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AYUFY - The legacy of Kerala Ayurveda
AYUFY, a Kerala-based Ayur-tech startup, founded by 50 young Kerala Ayurvedic doctors, is set to integrate Ayurveda with technology. Our online platform (www.ayufy.com) offers medical consultations, health awareness programs, and educational initiatives, with a focus on women & child health specialties

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Welcome to **AYUFY**, your digital gateway to the healing traditions of Ayurveda. 

**AYUFY** is proudly presented by **MEDISTACKS Healthcare Pvt Ltd**, delivering specialized consultations from experienced and renowned Ayurvedic Doctors, with a particular focus on Infertility and women's health issues spanning from menarche to menopause.

**Our Commitment:**
At AYUFY, we firmly believe that Ayurveda holds the key to a more balanced, healthy, and fulfilling life. Our commitment is to make this ancient knowledge accessible to everyone, irrespective of geographical boundaries. We envision a world where Ayurveda becomes an integral part of people's lives.

**What Sets AYUFY Apart:**


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**First Super Specialty Ayurvedic App with more than *100Doctors.***

***Primarily focusing Ayurvedic Gynecology and infertility.***

*15 + language speaking Doctors in Different Time zones.*

***Focusing renowned Kerala Panchakarma treatments.***


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As an Ayufy Senior Infertility Consultant, I often meet couples facing fertility challenges. While factors like sperm count and motility are widely discussed, one important yet lesser-known factor in male fertility is sperm morphology—the shape and structure of sperm. This post explores the significance of sperm morphology and how a holistic approach, including principles from Ayurveda, can play a role in improving fertility.


	What is Sperm Morphology? 


	Sperm morphology refers to the size, shape, and structure of sperm. A healthy sperm has an oval head and a long, straight tail. These characteristics are important because they affect the sperm’s ability to swim properly and penetrate an egg during fertilization. Even if a man has a normal sperm count, poor morphology can reduce the chances of conception.


	Why is Sperm Morphology Important?


	Sperm with abnormal shapes—such as misshapen heads or short, coiled tails—may not swim efficiently or penetrate the egg, leading to difficulties with conception. Even if other parameters, such as count and motility, are normal, poor sperm morphology can negatively impact fertility. This is why sperm morphology is a critical aspect of semen analysis.


	Factors Affecting Sperm Morphology


	Several factors can contribute to abnormal sperm morphology, including genetics, lifestyle habits, environmental toxins, and underlying health conditions. Smoking, alcohol consumption, obesity, and exposure to chemicals can negatively influence sperm quality, including morphology.


	A Holistic Approach to Improving Sperm Morphology 


	In Ayurveda, the health of reproductive tissues is linked to overall wellness. The principle emphasizes a holistic approach to balancing the body and mind to promote reproductive health. By focusing on detoxification, proper nutrition, stress reduction, and healthy lifestyle choices, Ayurveda seeks to enhance the quality of sperm, including its morphology. The balance of the body’s vital energies (doshas) is central to improving overall fertility.


	Lifestyle Modifications for Better Sperm Health 


	A key Ayurvedic principle is that a balanced, healthy lifestyle contributes significantly to sperm quality. Some of the recommended practices include:


	- Balanced diet: Eating nutrient-rich, fresh foods supports the body’s ability to produce healthy reproductive tissue.


	- Stress management: Chronic stress can lead to hormonal imbalances that affect sperm health. Techniques such as meditation, yoga, and proper sleep are emphasized to manage stress.


	- Detoxification: Detoxifying the body of impurities or toxins, known as ama, helps improve the quality of reproductive tissues.


	- Regular physical activity: Moderate exercise enhances circulation, which is crucial for reproductive health, including sperm quality.


	- Mind-body harmony: Balancing physical and mental health is essential for maintaining the quality of reproductive tissue in men, contributing to better sperm morphology.


	Conclusion


	Sperm morphology plays a vital role in male fertility, influencing the chances of successful conception. Understanding this aspect and adopting a holistic, balanced lifestyle rooted in Ayurvedic principles can contribute to better reproductive health. A thorough semen analysis, along with conscious lifestyle choices, can guide couples in their fertility journey.

As an Ayufy Senior Infertility Consultant, I often meet couples facing fertility challenges. While factors like sperm count and motility are widely discussed, one important yet lesser-known factor in male fertility is sperm morphology—the shape and structure of sperm. This post explores the significance of sperm morphology and how a holistic approach, including principles from Ayurveda, can play a role in improving fertility.What is Sperm Morphol

Understanding the Importance of Sperm Morphology in Male Fertility

Type 2 diabetes is a chronic illness characterized by high blood sugar (glucose) levels. It is the most common type of diabetes. If not treated properly, it could have serious implications for your health. Eating a healthy, balanced diet is essential for managing type 2 diabetes.


	1. The Role of Macronutrients :


	Carbohydrates


	Carbohydrates have the greatest impact on blood glucose levels. It is critical to monitor the type and amount of carbohydrates consumed.


	* Complex Carbohydrates: Choose whole grains, lentils, and fiber-rich vegetables. This aids in delaying digestion and reducing blood sugar levels.


	* Simple Carbohydrates: Limit your intake of sugary drinks, candy, and processed grains that might increase blood sugar spikes.


	Protein


	Protein stabilizes blood sugar levels and offers a sense of fullness or satiety, leading to reduced calorie intake.


	* Lean Proteins: Include foods like egg chicken, turkey, fish, tofu, and lentils.


	* Dairy: Select low-fat options and be aware of extra sugars in flavored varieties .


	 Fats


	Healthy fats are necessary for good health and can increase insulin sensitivity.


	* Healthy fats include avocados, nuts, seeds, and olive oil. Ghee


	* Limit Saturated and Trans Fats: Reduce your intake of red meat, and processed meals.


	2. The role of Macro and Trace Minerals


	 Minerals like magnesium and chromium play a key part in insulin action and glucose metabolism. Zinc and selenium, which are trace minerals, help to cut down on oxidative stress and inflammation in people with type 2 diabetes. You can find these minerals in nuts, seeds, legumes, and whole grains.


	3. The role of vitamins


	 Vitamin D, B complex vitamins, and vitamin E are crucial to stay healthy and lower the chance of getting type 2 diabetes. Vitamin D, which you can get from sunlight exposure, fortified food and some fatty fish boosts insulin sensitivity and reduces inflammation. B vitamins, including B6, B12, and folic acid, make nerve function and energy production better. Nuts, seeds, and vegetables contain vitamin E, which fights inflammation.


	 4. Understanding GI and GL.


	Glycemic Index


	The Glycemic Index evaluates carbohydrates according to their effect on blood sugar levels:


	* Low GI Foods: (55 or lower) Include non-starchy vegetables, fruits, legumes, and whole grains.


	* Moderate GI foods (56-69) include whole wheat products, sweet potatoes, and brown rice.


	* High GI foods (70 and above) Include white bread, white rice, and sugary treats.


	Glycemic load


	Glycemic Load presents a more comprehensive picture by considering the GI and the portion quantity of meals.


	* Low GL: 10 or less. To maintain stable blood sugar levels, choose low-glycemic foods. * Moderate GL: 11-19. Consume moderately.


	* High GL: (20 or higher) Limit these foods to avoid blood sugar rises.


	5 Fiber-rich foods


	Fiber is important for managing diabetes because it slows sugar absorption and improves blood sugar levels.


	* Soluble fiber is found in oats, beans, lentils, apples, and berries.


	* Insoluble fiber is found in whole grains, nuts, and a variety of vegetables.


	6. Portion Control and Timing.


	Managing portion sizes and meal timing can have a major effect on blood sugar control.


	* Smaller, Frequent Meals: a gap between meals and nibbling on low-calorie fruits and nuts helps regulate blood sugar levels. and some find Eating fewer meals throughout the day helps keep blood sugar stable.


	* Balanced Plates: Make sure each meal has a decent balance of veggies, grains, and lentils, as well as a reliable source of protein.


	7. Hydration.


	Staying hydrated is vital for everyone, especially those with diabetes.


	* Water: Try to drink enough water throughout the day.


	* Limit sugary drinks, such as sodas, fruit juices, and energy drinks.


	8. Monitoring and Adjustments.


	Monitoring blood sugar levels regularly might help you understand how various foods and activities affect your body.


	* Blood Glucose Monitoring: Record your readings before and after meals.


	 9. Professional guidance:


	 Work with a dietician or healthcare provider to create a dietary plan that is tailored to your specific needs.


	Conclusion


	 Medical Nutrition therapy for individuals with Type 2 diabetes should be individualized based on their metabolic needs, preferences, and lifestyle changes


	There is no "one-size-fits-all" approach to diet and diabetes. Medical Nutrition therapy from a registered dietitian or nutritionist can help lower A1C levels by up to 2% in type 2 diabetes within 3 to 6 months.

Type 2 diabetes is a chronic illness characterized by high blood sugar (glucose) levels. It is the most common type of diabetes. If not treated properly, it could have serious implications for your health. Eating a healthy, balanced diet is essential for managing type 2 diabetes.1. The Role of Macronutrients :CarbohydratesCarbohydrates have the greatest impact on blood glucose levels. It is critical to monitor the type and amount of carbohydrates

Essential Nutrition Strategies for Managing Type 2 Diabetes 

Obesity and Diabetes are closely linked. Obesity can contribute to the development of Diabetes and Insulin Resistance…..


	 What is Obesity??


	 Obesity is a condition that occurs when a person has excess body fat that may affect their health and daily routine. A health expert consider a person has obese, when he/she is having a sufficiently high body mass index (BMI) i.e. BMI above 25, Obesity is associated with a higher risk of developing serious diseases, including Type 2 Diabetes, Heart Diseases and Cancer etc.


	 What is Diabetes??


	 Diabetes describes a group of conditions that occurs when your blood glucose/ blood sugar, is too high. There are mainly 3 types of Diabetes, they are


	 •Type 1 Diabetes


	 •Type 2 Diabetes


	 •Gestational Diabetes


	 Type 1 Diabetes:-


	 Type 1 Diabetes is believed to be an autoimmune condition. This means, when your immune system mistaking destroys the beta cells in your pancreas, that produces Insulin. The damage is permanent. Lifestyle factors are not believed to play a role in Type 1 Diabetes.


	 Type 2 Diabetes:-


	 Type 2 Diabetes is the most common type of Diabetes, occurs when your body can’t use insulin properly or your pancreas doesn’t make enough insulin or both. The contributing factors may include;


	 •Genetics


	 •More sedentary lifestyle


	 •Obesity etc…


	 Gestational Diabetes:-


	 Gestational Diabetes is caused by insulin blocking hormones that are produced during pregnancy. This type of diabetes only happens during pregnancy.


	 What is Insulin Resistance??


	 Insulin Resistance is a condition occurs when your body cells are not respond to the effects of insulin. This causes the pancreas to work harder to produce sufficient insulin. Overtime may cause pancreas to decrease its ability to release insulin, which can lead to Type 2 Diabetes.


	 How does Obesity lead to Diabetes??


	 Obesity results from an imbalance between calorie intake and consumption, leading to excessive accumulation of body fat. This excess fat, especially abdominal fat, contributes to insulin resistance. As insulin resistance progresses, the pancreas tries to compensate by producing more insulin to keep blood sugar level under control. The pancreas may become unable to keep up with this increased demand, leading to high blood sugar characteristic of Type 2 Diabetes.


	 Conclusion:-


	 The relationship between obesity and diabetes is clear, Obesity significantly increases risk of developing Type 2 Diabetes due to factors such as Insulin Resistance, Inflammation and Metabolic dysfunction. Managing Obesity with healthy balanced diet, regular exercise including Yoga, Meditation etc.., and the importance of medical supervision and adherence to prescribed medications cannot be overstated, as they play a vital role in weight loss and control blood sugar levels and managing the complications associated with Diabetes.

Obesity and Diabetes are closely linked. Obesity can contribute to the development of Diabetes and Insulin Resistance….. What is Obesity?? Obesity is a condition that occurs when a person has excess body fat that may affect their health and daily routine. A health expert consider a person has obese, when he/she is having a sufficiently high body mass index (BMI) i.e. BMI above 25, Obesity is associated with a higher risk of developing serious dis

IS THERE ANY RELATION BETWEEN OBESITY AND DIABETES?

<h4>The Importance of Early Management of Prediabetes</h4>

	 Prediabetes is a condition characterized by blood glucose levels that are higher than normal but not yet high enough to be classified as Type 2 diabetes, is a growing public health concern worldwide. It is estimated that the number of people with diabetes rose from 108 million in 1980 to 422 million in 2014 [WHO]. Alarmingly, most Individuals with prediabetes are unaware of their condition, making prevention of progression to type 2 diabetes a significant challenge. Regular blood sugar testing is crucial for managing prediabetes, as pathological abnormalities, such as insulin resistance and beta-cell dysfunction, can exist even before the onset of diabetes.


	 Definition and diagnosis 


	 Pre-diabetes or impaired glucose tolerance/fasting glucose means that normal blood sugar levels are higher than normal but not high enough to qualify as diabetes. The World Health Organization (WHO) has defined prediabetes as a state of intermediate hyperglycemia using two specific parameters.


	 --Impaired fasting glucose (IFG) is defined as fasting plasma glucose (FPG) of 6.1-6.9 mmol/L (110 to 125 mg/dL) and-


	-Impaired glucose tolerance (IGT) is a 2Hr plasma glucose of 7.8–11.0 mmol/L [140–200 mg/dL].


	 Along with that, -


	 Hemoglobin A1c (HbA1c), which shows the average glucose levels over the last 3 months in the range of 5.7-6.4%, then the person is considered to have prediabetes.


	 Common symptoms


	 Although prediabetic individuals often do not experience symptoms, some subtle signs may be present that are not always apparent. But what can be noticed are


	 * Itchy skin, darkened skin in your armpits or back and sides of your neck (Acanthosis nigricans) and skin tags


	 * Frequent urination [polyuria].


	 * Blurry vision


	 * Recurrent infections and delayed wound healing


	 * Fatigue or tiredness


	 * Increased thirst [ polydipsia]


	 * Abnormal hunger levels: cells' inability to create energy due to a lack of glucose uptake causes excessive hunger, resulting in hyperphagia and polyphagia, which are abnormally high appetites that are frequently accompanied by insatiable hunger.


	 Health Implications of Pre-Diabetes


	 Progression to Type 2 Diabetes


	 Ignoring prediabetes can lead to type 2 diabetes, a condition requiring lifelong management. Type 2 diabetes can cause severe health problems, including heart disease, nerve damage [neuropathy], kidney problems [nephropathy], and eye issues [retinopathy].


	 Strategies for Managing Prediabetes 


	 Lifestyle changes


	-Losing weight (every 1 kg reduction in weight reduces the risk by 16%)


	 .Exercise- is essential for the management of diabetes. 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week. Include strength training exercises to add muscle mass, thus improving insulin sensitivity Or Aim for at least 30 minutes of moderate exercise such as brisk walking, biking, or swimming on most days of the week.


	 Diet And Nutrition


	 Dietary changes (such as reducing fat intake to &lt;30%, of which &lt;10% is saturated fat, avoiding high sugary foods, and choosing a well-balanced diet with the right amount of protein, fat, and complex carbohydrates and vegetables)


	 .Stress Management: High-stress levels elevate blood sugar and insulin levels. Yoga, meditation, deep-breathing exercises, or pranayama can help manage stress. Or seek help from a health professional.


	 Supplements like Vitamin D, Magnesium, and Omega 3 can be taken under the supervision of healthcare professional


	 .Motivational interviewing. A communication strategy that is successful in modifying behaviors helps strengthen an individual's motivation towards a specific goal


	 .Education: Diabetes is complex, and many factors affect blood sugar levels. Do your best to educate yourself on prediabetes and diabetes from reliable sources. Depending on the case, along with the above modifiable factors, medications may also be prescribed to help manage blood sugar levels.


	 Conclusion


	 Managing prediabetes is crucial for maintaining good health as it helps prevent the progression of type 2 diabetes and other complications. However, a low awareness of prediabetes remains a barrier to early intervention and prevention. Increased education and outreach are required to improve the identification and management of prediabetes patients. Healthcare systems and policymakers can reduce the burden of type 2 diabetes and its complications by emphasizing early intervention.

The Importance of Early Management of Prediabetes  Prediabetes is a condition characterized by blood glucose levels that are higher than normal but not yet high enough to be classified as Type 2 diabetes, is a growing public health concern worldwide. It is estimated that the number of people with diabetes rose from 108 million in 1980 to 422 million in 2014 [WHO]. Alarmingly, most Individuals with prediabetes are unaware of their condition, makin

THE IMPORTANCE OF EARLY MANAGEMENT OF PREDIABETES

Understanding Insulin Resistance: Causes, Symptoms, and Management


	 Insulin resistance is a growing threat to the health of millions across the world. It occurs when cells in the body become less responsive to insulin, a hormone that causes blood glucose levels to rise. This condition is a precursor to type 2 diabetes and is associated with other health problems like obesity and heart disease, among others.


	 What is Insulin Resistance?


	 A hormone called insulin secreted by beta cells of pancreas helps cells to take in glucose from the blood stream so that it can be used as energy. In case of insulin resistance, muscles, fat, and liver cells do not respond well to insulin which means they cannot easily absorb glucose from blood. Therefore, more insulin is produced by pancreas to assist glucose enter cells. Such circumstances may lead to increased amounts of sugar in the blood due to higher levels of both insulin and sugar; hence causing type 2 diabetes and other health issues if not effectively managed.


	 Causes of Insulin Resistance


	 Genetics: Family history plays a significant role in determining whether someone suffers from this condition or not, especially when such people are related by blood.


	 Obesity: Excessive adipose tissue especially around the waistline increases risk factors for one developing reduction in insulin action


	 Physical inactivity hampers insulin effectiveness


	 Improper Nutrition: Foods high in sugar and refined carbohydrate resulting in insulin resistance. Many sweet foods/beverages result in elevated blood sugar, which leads to pancreas working harder.


	 Disordered Hormones: irregular hormonal functions such as PCOS and other endocrine conditions can promote the development of insulin resistance.


	 Symptoms of Insulin resistance


	 Insulin resistance often produces no symptoms, making it hard to detect early on. Few signs may be present like


	 Acanthosis Nigricans: This is darkened velvet-like skin patches commonly found in the armpits, neck, and groin.


	 Weight Gain: Around a person’s belly area.


	 Fatigue: An individual feels like they have not had enough sleep though they slept well enough.


	 Hunger: someone eats more than usual, especially sweets and carbohydrates.


	 Difficulty Concentrating: Brain fog or focus loss at times.


	 Diagnosing Insulin Resistance


	 Healthcare providers use several methods for diagnosing insulin resistance, including:


	 Blood Tests: This involves measuring fasting blood glucose levels and fasting plasma insulin levels above normally indicate IR status;


	 Glucose Tolerance Test (GTT): Checking how much your blood sugar goes up after taking a drink with glucose in it.


	 HOMA-IR: is an abbreviation for Homeostasis Model Assessment of Insulin Resistance, and its calculation is based on fasting glucose and insulin levels.


	 Treating Insulin Resistance


	 Insulin resistance can be easily managed by lifestyle modifications.


	 Healthy Diet: Concentrate on a well-balanced diet rich in whole foods incorporating plenty of vegetables, lean proteins, healthy fats as well as whole grains while avoiding refined sugars and processed foods.


	 Regular Exercise: 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week. Include strength training exercises to add muscle mass.


	 Weight Loss: Reducing your body weight by even a small percentage like five or ten can go a long way towards increasing your insulin sensitivity.


	 Medications: Sometimes doctors may prescribe certain medications depending upon the severity and other health issues.


	 Stress Management: High stress levels elevate blood sugar and insulin levels. Practices like yoga, meditation, and deep-breathing exercises or pranayama can help manage stress.


	 Summary


	 Insulin resistance is a potentially severe health problem that should not be ignored. Its causes, symptoms identification, and adoption of healthy lifestyle changes can facilitate control or even cure it; also consult a healthcare professional if you suspect you have insulin resistance.

Understanding Insulin Resistance: Causes, Symptoms, and Management Insulin resistance is a growing threat to the health of millions across the world. It occurs when cells in the body become less responsive to insulin, a hormone that causes blood glucose levels to rise. This condition is a precursor to type 2 diabetes and is associated with other health problems like obesity and heart disease, among others. What is Insulin Resistance? A hormone ca

UNDERSTANDING INSULIN RESISTENCE 

*DYSMENORRHOEA*


	 Dysmenorrhoea literally means painful menstruation.But a more realistic and practical definition includes cases of painful menstruation of sufficient magnitude so as to incapacitate day -to-day activities.


	 ◼️The primary dysmenorrhoea is one where there is no identifiable pelvic pathology.


	 ▪️Incidence:The incidence of primary dysmenorrhoea of sufficient magnitude with incapacitation is about 15-20percent.With the advent of oral contraceptives and non-steroidal anti-inflammatory drugs,there is marked relief of the symptoms.


	 ▪️Cause of pain:The mechanism of initiation of uterine pain in primary dysmenorrhoea is difficult to establish.But the following are too often related.


	 ▪️ Mostly confined to adolescents.


	 ▪️ Almost always confined to ovulatory cycles.


	 ▪️The pain is usually cured following pregnancy and vaginal delivery.


	 ▪️The pain is related to dysrhythmic uterine contractions and uterine hypoxia.


	 Uterine myometrial hyperactivity has been observed in cases with primary dysmenorrhoea .


	 The outer myometrium and the subendometrial myometrium are found to be different structurally and functionally.The subendometrial layer of myometrium is known as Junctional zone(JZ).There is marked hyperperistalsis of the JZ in women with endometriosis and adenomyosis.In women with dysmenorrhoea significant changes in JZ are seen.These include irregular thickening and hyperplasia of smooth muscle and less vascularity.This is known as Junctional zone hyperplasia.Dysperistalsis and hyperactivity of the uterine JZ are the important mechanisms of primary dysmenorrhoea .


	 🔹Role of vasopressin-


	 There is increased vasopressin release during menstruation in women with primary dysmenorrhoea .This explains the persistence of pain in cases even treated with antiprosta glandin drugs.The mechanism of action is yet to be explored.Vasopressin increases myometrial activity directly.It causes uterine hyperactivity and dysrhythmic contractions-&gt;ischaemia and hypoxia-&gt;pain.


	 🔹Endothelins causes myometrial smooth muscle contractions, specially in the endomyometrial junction (JZ).Local myometrial ischaemia caused by endothelins and PGF2α aggravate uterine dysperistalsis and hyperactivity.


	 🔹 Platelets activating factor (PAF) is also associated with the aetiology of dysmenorrhoea as it's concentration is found high.Leukotrienes and PAFs are vasoconstrictors and stimulater myometrial contractions.


	 🔹 Clinical features:


	 The pain begins a few hours before or just with the onset of menstruation.The severity of pain usually lasts for few hours,may extend to 24hours but seldom persists beyond 48hours.The pain is spasmodic and confined to lower abdomen;may radiate to the back and medial aspect of thighs.Systemic discomforts like nausea, vomiting, fatigue, diarrhoea, headache and tachycardia may be associated.It may be accompanied by vasometer changes causing pallor,cold sweats and occasional fainting.Rarely,syncope and collapse in severe cases maybe associated.


	 Abdominal or pelvic examination doesn't reveal any abnormal findings.


	 For detection of any pelvic abnormalities,ultra sound is very useful and it is not invasive.


	 ◼️ Secondary Dysmenorrhoea (Congestive)


	 Secondary dysmenorrhoea is normally considered to be menstruation -associated pain occuring in the presence


	 of pelvic pathology.


	 🔸 Cause of pain:


	 The pain maybe related to increasing tension in the pelvic tissues due to pre-menstrual pelvic congestion or increased vascularity in the pelvic organs.


	 🔸Common causes of secondary dysmenorrhoea :


	 Cervical stenosis,chronic pelvic infection, pelvic endometriosis, pelvic adhesions,adenomyosis,uterine fibroid, endometrial polyp,IUCD in utero and pelvic congestion.Obstruction due to mullerian malformations are the other causes.


	 🔸Right ovarian vein syndrome:


	 Right ovarian vein crosses the ureter at right angle.During pre-menstrual periods,due to pelvic congestion or increased blood flow,there maybe marked engorgement in the vein-&gt;pressure on ureter-&gt;stasis-&gt;infection -&gt;pyelonephritis-&gt;pain.

*DYSMENORRHOEA* Dysmenorrhoea literally means painful menstruation.But a more realistic and practical definition includes cases of painful menstruation of sufficient magnitude so as to incapacitate day -to-day activities. ◼️The primary dysmenorrhoea is one where there is no identifiable pelvic pathology. ▪️Incidence:The incidence of primary dysmenorrhoea of sufficient magnitude with incapacitation is about 15-20percent.With the advent of oral con

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