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Re: Preventing Conception (Long)From: AMD (anonymous@obgyn.net)Fri, 20 Mar 1998 18:19:08 -0600 (CST)
At Thu, 19 Mar 1998, Alexandra wrote: > >Please excuse my approach, this is my first post. I have tirelessly >searched the archives and have found no satisfactory answer to my >questions. >I understand that some methods of birth control prevent the implantation >of a fertilized egg and not fertilization itself. I have heard that >even the pill sometimes stops implantation and not conception. Is this >true? I would like to know of ALL available methods that specifically >PREVENT CONCEPTION (apart from surgery). > >-- >Alex > Alex, I think you are getting at the "does the pill cause abortion" question. I am not a medical professional, but I have also pondered and researched this issue. My understanding is that combined OCP's (not the progesterone-only mini-pills) have three different mechanisms to prevent pregnancy: 1. Change the cervical mucus so that it interferes with sperm getting into the uterus. 2. Changes the hormonal feedback loop to prevent ovulation. This is the primary contraceptive action. 3. Changes the endometrial lining to be inhospitable for implantation. I believe these changes are why women on OCP's have lighter, shorter periods with less cramping. Item #3 is why the pill has been targetted by some as abortive rather than contraceptive. Some even go as far as to say that this is the pill's primary mechanism of preventing pregnancy. This is not the forum to discuss the social issue of abortion, but I'd like to offer some "food for thought" about the magnitude of this problem related to the pill. Considering that some women do get pregnant on the pill, you have to assume that other women on the pill also have "breakthrough ovulation", but do not become pregnant. But it's impossible to guess if they did not become pregnant because they did not have sex at the time of ovulation, that item # 1 from above prevented any viable sperm from reaching the egg, fertilization resulted in a non-viable embryo, or item #3 prevented implantation. On the other hand, there are lots of women who ovulate every month and do not get pregnant despite their best efforts to conceive. There are many reasons that fertilization or implantation can fail under ideal circumstances. So it is almost impossible to quantify how many women on the pill ovulate and conceive, but do not become pregnant because the fertilized egg could not implant due solely to the effects of the pill. In my layman's opinion, the pill preventing a viable pregnancy by preventing implantation is probably a rare occurrence (except when it is used on an "emergency" basis). However, when pills are missed, breakthrough ovulation is more likely, which is why backup methods are recommended. This is also the case when illness causes vomiting or diarrhea, or when taking certain medications. In these circumstances, it may be more likely that mechanisms #1 and #3 help prevent pregnancy. Conception is a remarkable event that requires near-perfect timing and circumstances. I am amazed that anyone ever gets pregnant when I consider all the events that have to occur in the correct sequence at the proper time. When you consider that a healthy couple with no fertility problems can take several months to get pregnant (unless they're teenagers - ;)), I have difficulty believing that actual fertilization occurs very often in women taking OCP's correctly and consistently: ovulation is highly unlikely in the first place and the cervical mucus is not friendly to sperm. And what are the odds that you will happen to have sex in that particular 72 hours if ovulation does occur? Basically, the odds are stacked against fertilization for any woman (except teenagers), and those odds stretch to the very unlikely range for woman who take OCP's properly. Maybe some of the doctors have a more quantitative answer of how often this may actually happen. I don't intend any of this to be a definitive answer or medical fact. These are simply my thoughts that convinced me that OCP's are a reasonable option if you consider any form a contraception to be appropriate. It would be nice to have more definitive answers based on scientific studies, but for now I have to rely on my own logic and judgement. However, if even the theoretical possibility of the pill preventing the implantation of a viable embryo is distressing for you, you may want to consider another method of birth control. I would think that any method that keeps sperm out of the uterus would prevent fertilization with no risk that the method is preventing implantation. These would be things like condoms, diaphragm, cervical cap, sponge, withdrawl, and periodic abstinence. I would certainly stay away from IUD's, the mini-pill, and possibly Depo-provera and implants if you are concerned about the possibility of your contaceptive preventing implantation instead of fertilization. Your doctor should be able to help you understand the actions of the different types of birth control and determine which one suits all of your needs. Just my $.02. Andrea
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