DOES THE PILL CAUSE INFERTILITY? MYTHS AND TRUTHS ABOUT CONTRACEPTION

For half a century in the market, the contraceptive pill is still one of the most used pregnancy avoidance methods in Brazil, being preferred by 61% of Brazilians who use some form of contraceptive. But despite popularity, it still raises numerous doubts … can it affect fertility? Can everyone use it? Does it interfere with sexual desire? Get fat To clarify the matter, once and for all, we chatted with the gynecologist Fernanda Coimbra Miyasato, specialist in Human Reproduction, of Fertilizavitta (SP). The result you check next.

1) Can every woman take the contraceptive pill?

No. The pills are contraindicated for some patients: women with any cardiovascular disease; smokers over 35 years of age; previous or current history of deep venous thrombosis or pulmonary thromboembolism; uncontrolled hypertension; thrombophilia (diseases at risk of developing thrombosis); migraine; hepatical cirrhosis; acute hepatitis; tumor in the liver and prior or current history of breast cancer. Therefore, in addition to the clinical history, the gynecologist can request some tests called thrombophilia profile before starting the use of this medicine.

2) Can the pill cause infertility after many years of use?

 Not! This is myth. What usually occurs is that women use the pill for a long time during their most fertile period (up to 35 years of age), and when they stop it, they are already at a more advanced age, which makes pregnancy difficult. Moreover, during the period of use, the fertility of the couple is not “tested” and when it is left out, they may find that there was an earlier problem that had not been detected until then. The contraceptive can, for example, mask infertility problems, such as early menopause and low ovarian reserve, which drastically reduces the chances of pregnancy. In most women, the contraceptive effect is reversed at 3 months after discontinuation, with normalization of the menstrual cycle and ovulation.

3) What are the different types of birth control pills that exist today?

Basically, there are two types of birth control pills: the combined ones, which contain two hormones (estrogen associated with progestogen), and progestogen-only pills (especially indicated in breastfeeding, also called minipills). The effectiveness of the second one is smaller, so the control should be more rigid in this case (especially in relation to schedules). The estrogen used in most pills is the same, what modifies is the dosage. However, you can rest easy because all the top pills to get pregnant available in the market are classified with low dosage and have safe levels of hormones. As estrogen increases the risk of thrombosis, the existing amount of this substance has been progressively reduced in the most modern pills.

9) Can any medications affect the contraceptive effect?

Antibiotics: there is no scientific evidence of interference with the efficacy of the pill, except for rifampicin (used to treat tuberculosis, leprosy and prophylaxis of meningitis). Rifampicin reduces the levels of estrogen and progesterone in contraceptives.

Anticonvulsants: some, but not all, medications used for seizure management may also decrease the effectiveness of the pills. It is important to have a conversation with the neurologist and gynecologist about what is the best treatment option in this case.

Antiretrovirals: drugs used in the treatment of AIDS can also decrease the effectiveness of contraceptives.

10) Is it true that the pill reduces the risks of some types of disease? What for exemple?

Yes. The pill has several benefits besides contraception. It is a protective factor for osteoporosis, regulates the menstrual cycle and decreases the risk of anemia by reducing menstrual flow. It may also decrease or even treat PMS symptoms, as well as alleviate polycystic ovary symptoms (acne and hair enlargement, hair loss and oiliness of the skin). There is also a reduction in the risk of ovarian and intestinal cancer, that is, a protective effect is also observed here. Finally, it reduces the incidence of ectopic pregnancy (in the fallopian tubes) and pelvic inflammatory disease.

I’VE BEEN TRYING TO GET PREGNANT FOR OVER A YEAR AND I CAN NOT. WHAT SHOULD I DO?

pproximately two out of ten couples find it difficult to conceive. That is, 20% of couples have some type of difficulty to raise children by natural means and at least half of them will need specialized treatments. Despite the increased disclosure of available treatments, only 43% of infertile couples seek treatment and only 24% seek specialized treatment. Infertility is defined as difficulty in getting pregnant after a year of trying in the fertile period. After this period the doctor’s search is indicated. However, as age is an important factor in infertility, the Society for Reproductive Medicine recommends that women over the age of 35 wait only six months for a medical appointment.The couple needs to look for the doctor and both man and woman need to get tested.  This is justified by two reasons: in order to decide in partnership what they are going to do and also to know what the fertility problem is – they may have some impediment. Usually 30% of the causes are female, 30% male, 30% of the couple and 10% do not reach a defined cause. In the woman it is necessary to perform evaluation of the ovulation, the fallopian tubes and the uterus and check other diseases that are correlated with infertility. One of the main causes is anovulation (lack of ovulation), very common in patients with Polycystic Ovarian Syndrome (PCOS).

The tubal factor (tubal) is also very common. When compromising the fallopian tubes (where the ovum meets the sperm) occurs due to inflammation acquired by sexually transmitted diseases, post-surgery adhesions or endometriosis (presence of the endometrium outside the uterine cavity), pregnancy is not possible. There is also the uterine factor, as the presence of fibroids or polyps inside the endometrium make pregnancy difficult. In addition, there are hormonal factors such as excess prolactin, hormone that interferes with ovulation. In men, the main cause is varicocele (varicose veins of the scrotal sac), then infections in the testicles, epididymis, and prostate. After arriving at a diagnosis, there are basically four types of  assisted reproductive treatments. Scheduled coitus: ovulation is induced with medication, accompanied by serial ultrasonography and the couple is instructed to have sexual intercourse in the correct period;

– Intrauterine insemination: when the spermatozoa (after a preparation in the laboratory) are inserted in the uterine cavity through a catheter to facilitate the encounter with the ovule, in the period of ovulation;

– In  vitro fertilization  and ICSI (intracytoplasmic sperm injection): technique that involves inducing ovulation and withdrawing eggs and sperm from the couple to fertilize the laboratory. After fertilization occurs, the embryo is introduced into the uterus between 2 and 5 days;

Ovation: indicated for women who have entered into early ovarian failure, have removed the ovaries, are older than 45 or are already in menopause. In this case, eggs from younger women are donated for fertilization (in the laboratory) with the partner’s sperm. There are reports that the success of treatments are greater in couples who have a good doctor-patient relationship, as well as in those who perform psychological counseling during treatment.Already the progestogen, hormone present in the pill varies according to the brand. There are progestogens that decrease the effects of male sex hormones and others that decrease fluid retention, for example.

4) Is it true that the pill can cause thrombosis?

 Yes. The risk to non-users can increase by as much as six times. But even so, when there are no predisposing factors, it is small. The best thing to do, therefore, is to find a gynecologist to know if you are part of that group or not and which pill is most appropriate for you.

5) What other problems (for certain people) are associated with the pill?

 The most common side effects of estrogens, although rare, may be: nausea, enlarged breasts (ducts and fat), fluid retention, fibroids growth, gastritis, facial spots, varicose veins, and libido interference. The estrogenic and progestagenic effects when associated may be: breast tenderness, headache and hypertension. Eventually, depression and mood swings may occur. Swapping the pill can usually resolve this picture. The most important is to analyze case by case and use another medication or method when necessary.

6) Can the pill interfere with a woman’s sexual desire?

In fact, the pill reduces the secretion of androgenic (male) hormones, which can lead to decreased libido in some women. It is important to always analyze the personal history of the patient, since there are several factors that can contribute to the decline of libido, such as depression, anemia, obesity, drug use, stress, among others. There is no study confirming that the decrease in libido is due to contraceptive only, in fact, Febrasgo (Federation of Gynecology and Obstetrics Associations) reports that there is no change in 72% of women. Some even see increased desire, probably because of the loss of fear of becoming pregnant.

7) Does the Pill Fat?

There is no scientific proof that the birth control pill is fattening. Most of the pill’s side effects (such as fluid retention, which can result in a larger number in the balance) disappear 3 to 6 months after starting the drug.

8) Is there an ideal time to take the pill?

 There is no timetable indicated, but it is important to keep the regular schedule of the shots taken on a daily basis so as not to reduce its effectiveness and avoid irregular bleeding. A delay of more than 12 hours may already cause an unlock in ovulation.

WHY THE FIRST PREGNANCY MAY NEED TREATMENT AND THE SECOND DOES NOT (AND VICE VERSA)

Some couples may present a pleasant surprise after several treatments to conceive the first child and have a spontaneous pregnancy of the second. Most often, this happens in cases where the infertility diagnosis of the couple was sterility without apparent cause. That is, after the whole investigation of the couple, a diagnosis was not reached and still the couple did not get pregnant. Many couples who have this diagnosis undergo infertility treatments that result in the birth of a child. And that seems to make some couples fertile. Studies published in Fertility and Esterility show that, on average, 21% of couples successfully after in vitro fertilization (IVF) later become spontaneously pregnant. There are also some speculations that the second pregnancy will come from stress relief, correction of ovulatory problems such as polycystic ovary syndrome after the onset of pregnancy and improvement of the picture of endometriosis due to the suspension of the menstrual cycles during pregnancy and breastfeeding.

Now, the opposite can happen! When the first child’s pregnancy happens spontaneously and there is difficulty getting pregnant from the second child after a year of trying with frequent intercourse. This is called secondary infertility. Up to 60% of couples face this problem in order to get their second child conceived. Causes can be female or male or both. The factors that influence primary and secondary fertility are practically the same. The age factor is the main one, since from 35 years the chances of a woman getting pregnant are diminishing. In addition, complications may have occurred during childbirth, development of sexually transmitted diseases that may cause inflammation in the fallopian tubes, altered menstrual cycles with difficulty in ovulation, or even early menopause. In males, a decrease in semen quality and quantity may occur , due to stress, hormonal factors, onset of varicocele (varicose veins in the testicles) and ejaculation problems.

In addition, the couple’s lifestyle can also interfere with trying the second child, such as overweight and poor diet, alcohol or drug use, the presence of sexually transmitted diseases … All these factors can change ovulation and quality of the semen. The good news is that for couples who already have a child the chances of a second pregnancy with proper treatment are greater.