Parenting: Preconception

Perhaps we could find a new name for the birth control pill. After all, although we think of them only as a contraceptive, they're used for a variety of purposes: to ease symptoms of menopause and pre-menstrual syndrome, to regulate unpredictable periods and to control excessive menstrual bleeding. One brand is even touting itself as a weight loss aid! So why not use them to try to conceive a child as well as to prevent one?

Sounds confusing and contradictory, but the fact is that birth control pills are not really birth control pills at all, they are hormone regulators and it's this use that has fertility specialists taking a closer look at how they can help in cases of infertility.

A Happy Ending
Lisa McCall of Audubon, Penn., recently discovered she was pregnant. She believes that the birth control patch, Ortho Evra, helped her conceive after a miscarriage, a molar pregnancy, a course of Depo Provera and a history of irregular periods.

"My cycles before the patch were all over the place, 38 days one month, 28 the next, etc.," says McCall. "Once I got on the patch, they were 28-day cycles on the nose. I knew when I was supposed to ovulate before I ovulated, because my cycles were regular again."

McCall had decided to use Depo Provera for birth control after her marriage. She had two shots in one year and almost completely stopped having periods – something she hadn't realized would happen. Then, when she and her husband decided to have a child, her cycles were so irregular they weren't able to conceive for nearly a year and a half. When she did finally conceive, she had a molar pregnancy and wonders if the Depo had anything to do with that.

While there's no proof that Depo was responsible, Dr. Philip E. Chenette, of the Pacific Fertility Clinic in San Francisco, Calif., says that they like the Depo to be completely out of a woman's system before she becomes pregnant, and they do recommend a back-up form of contraception during that time. Furthermore, Dr. Lawrence B. Werlin, of the Coastal Fertility Medical Center in Irvine, Calif., says that if a woman is coming to the end of a course of Depo, it may help regulate her cycles to try a course of oral contraceptives.

Contraceptives and IVF
While the use of birth control pills is rather common to regulate cycles in fertile women, they are finding a new use in a reproductive technology known as in vitro fertilization (IVF). IVF is a method of assisted reproduction in which the man's sperm and the woman's egg (oocyte) are combined in a laboratory dish, where fertilization occurs. The resulting embryo is then transferred to the uterus to develop naturally. Usually, two to four embryos are transferred with each cycle. Traditionally, oral contraceptives have been used as part of the process of preparation for egg retrieval to minimize unexpected complications.

"The contraceptive is a hormone that regulates the menstrual cycle," says Dr. Chenette. "It allows us to set a precise cycle start date so patients can schedule their vacations and business needs, and it suppresses ovulation in the month before the treatment to minimize the risk of an ovarian cyst that could delay the cycle and to even out the stimulation. In other words, more eggs with better maturity."

However, recent studies have shown that pre-treating patients about to undergo IVF with oral contraceptives in conjunction with some newer medications also allows for a treatment regimen which includes fewer fertility drug injections and offers flexibility for egg retrieval.

According to the American Society for Reproductive Medicine, when the oral contraceptive regimen was followed by treatment with Follistim® (follitropin beta) and Antagon™ (ganirelix acetate), 78 percent of participant egg retrievals were scheduled during a five-day period. However, by altering the start date and discontinuation of the contraceptive pill by one day, the number of weekday retrievals increased to 89 percent.

"Currently, it is very difficult for physicians to predict the exact point during a woman's treatment cycle when her eggs will be fully mature and ready for retrieval," says Dr. Larry I. Barmat, of Abington Reproductive Medicine in Abington, Penn. "By pre-treating patients with oral contraceptive pills, physicians can more accurately schedule egg retrievals during a five-day work week. This allows treatment to be more patient-friendly, while at the same time not leaving the date of egg retrieval up to chance."

This is doubly beneficial for IVF patients. While it allows them to know in advance the probable time of egg retrieval and to plan accordingly, the ultimate benefit is that using Antagon™ in conjunction with the oral contraceptives results in the patient needing fewer shots – three to four on average as opposed to 21 shots with the more traditional treatments.

Pregnancy After Birth Control
In the case of IVF, pregnancy is the hoped-for result of a well-monitored program. However, for the average woman who is trying to get pregnant after using contraception, there are a few things to consider.

First, you will probably hear conflicting advice about whether or not to wait a couple of months after stopping oral contraceptives before attempting to conceive.

"Contraceptives give you specific amounts of hormones and shut off normal cycling," says Dr. Chenette. "They also cut down on the endometrial lining you produce. The biggest problem is that with the first cycle is that if the hormones don't function immediately, the lining may not function appropriately."

Dr. Chenette recommends that a woman wait to try to conceive until her cycles seem to be back to normal, a process that can take as few as two months.

On the other hand, Dr. Werlin notes that in patients who are on birth control pills because of fibrocystic ovaries, the best time to get pregnant may be in the first month when the hormones are still acting to suppress cysts. In addition, there is also some anecdotal evidence that a woman is most fertile in her first month after stopping hormone-based birth control.

As always, the best thing to do is to consult with a doctor you trust before you become pregnant to decide what will be best for you and your baby.