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BC question and possible TMI


Mom2Five
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Is there anyway to actually prevent pregnancy, besides abstinence. Ugh. I'm totally all for that, but I don't think dh would be, lol.

 

Seriously, I was convinced that there were no accidental pregnancies until I conceived my daughter in 2012. I was sure that it was  miraculous one time thing. Apparently not because I conceived my son in 2013. Womp, womp. This was after having planned 4 children and 4 pregnancies and then going almost 4 years with our bc method and not getting pregnant.

 

I would love to have all the children. I have always wanted 20 kids. Mentally and physically though I am just done. I have had 5 csections. I have other health issues as well that would make it very risky for me to have another. I also have severe medical anxiety. I could never take bc pills or have something implanted, and iud etc. Honestly I don't know how anyone does that, but I know the majority of ladies are fine and have none of the side effects/complications.

 

I have never been pro any type of permanent bc, such as a tubal or vasectomy. My last csection was an emergency situation at a different hospital/different dr and they asked me before hand about it but I just couldn't do it. Dh has said he is getting a vasectomy which is fine, his decision, but I've heard of so many people getting pregnant after that I will still be paranoid as all get out.

 

 

I have seen some people say they use two methods. I'm not sure how this is possible if I'm not willing to use hormones or something implanted...I guess its not.

 

:( :( :(

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Is NFP family planning? We use condoms as well. Every. single. time. But now I am kicking myself in the butt, for even doing anything when I knew I was ovulating. We used family planning before which I admit probably isn't a good method on it's own but it worked in between kids and for four years so I thought we were good. lol

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Your best bet for non permanent is an IUD. The Mirena was awesome for me. Used it unail I had essure done after DS, and for 3 years in between my kids.

 

With your health issues, though, I would go for essure or tubal ligation. When you know you are done, why risk it?

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I just saw a lawyer commercial for essure. It didn't sound too great, lol. My greatest fear is being put to sleep so I could never have a tubal. I will march hubby down to the vasectomy dr though. Hopefully he will be getting it done next month after the move. I could include family planning and maybe condoms. I don't know if he'd go for that after a vasectomy, but sounds good to me.

 

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I know they are becoming less common - but have you tried a diaphragm?   (supposedly it's more dependable than a condom.)  no hormones.

 

even IUDs have hormones  these days ..  . (the hormones from mine actually revealed other pre-existing underlying health concerns that were only manifested when I was on the hormones.  my gyn was peeved when I demanded it come out then.  I've been dealing with the health problems ever since  and it's been at least five years.)

Edited by gardenmom5
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I just saw a lawyer commercial for essure. It didn't sound too great, lol. My greatest fear is being put to sleep so I could never have a tubal. I will march hubby down to the vasectomy dr though. Hopefully he will be getting it done next month after the move. I could include family planning and maybe condoms. I don't know if he'd go for that after a vasectomy, but sounds good to me.

 

make sure for follow-up testing.  it can take several months afterwards to be considered "safe".  use something else in the meantime.

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It's not NFP when you use condoms (or so I was taught). That's FAM. Fertility Awareness Method. Barriers are used during fertile days. I took a class in the Billings Method (a form of NFP), but I was never good at charting and always second guessing myself. My dumb windows of "safe" days were limited and among those days you still can't have sex consecutively. Like, if you have sex one night, then you have to wait like 3 days? to have sex again because semen and discharge can be confused. If I recall correctly. So, when all was said and done I could hardly have sex at all. I am considering taking a class in the Creighton Method which is similar to Billings, but I haven't figured out if it's more informative to warrant my taking the class. I've also tried the "two day method" which is a simplified version of Billings, but with my signs I didn't find it helpful.

 

My dh once offered to have a vasectomy but has changed his mind and since I know there are issues/risks I don't think I can urge that. To answer your question, withdrawal method is one of the non hormonal options but not something to rely on!

 

I'm in a similar boat. I just don't want hormones and I don't want an IUD and technically pretty much everything is against my religion so it's all one big moral dilemma and headache.

 

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Is NFP family planning? We use condoms as well. Every. single. time. But now I am kicking myself in the butt, for even doing anything when I knew I was ovulating. We used family planning before which I admit probably isn't a good method on it's own but it worked in between kids and for four years so I thought we were good. lol

 

If done correctly, yes, Natural Family Planning can be very effective.

 

See stats here for one method:

 

http://www.boma-usa.org/faq.php?page=6

 

But I really believe it has a lot to do with the couple's willingness to follow it 100% and also the woman's ability to confidently read her signs. Maybe TMI but I think I naturally didn't have as many "safe" days and that was something out of my control.

 

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The hormones you get during ovulation have evolved (or been created by God, as it amounts to the same thing in this case) for hundreds of thousands of years (more?  probably a lot more) to do one very specific thing: get you pregnant.

 

They are well developed for this task :)  That is why I find the NFP method (which we use) to be quite unreliable if what you want to do is completely prevent pregnancy for a long time or forever.  Our bodies are just way too good at getting us pregnant; if you want to avoid pregnancy I think you have to pre-empt or outsmart your body, which basically means an IUD (you can maybe do the copper one depending on how you see the morality of it) or something else that doesn't rely on contravening your ovulation hormones.

 

Getting an IUD is not surgery, btw.  I had one ages ago and it was basically a pap smear.

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I conceived with an IUD, but I still recommend it (for people who take informed consent seriously.)

A friend conceived after a (clear test) vasectomy, but that's the only thing that's worked for us long-term.

 

Everything comes with a slight risk.  Let's be real - even relying on abstinence comes with the risk of getting "caught" without a back up plan.

And then pregnancy comes with its risks, too.

 

I don't think anyone should take BC options lightly, but even the best have their minute fail rates.

When my own kids are old enough to fully understand the slight but real risks to make an informed decision, I'll recommend IUDs as top contenders.

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You can actually use at least three methods without taking pills or having a device implanted: condoms plus spermicide (gel, film, suppositories, etc.) plus NFP/FAM. Condoms plus spermicide are as effective as taking BCP's.

 

All hormonal birth control and all IUD's have the potential to prevent implantation, so I'm not comfortable using them.

 

I honestly wouldn't worry too much after your husband has a vasectomy. Make sure he has follow-up testing. You could add a spermicide if it gives you greater peace of mind.

 

:grouphug:  :grouphug:  :grouphug:

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I know they are becoming less common - but have you tried a diaphragm? (supposedly it's more dependable than a condom.) no hormones.

 

even IUDs have hormones these days .. . (the hormones from mine actually revealed other pre-existing underlying health concerns that were only manifested when I was on the hormones. my gyn was peeved when I demanded it come out then. I've been dealing with the health problems ever since and it's been at least five years.)

You can get a non-hormone IUD.

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All hormonal birth control and all IUD's have the potential to prevent implantation, so I'm not comfortable using them.

 

I am prolife and I used to believe this as well. Then I read the following article and found out it is simply not true. http://www.aaplog.org/position-and-papers/oral-contraceptive-controversy/hormone-contraceptives-controversies-and-clarifications/

 

Summary: The "hostile endometrium" was one of three proposed mechanisms in the 1960s-1970s for how hormonal methods work. Since then, clear evidence has shown that they work via suppression ovulation and by thickening the cervical mucous. No evidence for the "hostile endometrium" has been found. Indeed, the prolife OBGYNs who wrote the article said that in any cycle where a women actually ovulates, her hormone levels were high enough to have a healthy uterine lining. Furthermore, it takes higher levels of the hormones to ovulate than to thicken the lining, so this idea that a women could conceive but the lining not be thick enough (because of birth control) is false. It is a speculation disproven decades ago, but the prolife movement won't let go of it.

 

I have also read a study from the 1980s about copper IUDs. Monkeys given copper IUDs had no sperm in their fallopian tubes after mating, while the control group conceived easily. The researchers concluded that the copper IUD works by killing or immobilizing the sperm, not by preventing implantation.

 

Sorry if I seem harsh about this. I am very frustrated with the well meaning people spreading these lies. We should all be celebrating instead, right? The most effective methods of non-surgical contraception don't cause failed implantation like we thought.

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Have you considered talking to someone about your medical anxiety? If it's so bad that it's preventing you from using even birth control, you might want to see if there's something you can do to lessen it. It could be OCD, and if that's the case it's very treatable with medication or therapy.

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Is NFP family planning? We use condoms as well. Every. single. time. But now I am kicking myself in the butt, for even doing anything when I knew I was ovulating. We used family planning before which I admit probably isn't a good method on it's own but it worked in between kids and for four years so I thought we were good. lol

 

 

There is a WIDE range of what people call NFP.

 

NFP is recognizing your mucus signs, taking basal temp, and charting, as well as (for added measure) cervical changes.

It's really pretty reliable as long as you understand how long  sperm can live in the female reproductive tract and chart.  

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Have you considered talking to someone about your medical anxiety? If it's so bad that it's preventing you from using even birth control, you might want to see if there's something you can do to lessen it. It could be OCD, and if that's the case it's very treatable with medication or therapy.

 

After my dd6 was born I had some severe complications and ended up in the hospital for a week. When I got home after than every little pain would make me lose it. If I got a pain in the back of my leg, I was sure it was a blood clot etc. After that I did talk to my OB and all he could prescribe would have been for postpartum etc. I just wanted something I could take when absolutely necessary to calm me down and not something that would constantly be in my system. I have found it very hard because most just think you are trying to get drugs. I even had a hard time getting pain pills after my last csection one week out because my dr went out of town.

I have always had severe medical anxiety though. I needed several surgeries as a child and have a life threatening allergy where I needed an epi pen several times. I just have always been aware of what could go wrong etc. Given the medical nature of my anxiety I do not like to take any medications. I just cant deal with the side effects. My dr once prescribed me a med for a uti and I totally freaked, had a mega panic attack and just couldn't take it. Luckily, I went and got another test at my Ob office and they sent it off and I did not have a uti.

As far as birth control I would never want to take it. Even if I did eventually get on a med to take only when my anxiety got really bad. I would be so freaked out the whole time about blood clots etc. An IUD I would be freaked out for the same and that it could become implanted somewhere else causing medical problems, the need for surgery etc. All I see are lawyer commercials with horrible side effects for all the bc out there.

If I ever get my insurance back I may try to see if a dr will prescribe me something just for when I'm really freaking out. Like right now I woke up last night with my left leg tingling and my heart racing. Now this morning my left foot still really hurts and my toes are still tingly and there is a part of a vein on the top of my foot that is pronounced and you can see a purple dot on the vein next to my toe. I am now freaking out...I'm crazy. So now all day I will be focused on my foot and leg and of course that magnifies the pain. It is so annoying.

I do have serious medical things going on that I am not imagining and id prob have more if I actually had the insurance to get diagnosed.

I am not sure about the OCD part but I will say a lot of my anxiety is more of not being sure when to get medical attention. LIke if someone told me I had a blood clot id say great lets go to the er and I'll get on blood thinners and hope all turns out well. But if I have a bad pain in the back of my leg and I have to wonder..should I go, Its probably nothing, but what if it is and I don't go to the er, what if I leave my 5 kids to go to the er and it turns out to be nothing then I have the medical bills. Same thing if my heart starts beating irregularly or skips or I have pains in my chest. And then another part of my anxiety is that if I ever did have to get to the hospital my dh would likely not be able to leave work so then how to I go with 5 kids.

Ugh, as you can see Im a nut case, but thanks for letting me vent.

Off to try not to think about my foot today and check in every 10 seconds for change of the purple dot.

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After my dd6 was born I had some severe complications and ended up in the hospital for a week. When I got home after than every little pain would make me lose it. If I got a pain in the back of my leg, I was sure it was a blood clot etc. After that I did talk to my OB and all he could prescribe would have been for postpartum etc. I just wanted something I could take when absolutely necessary to calm me down and not something that would constantly be in my system. I have found it very hard because most just think you are trying to get drugs. I even had a hard time getting pain pills after my last csection one week out because my dr went out of town.

I have always had severe medical anxiety though. I needed several surgeries as a child and have a life threatening allergy where I needed an epi pen several times. I just have always been aware of what could go wrong etc. Given the medical nature of my anxiety I do not like to take any medications. I just cant deal with the side effects. My dr once prescribed me a med for a uti and I totally freaked, had a mega panic attack and just couldn't take it. Luckily, I went and got another test at my Ob office and they sent it off and I did not have a uti.

As far as birth control I would never want to take it. Even if I did eventually get on a med to take only when my anxiety got really bad. I would be so freaked out the whole time about blood clots etc. An IUD I would be freaked out for the same and that it could become implanted somewhere else causing medical problems, the need for surgery etc. All I see are lawyer commercials with horrible side effects for all the bc out there.

If I ever get my insurance back I may try to see if a dr will prescribe me something just for when I'm really freaking out. Like right now I woke up last night with my left leg tingling and my heart racing. Now this morning my left foot still really hurts and my toes are still tingly and there is a part of a vein on the top of my foot that is pronounced and you can see a purple dot on the vein next to my toe. I am now freaking out...I'm crazy. So now all day I will be focused on my foot and leg and of course that magnifies the pain. It is so annoying.

I do have serious medical things going on that I am not imagining and id prob have more if I actually had the insurance to get diagnosed.

I am not sure about the OCD part but I will say a lot of my anxiety is more of not being sure when to get medical attention. LIke if someone told me I had a blood clot id say great lets go to the er and I'll get on blood thinners and hope all turns out well. But if I have a bad pain in the back of my leg and I have to wonder..should I go, Its probably nothing, but what if it is and I don't go to the er, what if I leave my 5 kids to go to the er and it turns out to be nothing then I have the medical bills. Same thing if my heart starts beating irregularly or skips or I have pains in my chest. And then another part of my anxiety is that if I ever did have to get to the hospital my dh would likely not be able to leave work so then how to I go with 5 kids.

Ugh, as you can see Im a nut case, but thanks for letting me vent.

Off to try not to think about my foot today and check in every 10 seconds for change of the purple dot.

 

I have OCD, and I think you might really benefit from talking with a therapist. There may come a time in the future where you'll need to take a medication, and being unable to might put you in danger. UTIs, for example, if untreated can become life-threatening kidney infections. It's not common, but it can happen.

 

I've had issues in the past with taking new medications and being freaked out from the potential side effects. It's actually fairly common with OCD. Now that my OCD is well-managed, I realize just how rare the majority of those side effects are, but at the time I was terrified. I would really encourage you to talk to someone. Your doctor can also prescribe something like Ativan for times when the anxiety is overwhelming, but you'll have to be able to take it for it to do any good, of course.

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*This post has been edited since my original post in order to add in quotes from the above website.

 

I am prolife and I used to believe this as well. Then I read the following article and found out it is simply not true. http://www.aaplog.org/position-and-papers/oral-contraceptive-controversy/hormone-contraceptives-controversies-and-clarifications/

 

Summary: The "hostile endometrium" was one of three proposed mechanisms in the 1960s-1970s for how hormonal methods work. Since then, clear evidence has shown that they work via suppression ovulation and by thickening the cervical mucous. No evidence for the "hostile endometrium" has been found. Indeed, the prolife OBGYNs who wrote the article said that in any cycle where a women actually ovulates, her hormone levels were high enough to have a healthy uterine lining. Furthermore, it takes higher levels of the hormones to ovulate than to thicken the lining, so this idea that a women could conceive but the lining not be thick enough (because of birth control) is false. It is a speculation disproven decades ago, but the prolife movement won't let go of it.

 

I have also read a study from the 1980s about copper IUDs. Monkeys given copper IUDs had no sperm in their fallopian tubes after mating, while the control group conceived easily. The researchers concluded that the copper IUD works by killing or immobilizing the sperm, not by preventing implantation.

 

Sorry if I seem harsh about this. I am very frustrated with the well meaning people spreading these lies. We should all be celebrating instead, right? The most effective methods of non-surgical contraception don't cause failed implantation like we thought.

 

ETA: I made time this morning to read your link and found it remarkably fascinating.  I found one very serious problem with it.  God bless those doctors and what they are trying to do, but upon reading the document, they mention (paraphrasing) an acceptable risk.

 

I thought this was an interesting quote regarding Norplant.  In the interest of full disclosure, I myself used Norplant in both 1996 and 1999 before being convicted that I could no longer use hormonal birth control.   I was pro-choice until 1996 and only became anti birth control in 1999.

 

From that paper regarding Norplant: - For those unfamiliar with Norplant - they were little "matchsticks" inserted under the skin.

The general incidence of ectopic pregnancy in the USA is about 2% of reported pregnancies . Between 6 to 10% of unintended pregnancies on Norplant and POPs may be ectopic. This increased ectopic effect has not been well explained. As mentioned above, it may be related to selective progestin effect on the tube. We see no data to prove or indicate that a number of embryos are produced, with some becoming ectopic pregnancies and with the remainder moving into the uterus to be aborted by an inhospitable lining. But just as in the POP discussion, elective use of a medication with this untoward risk factor, especially when there are hormonal contraceptives with no increased risk factor for either the unborn or the pregnant woman, raises serious ethical questions for many of us.

 

 

Combination pill outcomes - to further define clinical abortion takes place after a pregnancy has been confirmed  - the baby has been implanted and confirmed.  

Theirs: 

Pre-clinical abortions can further be divided into “pre-implantation abortions, those occurring before the conceptus implants 6 days after fertilization, and those occurring after implantation, but before clinical recognition of the pregnancy. 

Further

From the pre-clinical, especially the pre-implantation perspective, the answer must be sought by evaluating indirect data, since there is no direct data regarding these loss rates available for users of COCs. Most studies evaluating efficacy of COCs only measure clinically evident pregnancies as an end point. There is scarce literature about ovulation rates on COCs, although more than 40 such studies were reviewed in preparing this paper. Of the COC studies that evaluated ovulation, fertilization and pregnancy rates are almost never evaluated. The reason for this should be obvious: if a patient in a COC study is told that she has ovulated, she will avoid exposure to sperm, thus preventing an unwanted pregnancy.

 

Essentially?  Insufficient data.

 

I found this article so unbelievably fascinating and I thank you for sharing it.  But I found it written including two perspectives - one, that the risk of the mother must be weighed against the risk of pregnancy and spontaneous miscarriage / ectopic / outcome.   I can understand where they are coming from - they are looking quite a bit at third world countries and who wants to see a risky pregnancy, mamas die, and babies left orphans?  :(   They also share the feeling that there is some small, acceptable risk.  For myself, such a thing does not exist.

 

 

I do *not* want to contribute the OP's anxiety at all.  However, I do want her to have the truth if that is what she is seeking in order to make an informed choice.  If any possibility of abortion is against her personal beliefs, she should be aware.

 

And I also noticed this in the above article: 

 

'If, in the 40 years of COC experience, there were the slightest hint that the product might cause an increase in ectopic pregnancy rates, such warning would have been mandated in the product literature to protect the manufacturer from lawsuits, as well as to warn the user of the possible complication. There are no such warnings in COC labeling. An ectopic pregnancy noted in a woman who has compliantly used COCs, and has no other major risk factors for ectopic pregnancy, is so rare that it would be a reportable case.'

 

By their own admission, the product literature must protect the manufacturer and so any possible complications must be mentioned.  When you see a reportable case you will, in turn, see that reported in the literature.  And so I sought the literature from the manufacturers themselves.

 

The problem is this:

http://labeling.bayerhealthcare.com/html/products/pi/Skyla_PI.pdf

5.2

"If a woman becomes pregnant with Skyla in place and if Skyla cannot be removed or the woman chooses not to have it removed, warn her that failure to remove Skyla increases the risk of miscarriage, sepsis, premature labor and premature delivery. Follow her pregnancy closely and advise her to report immediately any symptom that suggests complications of the pregnancy"

(There is more at the link.  The link is the ACTUAL information created by the maker.)

 

The Pill: I randomly chose Yasmin - a combination pill

http://labeling.bayerhealthcare.com/html/products/pi/fhc/Safyral_PI.pdf (This is their own insert.)

 

12.1 "Mechanism of Action COCs lower the risk of becoming pregnant primarily by suppressing ovulation. Other possible mechanisms may include cervical mucus changes that inhibit sperm penetration and endometrial changes that reduce the likelihood of implantation."

 

As well as this:

  • "Pregnancy while using Skyla is uncommon but can be life threatening and may result in loss of pregnancy or fertility."  (Under safety information.)

 

ETA: I hope the tone of this is received well.  I don't mean it harshly.  I just couldn't let the "spreading of lies" part pass.  I'm sorry if it sounds accusatory or sassy.    One of the things that is super important in any area of study is first source documents.  This comes from the manufacturer themselves.

Full disclosure:  I am pro-life.  I believe life begins at the moment of conception.  I think there is NO acceptable risk that I could purposefully and intentionally choose that could potentially abort a child.... None.  

 

And moreover, I don't say it lightly.  On December 3, 2015 I almost died during a spontaneous miscarriage at home.  Ambulance, bleeding out, serious blood transfusion, emergency DC.  We've had to seriously evaluate our belief systems in the months since.  This isn't some kind of idealistic, baby Christian, haven't lived it kind of judgement I'm proclaiming to sway anyone.  I'll let their own literature speak for itself.  

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Some thoughts....

 

There are devices that help with NFP if you're having a hard time determining fertile vs. non-fertile days.  The LadyComp uses your temperatures, and the Marquette method uses a the Clearblue fertility monitor to check hormone levels in your urine. 

 

If you have or are planning on getting a microscope, you or your husband could use it to check from time to time whether he's still shooting blanks after the vasectomy.  (I don't mean to do this as a substitute for his follow-up appointments with the doctor, more for your peace of mind that the tubes haven't re-grown.)

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I am prolife and I used to believe this as well. Then I read the following article and found out it is simply not true. http://www.aaplog.org/position-and-papers/oral-contraceptive-controversy/hormone-contraceptives-controversies-and-clarifications/

 

Summary: The "hostile endometrium" was one of three proposed mechanisms in the 1960s-1970s for how hormonal methods work. Since then, clear evidence has shown that they work via suppression ovulation and by thickening the cervical mucous. No evidence for the "hostile endometrium" has been found. Indeed, the prolife OBGYNs who wrote the article said that in any cycle where a women actually ovulates, her hormone levels were high enough to have a healthy uterine lining. Furthermore, it takes higher levels of the hormones to ovulate than to thicken the lining, so this idea that a women could conceive but the lining not be thick enough (because of birth control) is false. It is a speculation disproven decades ago, but the prolife movement won't let go of it.

 

I have also read a study from the 1980s about copper IUDs. Monkeys given copper IUDs had no sperm in their fallopian tubes after mating, while the control group conceived easily. The researchers concluded that the copper IUD works by killing or immobilizing the sperm, not by preventing implantation.

 

Sorry if I seem harsh about this. I am very frustrated with the well meaning people spreading these lies. We should all be celebrating instead, right? The most effective methods of non-surgical contraception don't cause failed implantation like we thought.

 

No worries, Hoppy. I am well-acquainted with the controversy over this issue, even among pro-lifers. I have been a guest lecturer on this topic in college nursing classes and have studied it in depth. 

 

I am familiar with the article you posted from the American Association of Pro-Life Obstetricians and Gynecologists. You are aware that other members of that organization have come to different conclusions? Here is an article signed by many of those members. They assert, “The undersigned believe that the facts as detailed in this document indicate the abortifacient nature of hormonal contraception. This is supported by the scientific work of the Alan Guttmacher Institute which can, in no way, be confused with a right-to-life organization....we have no desire to cause confusion and division among pro-life forces. However, we do want to make it clear that we do desire that all women using the pill are truthfully and fully informed about all its modes of action.â€

 

Also from their article:

 

From an interview with Richard Hill, a pharmacist who works for Ortho-McNeil (a pill manufacturer), speaking on whether or not the pill creates an inhospitable endometrium: “...it’s not theoretical. It’s observable. We know what an endometrium looks like when it’s rich and most receptive to the fertilized egg. When the woman is taking the Pill, you can clearly see the difference, based both on gross appearance – as seen with the naked eye – and under a microscope. At the time when the endometrium would normally accept a fertilized egg, if a woman is taking the Pill it is much less likely to do so.â€

 

For those interested in the topic, I highly recommend you read Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent, by Walter L. Larimore, MD and Joseph B. Stanford, MD, MSPH, Archives of Family Medicine, 2000;9:126-133, American Medical Association. From that paper:

 

“The primary mechanism of oral contraceptives is to inhibit ovulation, but this mechanism is not always operative. When breakthrough ovulation occurs, then secondary mechanisms operate to prevent clinically recognized pregnancy. These secondary mechanisms may occur either before or after fertilization. Postfertilization effects would be problematic for some patients, who may desire information about this possibility. This article evaluates the available evidence for the postfertilization effects of oral contraceptives and concludes that good evidence exists to support the hypothesis that the effectiveness of oral contraceptives depends to some degree on postfertilization effects. However, there are insufficient data to quantitate the relative contribution of postfertilization effects. Despite the lack of quantitative data, the principles of informed consent suggest that patients who may object to any postfertilization loss should be made aware of this information so that they can give fully informed consent for the use of oral contraceptives."

 

Regarding IUD's, I will copy some of my comments from a previous thread:

 

IUD's can indeed prevent implantation.  

 

Estimated post-fertilization losses specifically attributable to the IUD, per year, for various types:

Inert IUD--0.72 to 1.97 losses per year

Copper-380 IUD (Paraguard)--0.19 to 1.04 losses per year

Levonorgestrel-20 IUD (Minera)--0.19 to 1.82 losses per year

 

"These estimates indicate that, although prefertilization effects are more prominent for the copper IUD, both prefertilization and postfertilization mechanisms of action contribute significantly to the effectiveness of all types of intrauterine devices."

 

Source: Mechanisms of action of intrauterine devices: Update and estimation of postfertilization effects by Joseph B. Stanford, MD, MSPH, and Rafael T. Mikolajczyk, MD. American Journal of Obstetrics and Gynecology, 2002;187:1699-708.

 

"Insertion of an IUD in the early luteal phase is a highly effective emergency contraceptive, suggesting that the IUDs act after fertilization.† 

 

Source: Cheng L, Gulmezoglu AM, Van Oel CJ, Piaggio G, Ezcurra E, Van Look PFA. Interventions for emergency contraception [Reviews]. The Cochrane Library 2007; Vol. 2.

 

“Indirect clinical evidence is supportive of the hypothesis that the effect of the copper IUD on the endometrium plays a role in its contraceptive action (Spinnato, 1997)...Also, several long-term studies have established that when pregnancy occurs in IUD users the embryo is more likely to be ectopic than in control women using no contraception or in those who become pregnant while taking oral contraceptives (Sivin and Tatum, 1981; World Health Organization, 1994). The ratio of ectopic to intrauterine implantations is ∼1 in 6–8 among IUD pregnancies compared to 1 in 20 control pregnancies. The most plausible explanation for these findings is that IUDs are more effective at preventing pregnancy when it implants in the uterus rather than the tube, implying that with an IUD in place some embryos reach the uterine cavity but fail to implant.â€

 

Before objecting to the older dates of three studies above, please note that all were cited as valid supporting references in Oxford Journal's Human Reproduction Update, Volume 14, Issue 3, Pp. 197-208, 2008.

 

So, I'm afraid I'm not celebrating, and I'm not spreading lies. My conscience compels me to act with an abundance of caution when innocent human life is involved and encourage others to do the same.

Edited by MercyA
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I am familiar with the article you posted from the American Association of Pro-Life Obstetricians and Gynecologists. You are aware that other members of that organization have come to different conclusions? Here

 

I read through this article. I haven't had a chance to read the others you posted. I didn't think the authors did a good job refuted the original article. First, they started with the premise that contraception is automatically wrong. That may be their belief, but it isn't scientific evidence. Secondly, the quoted the part about the less fertile endometrium multiple times but never addressed (that I saw, anyway) the main point about that: Yes, it is less fertile in cycles where ovulation is inhibited, but when breakthrough ovulation occurs, the hormonal levels are high enough that the endometrium will be healthy.

 

The article also quoted people from drug companies asserting implantation problems may happen, but as far as I saw, no evidence for this was provided. The original articles started that drug company inserts have stated this for decades, but that there isn't any evidence to back it up. It sounds like they think it was an unproven theory long ago that has just been repeated as truth since then.

 

Edited to remove the stuff about the monkey study. I think I misremembered some details. I need to reread it.

Edited by HoppyTheToad
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I find this all very interesting (the implantation with IUD issue) as I was of the understanding, like Hoppy, that the previous research was wrong and it turns out IUDs (much less other hormonal birth control methods) don't prevent implantation.  If this is not true, and they *do* prevent implantation, I'll have to reassess what to do should we ever be done having kids before I'm infertile, sigh.

 

OP, I'm sorry, I didn't realize what you meant when you said you were averse to medical procedures.  That sounds really hard.

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I read through this article. I haven't had a chance to read the others you posted. I didn't think the authors did a good job refuted the original article. First, they started with the premise that contraception is automatically wrong. That may be their belief, but it isn't scientific evidence. Secondly, the quoted the part about the less fertile endometrium multiple times but never addressed (that I saw, anyway) the main point about that: Yes, it is less fertile in cycles where ovulation is inhibited, but when breakthrough ovulation occurs, the hormonal levels are high enough that the endometrium will be healthy.

 

The article also quoted people from drug companies asserting implantation problems may happen, but as far as I saw, no evidence for this was provided. The original articles started that drug company inserts have stated this for decades, but that there isn't any evidence to back it up. It sounds like they think it was an unproven theory long ago that has just been repeated as truth since then.

 

Thanks for taking the time to read the article. I agree that the authors could have presented a stronger rebuttal. I am not anti-birth control myself, only anti-abortifacient birth control. 

 

For evidence regarding implantation inhibition, please see the Archives of Family Medicine article I linked earlier, Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent, which says in part:

 

"To assess the clinical significance of an altered endometrium, it was helpful to examine data that compared endometrial thickness with the receptivity of the endometrium to preembryos during in vitro fertilization procedures. Magnetic resonance imaging scans of the uteri of women reveal that the OC users have endometrial linings that are consistently thinner than the endometrial linings of nonusers,48-50 up to 58% thinner. Of the first 4 ultrasound studies published, the first did not find a relationship between endometrial thickness and in vitro fertilization implantation rates; however, subsequent studies noted a trend, and one demonstrated that a decreased thickness of the endometrium decreased the likelihood of implantation. Larger, more recent, and more technically sophisticated studies all concluded that endometrial thickness is related to the functional receptivity of the endometrium. Furthermore, when the endometrial lining becomes too thin, then implantation does not occur. The minimal endometrial thickness required to maintain a pregnancy in patients undergoing in vitro fertilization has been reported, ranging from 5 mm to 9 mm to 13 mm, whereas the average endometrial thickness in women taking OCs is 1.1 mm. These data would seem to lend credence to the Food and Drug Administration–approved statements that " . . . changes in the endometrium . . . reduce the likelihood of implantation."We considered this level II.2 (good to very good) evidence (Table 1)."

 

Further:

 

"Integrins are a family of cell adhesion molecules that are accepted as markers of uterine receptivity for implantation....integrin expression is significantly changed by OCs. Integrins have been compared using endometrial biopsy specimens from normally cycling women and women taking OCs. In most OC users, the normal patterns of expression of the integrins are grossly altered, leading Somkuti et al to conclude that the OC-induced integrin changes observed in the endometrium have functional significance and provide evidence that reduced endometrial receptivity does indeed contribute to the contraceptive efficacy of OCs. They hypothesized that the sex steroids in OCs alter the expression of these integrins through cytokines and therefore predispose to failure of implantation or loss of the preembryo or embryo after implantation. We considered this level II.3 (good) evidence (Table 1)."

 

Regarding the assertion that hormone levels high enough to allow breakthrough ovulation will also provide a hospitable endometrium:

 

"If breakthrough ovulation occurs while using the COC, then to some extent ovarian and blastocyst steroidogenesis could theoretically "turn on" the endometrium, causing it to normalize prior to implantation in the ovulatory cycle. However, after discontinuing use of COCs, it usually takes several cycles for a woman's menstrual flow to approach the volume of women who have not taken hormonal contraception, suggesting that the endometrium is slow to recover from its COC-induced atrophy. Furthermore, in women who have ovulated secondary to missing 2 low-dose COCs, the endometrium in the luteal phase of the ovulatory cycle has been found to be nonsecretory.â€

 

Also consider:

 

"If the action(s) of OCs on the fallopian tube and endometrium were such as to have no postfertilization effects, then the reduction in the rate of intrauterine pregnancies in women taking OCs should be proportional to the reduction in the rate of extrauterine pregnancies in women taking OCs. If the effect of OCs is to increase the extrauterine-to-intrauterine pregnancy ratio, this would indicate that one or more postfertilization effects are operating. All published data that we could review indicated that the ratio of extrauterine-to-intrauterine pregnancies is increased for women taking OCs and exceeds that expected among control groups of pregnant women not currently using OCs. These case-controlled series come from 33 centers in 17 countries and include more than 2800 cases and controls."

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There is a WIDE range of what people call NFP.

 

NFP is recognizing your mucus signs, taking basal temp, and charting, as well as (for added measure) cervical changes.

It's really pretty reliable as long as you understand how long sperm can live in the female reproductive tract and chart.

Bingo. And it's useful for avoiding OR conceiving. But for most hormonally normal women it is a reliable, useful source of information and can help inform decisions on avoiding or utilizing a barrier much more effectively than just guessing :)

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Very interesting comments here. We were taught in my NFP class that the pill made implantation difficult and could lead to an abortion. The class was taught by an MD and spouse. They actually said they didn't like the method using the basal body thermometer. By the time you see the ovulation signs it may be after the fact. (embarrassed to say but for years I thought the BBT was used down below! That was a deterrent for me lol)

 

There is a WIDE range of what people call NFP.

 

NFP is recognizing your mucus signs, taking basal temp, and charting, as well as (for added measure) cervical changes.

It's really pretty reliable as long as you understand how long  sperm can live in the female reproductive tract and chart.  

 

Just to clarify for others, not necessarily all within the same method. Some use many of the above, some use just cervical mucus. For example I know Sympto-thermal method involves basal temp, but the Billings Method does not.

 

One of the biggest downsides to NFP (for avoiding pregnancy) in my experience is that the "mood" strikes during the fertile period and one or both of us was not interested during the infertile period. Also, if you're a fan of morning sex you could be out of luck. Must chart all day and have sex at night in most if not all cases. If you're already using condoms then it's not going to change much other than being aware of risk if condom breaks. I know people that use condoms all the time so I don't think learning to chart would change anything. I love the concept of NFP but I did see a lot of issues in practice that no one told me about.

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I wanted to clarify that earlier when I mentioned "spreading lies," I didn't mean anybody who sincerely believes the research shows possible implantation problems. I more meant it as people spreading something that ranges from something that may have been overly simplified into a soundbite to the point it may not even be true anymore. For example, after all the news coverage of the Hobby Lobby court case, my FIL thought all the arguing was about RU-486, a drug that everyone agrees causes an abortion. He was quite surprised to find out that Plan-B, the morning-after pill discussed the most, was actually a different product and that people disagree whether it causes abortions. Nowhere in all the yelling on TV and the radio about the issue did he ever hear anyone address how each drug works or explain that they are not the same product. Essentially,mthe soundbites he heard had ceased to be truth.

 

In any case, I want to apologize to anyone I've offended. I wasn't very gracious and Mercy and Blessed Mama were. Unfortunately, I do know many (non-Catholics) people against all contraception, sometimes including NFP, and I can definitely see some of them unknowingly passing along untruths about hormonal methods based on soundbites they've heard without ever looking at the science of it. I am convinced that no amount of data to the contrary (if it exists now or in the future) would get them to give up the idea of the pill causing abortions.

 

When I get a chance, I will read the other links Mercy posted. I am especially interested to find out if the MRI studies on uterine linings were done in cycles where the women had breakthrough ovulation or not.

 

Personally, while I am currently morally fine with hormonal methods, I do wish that medical or prolife groups raised money for non-hormonal methods. I think it would be great if Americans would research that easily reversible injectible vasectomy being studied in India. Healthwise, I am not a fan of hormonal methods. We need new, safe, effective, harder-to-misuse non-hormonal methods. I wish there were some national organization competing against PP that provided affordable reproductive services minus providing abortions.

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No apology necessary, Hoppy, you were fine. I don't mind rational discussion with people like you who have actually looked into the issue.

 

BTW, I totally understand what you mean about the Hobby Lobby news coverage, and I am convinced your FIL was not the only person left confused!

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I loved my copper IUD. Ten years (ok, 12, I was reluctant to part with it) of worry-free and hormone-free contraception and it cost me a trip to the gyn and a day of cramping. It might be worth taking a Valium and going for it. It's practically nothing compared to childbirth.

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