In recognition of August 18th as Birth Control Pill Day, we wanted to raise awareness about one of the many benefits of birth control for women: using it during In Vitro Fertilization (IVF) treatment. Specifically, taking birth control pills before an IVF cycle.
When a woman is struggling to conceive and comes to a fertility doctor to help her get pregnant, her doctor, a reproductive endocrinologist, may discuss IVF, which has the highest success rate of all fertility treatments. If the woman and her doctor agree IVF is the best path to pregnancy, the doctor and a team of nurses will begin preparing the woman to begin her IVF cycle.
As part of this preparation, the woman will receive a list of all the medications she will need (the majority being hormone injections), and often, she’ll see birth control medication on the list. And when this happens, many women are entirely confused.
Why, they think, would I take a pregnancy prevention pill to help me get pregnant?
RMA Physicians Dr. Leo Doherty and Dr. Emily Osman break down commonly asked questions about being on birth control medication during an IVF cycle and explain how the medication is used to create optimal timing during your treatment.
“When patients hear that we are recommending birth control prior to their infertility treatment, they sometimes think they have come to the wrong specialist,” joked Dr. Leo Doherty, who practices out of RMA New Jersey’s Freehold, Somerset, and Basking Ridge offices.
“While birth control pills can be used for contraception, with the goal of preventing pregnancy, they can also be used to ‘hit the pause button’ on a woman’s monthly cycle and keep her follicles, which contain eggs, and uterine lining in a baseline state that is very useful prior to beginning IVF treatment and achieving a pregnancy.”
Birth control pills function by suppressing a woman’s hormones and preventing ovulation, thereby making pregnancy impossible or extremely unlikely.
Specifically, Dr. Doherty explained, birth control pills prevent the growth and development of a woman’s follicles (each of which contains an egg) and keep her endometrial lining thin.
Without the development of one primary or lead follicle, ovulation will not occur, and without an adequate uterine lining, the embryo will not successfully implant inside the woman’s endometrium.
This baseline state is optimal for the start of IVF fertility treatment, where the goal of IVF is to grow as many follicles as possible in one cycle. After stopping birth control pills, self-administered hormone injections are used to stimulate the growth of the ovarian follicles.
“This coordinated growth allows us to maximize the number of mature fertilizable eggs at the time of egg retrieval,” Dr. Doherty said. “By preventing a ‘front-runner’ or lead follicle from developing by using a birth control pill, the follicles that develop during ovarian stimulation tend to be more synchronized.”
Other circumstances that could prompt putting a woman into this baseline state include waiting on embryo testing results, insurance authorization for a treatment cycle, or facilitating surgical scheduling.
Once these things are completed, the pill is stopped, the menstrual cycle becomes “un-paused,” and treatment can resume.
In addition, because birth control pills reduce your body’s production of estrogen and progesterone, they can be taken (and are often prescribed) to relieve symptoms of endometriosis in women not trying to conceive.
At RMA, Dr. Doherty said, doctors typically prescribe combined oral contraceptive pills (OCPs), which contain both estrogen and progesterone.
These are the same as the birth control pills women take every day to prevent pregnancy. These OCPs are monophasic, which means they have a steady dose of both estrogen and progesterone and are well tolerated by women.
For women who cannot take OCPs, RMA doctors prescribe progesterone-only pills, the most common of which is norethindrone.
“Being on birth control long term does not cause infertility,” she said. “There are no differences in pregnancy rates, fertility treatment success, or miscarriage rates between women on long-term birth control pills versus those that are not.”
Dr. Osman said that once a woman decides to get off the pills, normal hormone production will be restored in women who were having regular cycles prior to the use of birth control pills.
She added that it may take up to three months to start having regular menstrual cycles after stopping the pill, but if your cycles do not resume after that time, you may want to consider seeing a fertility doctor.
According to Dr. Osman, you may want to avoid birth control pills if you have a history of high blood pressure, blood clots or if you are a smoker.
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