MA: Most young women lately believe that contraceptives could be one of the causes of infertility among women, as there is a big number of young ladies who seem to be having issues with conceiving and so that’s the narrative. I wanted us to start there;
Is there any truth to it?
Gynae:
Let me start off by saying, people who are concerned about their fertility, should know that over 80% of couples in the general population will conceive within one year if the woman is aged under 40 years and they (the couple) are having regular unprotected sexual intercourse.
Of those who do not conceive in the first year, about half will do so in the second year (cumulative pregnancy rate over 90%).
From the medical point of view, there is no truth to the myth that contraceptives are a major factor causing infertility. The causes of infertility are multi- factorial. I always say multi- factorial because you have to think about ‘how does a woman get pregnant’?
Now, the way a woman gets pregnant; most people don’t look at pregnancy and how you get pregnant from a simple point of view.
The normal way a woman gets pregnant starts from having unprotected sex, with the male partner having an erection, inserting his erect penis into the woman’s vagina, and having an orgasm with the ejaculate (sperm) being inserted deep into the female vagina.
The sperm now has to travel up the cervix of the woman, through the uterus, down the fallopian tubes and if she is ovulating from a healthy ovary, the sperm then fertilizes the female egg.
When the sperm fertilizes the female egg, that is when pregnancy occurs.
If you now think about the journey I have just explained, from the male to fertilization of the female egg, a lot of things can go wrong during that journey.
The main causes of infertility (UK NICE Guidance, February 2013, updated September 2017) in the UK (which tends to be similar in most countries) are.
1. Unexplained infertility (no identified male or female cause) (25%).
2. Factors in the male causing infertility (30%).
3. Ovulatory disorders (25%).
4. Tubal damage (20%).
5. Uterine or peritoneal disorders (10%).
As you can see, a major cause of infertility, 30%, is down to the male partner, hence why I started by explaining to you how a woman gets pregnant. The man must have fertile sperm to impregnate the woman. At fertility clinics, the woman is strongly advised to attend with her male partner and BOTH have to be investigated as part of a thorough infertility investigation.
If you start with the man, poor general health (obesity, smoking, tight-fitting underwear, excessive alcohol consumption, anabolic androgenic steroids, marijuana, opioid narcotics, cocaine and methamphetamines) will impair male fertility.
Also sexually transmitted infections (STIs).
To the woman, just like the male, poor general health (obesity, smoking, excessive alcohol consumption, Illicit drugs) will impair female fertility. Problems of the cervix, uterus or tubes as a result of infection or endometriosis (period disorder) can also cause infertility. Also disorders of ovulation.
You now realize contraceptives are not something you will think about as a major factor when the woman is infertile because usually most causes, as described above, are NOT related to contraceptives.
Now, the main aim of the combined oral contraceptives is to stop the ovaries from producing eggs hence preventing ovulation and pregnancy. Most women fall pregnant within a couple of months of stopping the combined pill. The mini-pill, injectable contraception and implants all act on the lining of the Uterus and ovaries to prevent pregnancy. Most women fall pregnant within a couple of months of stopping these, but a few might be delayed for 8-12months.
MA: So, you cannot say infertility is an issue, unless you have had unprotected sex for 2 years and you haven’t got pregnant?
Gynae: YES! So, you see that with that kind of classical definition I stated previously, (80% of couples in the general population will conceive within one year if the woman is aged under 40 years and they (the couple) are having regular unprotected sexual intercourse. Of those who do not conceive in the first year, about half will do so in the second year (cumulative pregnancy rate over 90%)), most contraceptives by the time you stop them, most couples would get pregnant within 2 years.
MA: Thank you!
Any advise or parting shot?
Gynae: Due to all the myths and untruths out there, especially on the internet and social media, if you have fertility issues, it’s advisable to see a gynecologist to have a proper assessment and necessary tests to know exactly what the cause of infertility is. This depends on your age, your history, and so much more.
For example, if you have been actively trying to get pregnant for 6 months but you very well know you have had STDs in the past, it might be good to go and check yourself earlier.
If you’re with a guy, who also had STDs before and you want to have a child together, it might be a good idea for him to have his sperm test checked.
Also, if you’re over 40 years of age, it might be a good idea not to wait too long to get checked.
It all depends on the individual, the circumstances, background, and all of that. So bottom line, if you’re trying to have a baby, before you blame the pill, go talk to a gynecologist.
Also remember, your general health (weight, diet, smoking & alcohol) matters!