3.7 Exercise Problems

Q1.  What do you think is the significance of reproductive health in a society?

Answer: Reproductive health in a society is significant because the people are aware of
(i) birth control methods and advantages of small family,
(ii) sexually transmitted diseases and methods to avoid them,
(iii) importance breast feeding and post natal care of the mother and baby and
(iv) equal opportunities for the male and female children.

Q2. Suggest the aspects of reproductive health which need to be given special attention in the present scenario.

Answer: The aspects of reproductive health which need to be given special attention are :

• Introduction of sex education in schools to give right information to the young minds about reproductive organs, accessory organs of reproduction, secondary sexual characters, adolescence and related changes, safe and hygienic sexual practices, STDs etc.
• Providing knowledge about available birth control methods, care of pregnant mothers, post-natal care of the mother and child, importance of breast feeding etc.
• Creating awareness about consequences of uncontrolled population growth and social evils (sex abuses and sex-related crimes, use of drugs, tobacco and alcohol etc.) among young people.

Q3. Is sex education necessary in schools? Why?

Answer: Yes, sex education is necessary in school. Because introduction of sex education in school encourage to provide the right or correct information to the young peoples so as to discourage children from believing in myths & having misconceptions about sex related aspects. Proper information about reproductive organs, safe & hygienic sexual practices, STD’s etc. would help people, those in the adolescent age group to lead a healthy reproductive life. In many countries, sexual education raises much contentious debate. Chief among the controversial points is whether covering child sexuality is valuable or detrimental; the use of birth control such as condoms and hormonal contraception, and the impact of such use on pregnancy, outside marriage, teenage pregnancy, and the transmission of STDs. Increasing support for abstinence only sex education by conservative groups has been one of the primary causes of the controversies.

Q4. Do you think that reproductive health in our country has improved in the past 50 years? If yes, mention some such areas of improvement.

Answer:  Yes, in the last 50 years, reproductive health in our country has improved. Some such areas of improvement are (i) massive child immunization (ii) maternity and child health (iii) increasing use of contraceptives (iv) family planning.
Bringing sexual and reproductive health services to the millions of people living in countries which still suffer from short life expectancies, high levels of child and maternal mortality, illiteracy and poor overall health remains a major challenge for governments and non government organizations.

Q5. What are the suggested reasons for population explosion?

Answer:  (i) Increased health facilities along with better living conditions had an explosive impact on the growth of population.
(ii) Decline in Death rate
(iii) Decline in Maternal Mortality Rate
(iv) Decline in Infant Mortality Rate
(v) Increase in the number of people in the reproductive age.

Q6. Is the use of contraceptives justified ? Give reasons.

Answer: Population in India is increasing at a very fast rate and such a growth necessitated intense use of contraceptive methods to bring all the fertile couples under its cover. It will help in bringing the birth rate down and consequently check the population growth. Therefore, the use of contraceptives is justified. It is essential to mention here that the selection of a suitable contraceptive method should be practiced in consultation with qualified doctors. The government provides these facilities free at the family planning centres. Contraceptives are given free or at nominal prices at these centres to the couples of reproductive age desirous of preventing conception.

Q7. Removal of gonads cannot be considered as a contraceptive option. Why?

Answer:  Removal of gonads or its parts is a surgical method, of sterilization. Vasectomy and tubectomy are carried out in males and females respectively. It will lead to infertility & both male and female will be dependent on hormones in their remaining life to regulate functioning of reproductive organs. These are very effective but their irreversibility is very poor, so they are not good options for contraception.

Q8.  Amniocentesis for sex determination is banned? In our country , Is this ban necessary? Comment Amniocentesis for sex determination is banned? in our country. Is this ban necessary? Comment.

Answer:  Since Amniocentesis is misused to find out the sex of the foetus leading to female foeticides, it is necessary. It is the prenatal diagnostic technique, that helps to find out chromosomal (genetic) disorders, metabolic disorders of the foetus ; in extreme cases where the foetus is found to be suffering from an incurable disorder Medical Termination of Pregnancy (MTP) is banned. The solution to the problem is not ‘ passing more laws, such as banning sex determination ultrasounds but raising the social & economic status of women .

Q9. Suggest some methods to assist infertile couples to have children.

Answer:  ART (Assisted Reproductive Technologies) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman’s body, mixing them with sperm in the laboratory and putting the embryos bath into a woman’s body. Success rates vary depending on many factors. Something that affects the success rate of ART includes age of the partners, reason for infertility type of ART, if the egg is fresh or frozen. Various methods are now available to help such couples are – in vitro fertilization , gamete intra fallopian transfer, intracytoplasmic sperm injection & artificial insemination.

• In vitro fertilization – Patient’s egg & her partner’s sperm are collected & mixed together in a laboratory to achieve fertilization outside the body. The embryo produced may then be transferred into the female patient. It is commonly known as test tube baby programme.
• Gamete Intra Fallopian Transfer (GIFT) – A procedure in which eggs are retrieved from a woman, mixed with sperm & immediately replaced in one or other of the women’s fallopian tubes so that they fertilize inside the body (in vivo).
• Intra Cytoplasmic Sperm Injection (ICSI) – In this method, sperm & eggs are retrieved from both the parents. A single sperm is injected directly into an egg, then the fertilized egg is implanted into the woman’s uterus.
• Artificial insemination – In this technique, the semen is collected either from husband or a healthy donor & is artificially introduced either into the vagina or into the uterus of the female (IUI-Intra uterine insemination) .

Q10. What are the measures one has to take to prevent from contracting STDs?

Answer: (i) Avoiding sex with unknown partner / multiple partners.
(ii) Always use condoms during intercourse.
(iii) In case of doubt, go for medical professional for early detection and get complete treatment if diagnosed with disease.
(iv) Education & counselling of persons at risk on ways to adopt safer sexual behaviour.

Q11. State True/False with explanation
(a) Abortions could happen spontaneously too. (True/False)
(b) Infertility is defined as the inability to produce a viable offspring and is always due to abnormalities/defects in the female partner. (True/False)
(c) Complete lactation could help as a natural method of contraception. (True/False)
(d) Creating awareness about sex related aspects is an effective method to improve reproductive health of the people. (True/False)

Answer:  (a) True. Due to internal factors like incompatibility, abortion could happen spontaneously.
(b)False. It is due to abnormalities/defects in either male or female or both the partners.
(c)True, but it is limited to period up to six months after parturition.
(d)True. Creating awareness about sex-related aspects removes the myths and misconceptions about these problems.

Q.12. Correct the following statements:
(a) Surgical methods of contraception prevent gamete formation.
(b )Ail sexually transmitted diseases are completely curable.
(c) Oral pills are very popular contraceptives, among the rural women.
(d) In E.T. techniques, embryos are always transferred into the uterus.

Answer: (a) Surgical methods of contraception prevent gamete transport & thereby prevent conception.
(b) Except for hepatitis-B, genital herpes, and HIV infections, other STD diseases are completely curable if detected early and treated properly.
(c) Oral pill are very popular contraceptives among the educated urban women.
(d) In E.T. techniques, embryos with 8 blastomeres are transferred into fallopian tube and more than 8 blastomeres are transferred into the uterus.

Exemplar Section

VERY SHORT ANSWER TYPE QUESTIONS

Q1. Reproductive health refers only to healthy reproductive functions. Comment.

Answer: Reproductive health refers to a total well-being in all aspects of reproduction, i.e., physical, behavioural, psychological, social and physiological.

Q2. Comment on the Reproductive and Child Health Care programme of the government to improve the reproductive health of the people.

Answer: Creating public awareness regarding reproduction related aspects and providing facilities to build up a healthy society with added emphasis on the health of mother and child are the basic aims of the RCH programmes.

Q3. The present population growth rate in India is alarming. Suggest ways to check it.

Answer: The most important step to overcome this problem is to motivate smaller families by using various contraceptive methods.

• Government of India advertises in the media as well as in posters, showing a happy couple with two children with a slogan “Hum Do Hamare Do” (We two, our two).
• Many couples, mostly the young, urban working ones have even adopted a one child norm.
• Statutory raising of marriageable age of the female to 18 years and that of males to 21 years and incentives given to couples with small families are two of the other measure taken to tackle this problem.

Q4. STDs can be considered as self-invited diseases. Comment.

Answer: STDs can be considered as self-invited diseases caused due to the conscious behaviour of person. STDs occur in those individuals that have unprotected sex with multiple or unknown partners.

Q5. Suggest the reproduction-related aspects in which counselling should be provided at the school level. 

Answer:

• Introduction of sex education in schools should also be encouraged to provide right information to the young so as to discourage children from believing in myths and having misconceptions about sex-related aspects.
• Proper information about reproductive organs, adolescence and related changes, safe and hygienic sexual practices, sexually transmitted diseases (STD), AIDS, etc., would help people, especially those in the adolescent age group to lead a reproductively healthy life.

Q6. Mention the primary aim of the “Assisted Reproductive Technology” (ART) programme.

Answer: The primary aim of the “Assisted Reproductive Technology” (ART) programme is the couples could be assisted to have children through certain special techniques.

Q7. What is the significance of progesterone-estrogen combination as a contraceptive measure?

Answer: Oral administration of small doses of progesterone-estrogen combination is a contraceptive measure which inhibit ovulation and implantation as well as alter the quality of cervical mucus to prevent/retard the entry of sperms.

Q8. Strict conditions are to be followed in medical termination of pregnancy (MTP) procedures. Mention two reasons.

Answer: Government of India legalised MTP in 1971 with some strict conditions to avoid its misuse. Such restrictions are all the more important to check indiscriminate and illegal female foeticides which reported to be high in India.

Q9. Males in whom testes fail to descend to the scrotum are generally infertile. Why?

Answer: If the testes fail to descend to the scrotum, gametogenesis could be inhibited, the process of spermatogenesis require a marginally lesser ambient temperature than that in the abdominal cavity.

Q10. Mention two advantages of lactational amenorrhea as a contraceptive method.

Answer: (i) There is no ovulation and therefore the menstrual cycle do not take place.
(ii) As no medicines or devices are used in these methods, side effects are almost nil.

SHORT ANSWER TYPE QUESTIONS

Q1. Suggest some important steps that you would recommend to be taken to improve the reproductive health standards in India.

Answer:

• Creating awareness among people about various reproduction related aspects and providing facilities and support for building up a reproductively healthy society are the major tasks under these programmes. With the help of audio-visual and the print-media, governmental and non-governmental agencies have taken various steps to create awareness among the people about reproduction-related aspects.
• Parents, other close relatives, teachers and friends, also have a major role in the dissemination of the above information. Educating people, especially fertile couples and those in marriageable age group, about available birth control options, care of pregnant mothers, post-natal care of the mother and child, importance of breast feeding, equal opportunities for the male and the female child, etc., would address the importance of bringing up socially conscious healthy families of desired size.

Q2. The procedure of GIFT involves the transfer of female gamete to the fallopian tube. Can gametes be transferred to the uterus to achieve the same result? Explain.

Answer: The uterine environment is not congenial for the survival of the gamete. If, directly transferred to the uterus they will undergo degeneration or could be phagocytosed and hence viable zygote would not be formed.

Q3. Copper ions-releasing IUDs are more efficient than non-medicated methods. Why?

Answer: Unlike non-medicated IUEs, the copper releasing IUDs releases Cu ions that suppress sperm motility and fertilising capacity of sperms.

Q4. What are the probable factors that contributed to population explosion in India?

Answer: Probable reasons for population explosion are:

1.  A rapid decline in death rate.
2. Decline in MMR (Maternal mortality rate).
3. Decline in IMR (Infant mortality rate).
4. An increase in number of people in reproducible age.

Q5. Briefly explain IVF and ET What are the conditions in which these methods are advised?

Answer: IVF and ET refer to In Vitro Fertilisation and Embryo Transfer. Gametes from the male and female are collected hygienically and induced to fuse in the laboratory set up under simulated conditions. The zygote formed is collected and is introduced into the uterine region of a host dr surrogate mother at an appropriate time (secretory phase). Early embryos (up to 8 cell) are generally transferred to the fallopian tube whereas embryos with more than 8 cells are transferred to the uterus.

Q6. What are the advantages of natural methods of contraception over artificial methods?

Answer: Advantages of natural methods of contraception over artificial methods:

1. As no medicines or devices are used in these methods, side effects are almost nil.
2.  There is no surgical intervention, so natural method is reversible in nature.

Q7. What are the conditions in which medical termination of pregnancy is advised?

Answer: 

• MTP is used to get rid of unwanted pregnancies either due to casual unprotected intercourse or failure of the contraceptive used during coitus or rapes.
• MTPs are also essential in certain cases where continuation of the pregnancy could be harmful or even fatal either to the mother or to the foetus of both.

Q8. Comment on the essential features required for an ideal contraceptive.

Answer:An ideal contraceptive should be:

1. User-friendly
2. Easily available
3. Effective
4. Reversible
5. No or least side-effects.
6. Should not interfere with the sexual drive, desire or sexual act of the user

Q9. All reproductive tract infections RTIs are STDs, but all STDs are not RTIs. Justify with example. 

Answer: The common STDs are gonorrhea, syphilis, genital herpes, chlamydiasis, hepatitis-B, AIDs etc. Hepatitis-B, and AIDs are not infections of the reproductive organs though their mode of transmission could be through sexual contact also. All other diseases are transmitted through sexual contact and are also infections of the reproductive tract.

LONG ANSWER TYPE QUESTIONS

Q1. What are the Assisted Reproductive Techniques practiced to help infertile couples? Describe any three techniques.

Answer: Inability to conceive or produce children even after 2 years of unprotected sexual cohabitation is called infertility. In India, often the female is blamed ‘ for the couple being childless, but more often than not the problem lies in male partner. Specialised health care units (infertility, clinics) could help in diagnosis and corrective treatment of some of these disorders and enable these couples to have children. However, where such corrections are not possible, the couples could be assisted to have children through certain special techniques commonly known as ART (Assisted Reproductive Technologies).

Test Tube Baby Programme
In vitro fertilisation (IVF) followed by embryo transfer (ET) is a method to treat infertility and commonly known as the ‘Test tube baby’ programme. IVF-Fertilisation outside the body in almost similar conditions as that in the body. In this method ova from the wife/donor (female) and sperms from the husband/donor (male) are collected and are induced to form zygote under simulated conditions in the laboratory.

• ZIFT (Zygote Intra Fallopian Transfer): The zygote or early embryos (up to 8 blastomeres) could then be transferred into the fallopian tube.
• IUT (Intra Uterine Transfer): Embryos with more than 8 blastomeres could be transferred into the uterus, to complete its further development.
• Embryos formed by in vivo fertilization (fusion of gametes within the female) also could be used for such transfer to assist those females who cannot conceive.

GIFT
Transfer of an ovum collected from a donor into the fallopian tube (GIFT; Gamete Intra Fallopian Transfer) of another female who cannot produce one but can provide suitable environment for fertilization and further development.
AI Technique

• Infertility cases either due to inability of the male partner to inseminate the female or due to very low sperm counts in the ejaculates, could be corrected by artificial insemination (AI) technique.
• In this technique, the semen collected either from the husband or a healthy donor is artificially introduced, either into the vagina or into the uterus (IUI-Intra Uterine Insemination) of the female.

Q2. Discuss the mode of action and advantages/disadvantages of hormonal contraceptives.

Answer:

• Oral administration of small doses of either progestagens or progestogen- estrogen combinations is another contraceptive method used by the females.
• Most important component of oral contraceptive is progesterone. They are used in the form of tablets and hence are popularly called the pills. Pills have to be taken daily for a period of 21 days starting preferably within the first 5 days of menstrual cycle. After a gap of 7 days (during which menstruation occurs) it has to be repeated in the same pattern.
•  Oral contraceptive pills inhibit ovulation and implantation as well as alter (change) the quality of cervical mucus to prevent or retard entry of
  sperms. Progesterone present in OCP- is meant for checking ovulation. Pills are very effective with lesser side effects and are well accepted by the females. Combination or IUDs within 72 hours of coitus have been found to be very effective as emergency contraceptives as they could be used to avoid possible pregnancy due to rape or casual unprotected intercourse.

Q3. STDs are a threat to reproductive health. Describe any two such diseases and suggest preventive measures.

Answer:Diseases or infections which are transmitted through sexual intercourse called sexually transmitted diseases (STD) or VD (Venereal diseases) or RTI
(Reproductive tract infections).
Examples of STDs:
(i) HIV (AIDS)
(ii) Hepatitis-B
(iii) Genital herpes
(iv) Chlamydiasis
(v) Gonorrhoea
(vi) Genital warts
(vii) Syphilis
(viii) Trichomoniasis

AIDS

• AIDS is caused by HIV virus (Human Immuno deficiency virus or Human T-cell leukemia virus). There is always a time-lag between the infection and appearance of AIDS symptoms (incubation period). Incubation period may vary from a few month to many years (usually 5-10 years).
• ARC (AIDS Related Complex) is a mild or initial form of AIDS which develop after a few mon|h of infection. In AIDS patient, a reduction of 10% weight indicates ARC. After infection, HIV enters in macrophages where RNA of virus replicates to form viral DNA with the help of enzyme reverse transcriptase. Viral DNA incorporated into host cell DNA and directs the infected cell to produce new virus particles. The macrophages continue to produce virus therefore macrophages are called HIV Factory.
• Simultaneously HIV enters into helper T-lymphocytes (TH) or T4 replicates and produce progeny viruses. The progeny viruses released in the blood attack other helper T-lymphocytes. This is repeated leading to a progressive decrease in the number of helper T-lymphocytes in the body of infected person. During this period person suffers from: (i) Bouts of fever, (ii) Diarrhoea, (iii) Weight loss
• Due to the decrease in TH cells, person start suffering from infections that could have been otherwise overcome such as those due to bacteria especially Mycobacterium, virus, fungi and even parasites like Toxoplasma. The patient becomes so immuno-deficient that he/she is unable to protect himself/herself against these infections. Diagnostic test for AIDS is ELISA (Enzyme Linked Immuno Sorbent Assay). Werstrn blot is used as confirmatory or supplemental test for AIDS. Routine test of AIDS is PCR.

Hepatitis-B

Hepatitis-B viras is horizontally transmitted by blood transfusions, contaminated needles, body fluids like semen, saliva, sweat, tear and breast milk. Hepatitis-B is also transmitted vertically from infected mother to foetus through placenta. For prevention and control hepatitis-B vaccine is now available. Hepatitis-B vaccine was developed by Blumberg, for which he was awarded Nobel Prize in 1976.

Q4. Do you justify the statutory ban on aminocentesis in our country? Give reasons.

Answer:

• Intentional or voluntary termination of pregnancy before full term is called MTP or induced abortion. Nearly 45 to 50 millions MTPs are performed in a year all over the world which accounts to l/5 th (20%) of the total number of conceived pregnancies in a year. MTP has a significant role in decreasing the population though it is not meant for this purpose.
•  Government of India legalized MTP in 1971 with some strict conditions
  to avoid its misuse. Such restrictions are more important to check indiscriminate and illegal female foeticides which reported to be high in India. ‘ .
• MTP is used to get rid of unwanted pregnancies either due to casual unprotected intercourse or failure of the contraceptive used during coitus or rapes. MTPs are also essential in certain cases where continuation of the pregnancy could be harmful or even fatal either to the mother or to the foetus or both. MTPs are considered relatively safe during the first trimester (up to 12 weeks of pregnancy). 2nd trimester abortions are much more risky. Another dangerous trend is the misuse of amniocentesis to determine the sex of unborn child.
• Amniocentesis is a foetal sex determination test based on the chromosomal pattern in the amniotic fluid surrounding the developing embryo. Amniocentesis is employed for determining hereditary abnormality in embryo. Statutory ban on amniocentesis for sex-determination to legally Check: (i) Increasing female foeticides, (ii) Massive child immunisation.

Q5. Enumerate and describe any five reasons for introducing sex education to school-going children. 

Answer: Proper information about reproductive organs-physiology and its functioning; discourage myths and misconceptions about sex-related aspects; knowledge about safe and hygienic sexual practices; adolescence and related changes, prevention of STDs, AlDs etc.