When does pregnancy occur if you stop protecting yourself?
Methods of contraception and pregnancy planning
Contraception is not only a way to protect against unwanted pregnancy, but also a way of preserving your reproductive health.
Marina Pilnenskaya obstetrician-gynecologist, Moscow
It allows you to plan the birth of a healthy child when you and your spouse are ready for it. Thus, proper contraception and adequate withdrawal of protection are the basis of family planning.
There are two main directions of contraception: hormonal and non-hormonal. These funds have a different contraceptive mechanism. They are also different in terms of effectiveness and impact on the body.
To barrier contraception, in addition to the use of a condom (this method can be abolished on the eve of the planned conception), the use of spermicides - candles or ointments introduced into the vagina shortly before sexual intercourse - also applies. The method is based on the chemical effect on spermatozoa. Substances that have a contraceptive effect, immobilize spermatozoa in the genital tract of a woman, individual drugs reduce the risk of transmission of certain infections. Since spermicides act for a very short period of time and do not affect the woman's ability to conceive, fertilization after their application is possible already during the next sexual intercourse. Pregnancy that has occurred against the background of the use of spermicides is not recommended to be interrupted, as the oocyte can only be reached by a full, intact spermatozoon. During pregnancy, an early ultrasound is recommended at week 8-9, carrying out a triple test.
Another non-hormonal method is intrauterine contraception, or setting up an intrauterine contraceptive (IUD). Its contraceptive effect is based on changes in the peristalsis (motor activity) of the fallopian tubes and changes in the state of the endometrium: the contraceptive prevents implantation - the introduction of a fertilized fetal egg into the wall of the uterus. Side effects of this method - violation of the menstrual cycle, the appearance of intermenstrual bleeding, exacerbation of urogenital infections, ectopic (tubal) pregnancy.
Between the removal of the spiral and the complete cancellation of protection, a 1-3 cycle interval is desirable. This time is necessary for the restoration of the endometrium, although after removal of the IUD, the ability to conceive is restored, as a rule, very quickly. For 2-3 cycles it is recommended to use other methods of contraception (condom) - this is necessary to restore the work of the uterus and fallopian tubes and, consequently, reduce the risk of spontaneous miscarriage and ectopic pregnancy.
The removal of the spiral is carried out on the 2-3rd day of menstruation, when the cervix is ajar and the extraction of IUD is most painless. But it is necessary to apply to a gynecologist for removal of IUD for 2-3 weeks before the onset of menstruation. The doctor will take your tests, including the degree of purity of the vagina. If an infection is detected or suspected, the disease can be treated before the IUD is removed. This will make the removal procedure safe, prevent the penetration of infection from the vagina into the uterine cavity.
At the time of the procedure, the doctor enters into the vagina special gynecological mirrors, the same tools he uses and during a routine examination. IUDs that have threads are usually removed by sipping for them. If, for one reason or another, the filaments are not visible, then hospitalization is necessary to remove the IUD, then the spiral is removed during hysteroscopy, a procedure that is performed against a background of general anesthesia. An optical device is inserted into the uterus cavity, which allows you to see on the screen what is happening in the uterus. If the spiral is detected, it is removed with a special tool.
Pregnancy occurs after the extraction of IUDs during the year in 90% of women.
In the case of pregnancy on the background of the use of IUD and the desire of a woman to remain pregnant with the presence of IVM strands should be deleted. If the IUD strands are not detected and the pregnancy is diagnosed, the IUD is not removed. The changes observed in the lining of the uterus against the background of the spiral are a risk factor for early termination of pregnancy in the event of its onset. It should be noted that no increase in the frequency of developmental defects or any damage to the fetus has been observed if the pregnancy wears out against the background of the IUD.
The contraceptive effect in this case is based on the suppression of ovulation - the release of the egg from the ovary, which occurs in the middle of the menstrual cycle, on the change in the state of the cervical mucus. There are the following types of hormonal contraceptives:
- combined (they contain estrogens and progesterone analog - gestagen); At present, new forms for the use of combined contraception have appeared. These are the neural forms - plaster and vaginal ring;
- Progestin-only contraceptives: minipiles (contain only progesterone analog - progestogen), as well as various types of contraception, when in the body, in one way or another, a hormone depot is created that regularly enters the bloodstream and has a contraceptive effect. Such methods include a spiral and capsules sewn under the skin.
If during the reception of hormonal contraceptives you have had complications, then before planning pregnancy, you need to undergo examinations and take tests:
- Consultations and examinations with specialists (gynecologist, endocrinologist); A smear on oncocytology from the surface of the cervix (Pap smear - a Pap smear).
- Ultrasound of the pelvic organs.
- Biochemical blood test for evaluation of liver and pancreatic function, especially if complaints from the work of these organs were noted.
- If during the reception of hormonal contraceptives there were complaints from the mammary glands, an examination by a mammologist and ultrasound of the mammary glands is necessary.
- One of the possible complications arising on the background of hormonal contraception is a violation of the state of the blood coagulation system, the formation of thrombi, the violation of blood flow in small vessels and, as a result, disruption of the organs. If during the reception of hormonal contraception there were complaints of headaches, pain in the legs, you need to make a hemostasiogram (analysis of the blood coagulation system).
- The timing of the use of combined hormonal contraceptives (tablets, patches, vaginal rings) suggests two options:
- A short course (3-4 months) is prescribed as treatment for certain hormonal disorders.
- A long course (more than 6 months) is used as a contraception.
After a short course, you do not have to wait after the abolition of contraception, you can immediately plan a pregnancy. In most women, ovulation occurs in the first cycle after the abolition of hormonal contraception. This is due to the so-called rebound effect (the effect of withdrawal) - increased release of pituitary hormones (endocrine glands located in the brain) in response to the abolition of contraception.
After canceling the long course of hormonal contraception, it is necessary to postpone the planning of pregnancy for 2-3 cycles. This is due to the fact that during the use of the contraceptive the mucous membrane of the uterus becomes thinner (during the intake of oral contraceptives there are no changes characteristic of the menstrual cycle - proliferation of the endometrium). Therefore, the conditions for normal implantation of the embryo deteriorate. That is, the probability of early termination of pregnancy increases. In addition, the hormones that make up hormonal contraceptives change the vitamin and mineral balance in the body, preventing, for example, the absorption of vitamin C, certain trace elements and folic acid, and at the same time contributing to excessive absorption of vitamin A, which can adversely affect the development of the future child.
At this time, non-hormonal contraception (barrier, interrupted sexual intercourse, calendar method) can be used.
In most women, the ability to conceive is restored within 2-3 months, for some within 3-4 months. In some cases (especially with prolonged use of hormonal contraceptives) there are violations of ovulation within 6-12 months. If the menstrual cycle is broken and does not recover, consult a doctor.
If the pregnancy occurred against the background of the use of hormonal contraceptives, immediately confirm the pregnancy (the analysis for the hCG - pregnancy hormone - is done within 2 hours). If there is a pregnancy, cancel contraception.
Usually the pregnancy that occurs in such a situation does not need to be interrupted, but the final answer to this question can still be given only by the doctor: it depends on what drug the woman took, what period of pregnancy it took to take the drug, etc.
Postcoital contraception (the use of tablets with a high dose of hormones right after intercourse) is based mainly on blocking the implantation - attaching the fetal egg to the wall of the uterus. Pregnancy that has occurred against the background of such contraception, too, there is no need to interrupt.
Separately, it is necessary to say about the so-called prolonged drugs - they contain only gestagens (an example of such a drug is DEPO-PRO VER). Injections of drugs are done 1 time in 1-5 months. Subcutaneous implants are capsules that are injected subcutaneously into the shoulder area and produce a hormone daily, providing contraception for 5 years. An example is PORPLAPT, which is 6 cylindrical capsules that are injected subcutaneously under the local anesthetic into the forearm of the left arm. There are intrauterine contraceptives containing levonorgestrel in the rod, which is released daily during the year (an example of such a drug is MIRENA).
Restoration of the ability to conceive after the abolition of long-acting contraceptives can occur only after several months (up to 1.5 years). If the plans have changed, then the PORPLANTE and MIRENA can be removed, the effect of DEPO-CHECK-IN injection can not be canceled.
Considering the aforesaid, prolonged contraceptives recommend only to women who in the near future do not plan pregnancy.
If pregnancy has not occurred in the first months after the abolition of contraception, then do not get upset. For the onset of pregnancy requires a combination of very many factors in a specific time interval. Even under condition of absence of any infringements of health at spouses, a sexual life without protection in the proper days of a cycle the probability of conception in a concrete cycle makes on the average 20-25%. If, however, you are very concerned about the problem of pregnancy, consult a doctor who is involved in infertility and miscarriage. The doctor will help you determine the most fertile days for the cycle, and, if necessary, recommend a survey.