implants, and levonorgestrel (LNG) IUDs are considered to have no impact on breastfeeding based on limited clinical evidence. Contraceptive methods that contain estrogens may increase a woman's risk for VTE in the peri-partum period and should be deferred approximately 30 days postpartum. Sterilization and long acting reversible contraceptives (LARC), including IUDs and contraceptive arm implants, have been proven to be the most reliable and cost-effective methods, which also have high rates of patient satisfaction and continuation. Women have a range of safe contraceptive choices they can use to prevent pregnancy or to space their pregnancies. Health care systems should empower women to become educated about and gain access to postpartum contraception so as to address unintended pregnancy disparities among this group of women. Above all, counseling should be

patient-centered when choosing the right method for the woman.

Keywords: postpartum contraception, lactation amenorrhea, venous thromboembolism,

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

**Unintended Pregnancies**

Unintended Pregnancies

http://dx.doi.org/10.5772/intechopen.73534

LARC, unintended pregnancy

Abstract

Jessica Maria Atrio, Isha Kachwala and Karina Avila

Jessica Maria Atrio, Isha Kachwala and Karina Avila

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

Provisional chapter


3.3.2. Conductivity-Voltage Measurements

Moreover, to quantify the interface defect distribution for all samples, the interface state density (*Dit*) has been extracted by the conductivity-voltage measurements with frequencies varying from 100 kHz to 1 MHz. *Dit* is related to the parallel interfacial trap capacitance (Cit) and parallel conductivity (G). At the same time, Cit can be related by the following equation. Cit = *qDit*, while the condition is that the position of the energy level does not change *Dit*. The basic principle of conductivity measurements is to analyze the losses due to the diversity of charge states at the trap level. Near the Fermi level, the synchronous conductivity occupancy is mobilized by the interfacial traps to produce a regular variation. The maximum loss occurs when the interface trap is resonantly shifted with the applied AC signal (*ωτ* = 1). The response time of the characteristic trap changes the frequency, *τ* = 2*π*/*ω*. The capture and emission rates from Shockley-Redhall theory modulate the response time [36]:

$$\tau = \frac{\exp\left[\Delta E / k\_B T\right]}{\sigma v\_{th} D\_{dos}} \tag{7}$$

where there is an energy difference Δ*E* between the trap level ET and the edge of the majority carrier band, *vth* is the majority carrier being thermally activated to obtain the average velocity, *Ddos* is the effective density of states of the majority carrier band, *kB* is the Boltzmann constant, and *T* is the temperature [37]. The curves between conductivity (G/ω) and gate voltage for all samples are shown in Figure 7a–c. The apparent shift of the conductivity peak proves the validity of the Fermi-level shift and confirms the existence of the Fermi-level deconvolution effect [38]. Assuming that the underlying surface oscillations can be neglected, the value of *Dit* is inferred using the normalized parallel conductivity peak (*GP*/*ω*)*max* [39].

$$D\_{it} \approx \frac{2.5}{Aq} \left(\frac{G\_p}{\omega}\right)\_{\text{max}}\tag{8}$$

where *A* is the device area. It is necessary to confirm the transformation law between the band bending potential of the energy location ET and the trap energy level distribution. Furthermore, the values of ET can be determined by the frequency of (*GP*/*ω*)*max*, where Equation (8) is used to calculate *Dit* and to correspond its value to Δ*E* [40].

$$
\Delta E = (\mathbf{E}\_{\rm C} - \mathbf{E}\_{\rm T}) = \frac{k\_B T}{q} \ln \left( \frac{\sigma v D\_{d\alpha}}{2 \pi f\_{\rm max}} \right) \tag{9}
$$

Figure 7d shows the variation of *Dit* for the three samples. With the increase of ΔE, the value of *Dit* shows an increasing trend. However, S3 possesses a lower density of interfacial states compared to S1 and S2, which indicates that the insertion of an Al2O3 passivation layer between the Sm2O3 gate dielectric and the InP substrate can suppress the formation of In and P suboxides and improve the quality of MOS capacitors.

We compared some of the data obtained from this work with some previously published work. As can be seen in Table 2, the Sm2O3 dielectric has a smaller leakage current density than TiO2 and HfO2, indicating that the Sm2O3 stacked gate dielectric has a larger conduction band shift, resulting in an increased barrier height and thus a reduced leakage current density. The Sm2O3 stacked gate dielectric has the smallest hysteresis value, indicating that the trapped charge in the gate dielectric is not very sensitive to the frequency response of the voltage, and will trap fewer electrons to keep the energy band from being bent, while the device maintains a consistent response to different test voltages in the antipattern region. In the interface state density, it is smaller than HfO2 as the gate dielectric directly deposited in InP, but it seems to be higher than TiO2 gate dielectric, considering the different testing methods, the interface state density of the current work is obtained directly by conductivity method with accuracy, the previous work is by C–V curve, there may be some differences.

**Figure 7.** Multi-frequency G–V characteristics of InP-based MOS capacitors of (**a**) S1, (**b**) S2, and (**c**) S3. (**d**) Energy distributions of Dit for S1, S2, and S3.

**Table 2.** Comparison of different InP MOS capacitor parameters.

3.3.3. *J*−*V* Analyses and Conduction Mechanisms at Room Temperature

Figure 8a shows the leakage current characteristics of all samples measured at room temperature. The leakage current density (*J*) values for S1, S2, and S3 at 1 V are 1.07 × 10−5, 8.42 × 10−6, and 2.87 × 10−6 A/cm2, respectively. It can be seen that S1 has a higher leakage current density, which can be attributed to larger interface traps and the border traps that deteriorate the interface quality and degrade the device performance [44]. For the S3 sample, the minimum leakage current density has been observed, which is due to the higher Δ*E*c and the suppressed tunneling in the Sm2O3/Al2O3/InP gate stack [45].

To investigate the leakage current characteristics of various stacked gate dielectrics, we systematically studied three different current conduction mechanisms (CCMs) under substrate injection, as shown in Figure 8b–d. The extracted important electrical parameters are listed in Table 3.

**Figure 8.** (**a**) J–V characteristics measured at room temperature. (**b**) SE emission, (**c**) PF emission, and (**d**) FN tunneling plots for all the samples under substrate injection.

**Table 3.** Extracted MOS capacitors electrical parameters measured at room temperature.

Schottky emission (*SE*) is a typical type of thermal ionization emission in which charges gain energy to overcome barriers to migration into the dielectric. The standard *SE* can be described as [46]:

$$J\_{SE} = A^\* T^2 \exp\left[\frac{-q\left(q\_B - \sqrt{qE/4\pi\varepsilon\_0\varepsilon\_r}\right)}{k\_B T}\right] \tag{10}$$

$$A^\* = \frac{4\pi qk\_B^2 m\_{ox} \ast}{h^3} = 120 \frac{m\_{ox} \ast}{m\_0} \tag{11}$$

where *A*\* is the effective Richardson constant, the free electron mass and the effective mass of electrons in the gate dielectric correspond to mo and mox\*, E is the electric field, *qϕB* is the Schottky barrier height, and εo and εr represent the vacuum dielectric constant and the optical dielectric constant, respectively [47]. It is observed in Figure 8b that at lower electric fields (0.36–0.81 MV/cm), there is a good linear relationship between ln(J/T2) and E1/2 for S1, S2, and S3. The slope of the SE diagram is denoted as q3/4πε0εr/kBT. The fitted εr and the refractive index *n* (*n* = εr 1/2) for S1, S2, and S3 are (4, 2), (4.96, 2.23), and (4.23, 2.06), respectively. All the fits are consistent with the previously reported values [48], revealing that CCM (current conduction mechanism) at room temperature is dominated by SE emission in the low electric field region.

The Poole–Frenkel (*PF*) emission can be ascribed to the thermally excited electrons obtaining sufficient energy to escape from traps into the conduction band of the dielectric at a higher electric field, which can be expressed by the following formula [49]:

$$J\_{PF} = AE \exp\left[\frac{-q\left(q\_t - \sqrt{qE/\pi \varepsilon\_0 \varepsilon\_{ox}}\right)}{k\_B T}\right] \tag{12}$$

where *A* represents a constant, the trap energy level of the conduction band corresponds to *ϕt*, and *εox* represents the dielectric constant. According to the previous theory, ln(*J*/*E*) should have a good proportionality with *E*1/2, as shown in Figure 8c. The εox extracted from the slope of the fitted line for all samples was calculated as 11.90, 13.01, and 13.41, which is in agreement with the reported reference [4]. It can be concluded that at higher electric fields (1.21–1.69 MV/cm), the PF emission dominates the CCM of all samples. Also, the value of the trap energy level (*ϕt*) can be extracted based on the intercept point of the fitted curve described as *lnB* − *qϕt kBT* . As shown in Figure 8c, the calculated values of *ϕt* are 0.53, 0.54, and 0.55 eV, corresponding to S1, S2, and S3. S3 has the largest *ϕt* value in the three samples, indicating that the electrons obtain more energy to cross the trap, leading to present the smallest leakage current density in the S3 sample.

The high-field dependent conduction mechanism is represented by Fowler-Nordheim tunneling, which is manifested by the fact that the insulating layer can be penetrated by electrons, which enter the conduction band of the gate dielectric in a high electric field. The leakage current density is linked to other parameters of Fowler-Nordheim (*FN*) tunneling and is described by the following Equation [46]:

$$J\_{FN} = \frac{q^3 E^2}{16\pi^2 \hbar q\_{\text{ox}}} \exp\left[ -\frac{4\sqrt{2m\_T^\* q\_B^{3/2}}}{3\hbar q E} \right] \tag{13}$$

where *ϕox* is oxide barrier height; *m*∗ *T* is the tunneling effective electron mass in the gate oxide film, and the other notations remain unchanged from the previous definitions. Figure 8d shows the curve of ln(*J*/*E*2) versus 1/*E*. The slope of the linear fit for the above samples shows an increase in current with increasing electric field, indicating that at high electric fields (1.47–1.85 MV/cm), all three samples are consistent with the *FN* tunneling conduction mechanism. Based on the previous analysis, it can be concluded that all samples are dominated by three main conduction mechanisms. In the lower electric fields, SE emission dominates, however, in the higher electric fields, PF emission dominates together with FN tunneling.

### 3.3.4. Low Temperature *J*–*V* Analyses and Conduction Mechanisms

To investigate the variation of CCMs in Sm2O3/Al2O3/InP MOS capacitor, low temperature (77–227 K) measurements were performed. The leakage current densities of Sm2O3/Al2O3/InP MOS capacitors measured at 1 V were extracted as 4.64 × 10−9, 1.48 × 10−8, 1.13 × 10−7, and 1.02 × 10−6 A/cm2, corresponding to the temperature range of 77–227 K, respectively. By observing the leakage current densities at different temperatures, the Sm2O3/Al2O3/InP gate stack exhibits nearly three orders of magnitude lower leakage current density at 77 K than that measured at room temperature, indicating that the low temperature is favorable for the MOS capacitor to exhibit optimized *J*–*V* characteristics. Figure 9b–d show the variation of the CCM under substrate injection along with the temperature trend. The extracted important electrical parameters are listed in Table 4. Figure 9b shows the fitted lines for the vertical temperature range suitable for SE emission at lower electric fields (0.49–0.90 MV/cm). The extracted important electrical parameters are listed in Table 4. With increasing temperature, the values of *εr* and n calculated from the slope and intercept are (20.39, 4.52), (18.53, 4.31), (10.40, 3.22), and (6.10, 2.47). It can be noted that at extremely low temperature of 77–177 K, these values are completely different from the theoretical values, indicating that SE emission is not the dominant conduction mechanism at lower temperatures. Figure 9c shows the curves in the temperature range 77–227 K compatible with PF emission at higher electric fields (0.64–1.44 MV/cm). Again, it can be noted that *ϕt* and εox are not in the expected range of values, indicating that the PF emission is not compatible for all samples at intermediate electric fields of 0.64–1.44 MV/cm. FN tunneling is a potential conduction mechanism because of its dependence on the electric field at low temperatures. Figure 9d shows the fitted line of FN tunneling with a temperature range of 77–227 K at higher electric fields (1.11–1.67 MV/cm), and the established slope indicates that FN tunneling is dominant at low temperatures. In conclusion, the effects of SE emission and PF emission are attenuated due to low temperature, and FN tunneling is used to explain the Sm2O3/Al2O3/InP stacked gate dielectric structure showing low drain current density.

**Figure 9.** (**a**) J–V characteristics measured at low temperature. (**b**) SE emission, (**c**) PF emission, and (**d**) FN tunneling plots for all the samples under substrate injection.

**Table 4.** S3's MOS capacitors electrical parameters measured at low temperature.

Additionally, the integrated dielectric properties in MOS capacitors can be estimated from two important values, including the electron effective mass *m*∗ *ox* and the barrier height *qϕB* [50]. The intercept of the SE emission fitting curve described as ln 120 *m*∗ 0*x m*0 − *qϕB kBT* and the slope of the FN tunneling fitting curve expressed as −6.83 × 107 *m*∗ *T m*0 *ϕ*3 *B* can be calculated together with the above two values. By setting the equation *m*∗ 0*x* = *m*∗ *T*, the two key physical quantities *m*∗ 0*x* and *qϕB* of Sm2O3/Al2O3/InP MOS capacitor are obtained by applying mathematical analysis, which are calculated as 0.23 mo and 0.95 eV, respectively. Figure 10 shows the determination of the electron effective mass and barrier height for S3 sample. The smaller *m*∗ 0*x* and the higher *qϕB* are beneficial to obtain better electrical properties and optimized interface quality.

**Figure 10.** The determination of the electron effective mass and barrier height for S3 sample under substrate injection.