How Do the Pill and Other Contraceptives Work? con't (page 2)

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Part B: Questions Regarding other Contraceptives

Q-A5O: How frequently does OCP use cause an early abortion?

At this point, no one knows. There are many factors which influence the answer to this question and it is possible that as technology improves, an accurate estimate will be made. One of the determining factors is how often OCP use allows ovulation to occur. If the rate of ovulation is documented to be substantially higher than the pregnancy rate, then one could start to make an estimate of the frequency of abortion in women who take the OCP.

Measuring a woman's ability to ovulate is difficult. Researchers measure ovulation rates in women who are taking the pill by using several parameters including: 1) Ultrasound measurements of the ovary, specifically the size of the largest (dominant) follicle (which contains the egg or oocyte), and 2) hormonal assays of progesterone and estradiol levels. Until now, many researchers have arbitrarily accepted that a pregnancy has occurred when the progesterone levels reaches a certain height, but it is possible that OCP use depresses the ovary's ability to produce progesterone despite pregnancy as noted as early as 1962 by Holmes et al 28 . It would seem more accurate to measure ovulation rates based on daily pelvic or vaginal ultrasound exams. In 1985, Ritchie 29  wrote in his review of the role of ultrasound in the evaluation of normal and induced ovulation that: "With daily scanning, ovulation can be demonstrated in >80% of cases." This statistic can only improve as technology moves forward.

There are a number of other reasons why determining the frequency of ovulation by such a method is important. First, studies of women who take OCPs often show a high rate of "ovarian activity" in their dominant follicles which may reach a size that is consistent with those seen in nonOCP users who ovulate. In other words, the ultrasound measurements indicate that these women (ie, the OCP users) are about to ovulate. But these same studies often conclude that ovulation has not occurred because the progesterone level has not reached a critical level [eg, 30 31 ]. This is somewhat counter-intuitive in light of a recent study [31] that found: "Patients using the lower-dose monophasic and multiphasic pills had follicular activity similar to that of those using nonsteroidal contraception, with the important exception that ovulation rarely occurred." This study, as almost all others, used the criteria that ovulation is confirmed when progesterone levels reach a certain level. This may not be accurate.

High-tech ultrasound may reveal that ovulation rates are higher than today's commonly quoted rates of 3 to 5% [29]. The two reasons for this are that today's OCPs contain far less estrogen and progestin than the early OCPs did and therefore suppress ovarian activity less often. Second, many studies have examined the rate of breakthrough ovulation in women who have recently started taking OCPs but the question that must be asked is: "Does the rate of ovulation go up in women who have taken OCPs for more than a year?." This phenomenon occurs with Norplant, where it was noted that the breakthrough ovulation rate in the first year was only 11%, but increased dramatically after that year, so that a 7-year average yielded an annual breakthrough ovulation rate of 44% 32  (although part of the reason for this increase may have been declining Norplant hormone levels over time). But could a woman's pituitary gland "compensate" or "reset itself" to adjust for the presence of the hormones in the OCP so that ovulation occurs more frequently with time? If so, future trials may show that the rate of breakthrough ovulation increases in women who take the low dose OCP for longer periods of time.

It seems likely that a study will be done in the future that measures the rate of ovulation based on serial ultrasounds (although some may claim that such a study might be unethical, it might be possible to avoid the ethical questions by studying women who are taking OCPs but are not sexually active). If such a study is performed in women who have been taking low dose OCPs for longer than a year, it could yield information that leads to a more credible estimate of the abortion rate for women taking OCPs.

Q-A5P: Does use of the intrauterine deuice (IUD) cause abortion?

Yes, use of the IUD does not prevent ovulation 33  and works by changing the inner lining of a woman's uterus so that the newly conceived child cannot implant in the womb.

Q-A5Q: Do groups who favor abortion admit that OCPs and the IUD work by causing early abortions?

The abortifacient nature of OCP and IUD use is openly admitted by the most ardent pro-abortion supporters. In his arguments before the Supreme Court in 1989, in a case that received worldwide publicity -- the case of Webster versus Reproductive Health Services -- Mr. Frank Susman, arguing for the pro-abortion side spoke to Justice Anthony Scalia and stated: "If I may suggest the reasons in response to your question, Justice Scalia. The most common forms of what we generally in common parlance call contraception today, IUD's, and low-dose birth control pills, which are the safest type of birth control pills available, act as abortifacients. They are correctly labeled as both." (The New York Times, 1989: 34 )

Q-A5R: Does use of other hormonal contraceptives such as the long acting progestins cause early abortions?

Norplant, manufactured by Wyeth-Ayerst, and DepoProvera, made by Pharmacia-Upjohn, are made of artificial progestins. Norplant is composed of levonorgestrel and Depo-Provera of medroxyprogesterone. Depo-Provera is a long-acting progestin that is injected every 3 months intramuscularly -- it is used worldwide despite the fact that studies have shown that it increases the risk of breast cancer by at least 190% in women who take it for more than 2 years before the age of 25! 35  Norplant is an artificial progestin that consists of a series of Silastic (ie, rubberlike) strips which are filled with levonorgestrel and are implanted under the skin of a woman's upper arm, slowly releasing the progestin into the woman's body over a 5-year time period.

Use of Norplant has been noted to allow breakthrough ovulation in over 44% of a woman's monthly cycles 132]. In addition, a study in rabbits conducted by a researcher named Chang [6] has shown that sperm freely reached the rabbits' fallopian tubes -- even when the rabbits were given high doses of synthetic progestin. The combination of a high rate of breakthrough ovulation and documented sperm migration to the fallopian tubes (in animals) implies that use of progestins such as Norplant and DepoProvera allow a high rate of abortion -- most likely, higher than the rate with OCP use.

Q-A5S: Does use of "the morning after pill" cause an early abortion?

The "morning after pill" consists of a series of high dose OCPs which some women have taken 1 or 2 days after thinking that they have conceived. These high dose hormones act as abortifacients at times by unfavorably altering the lining of the uterus, thus preventing the newly conceived child from implanting. The animal model described by Castro-Vazquez in 1971 demonstrated this effect in rats 36. In addition, the Medical Letter stated that some studies suggest -- and some do not -- that Preven (the emergency contraceptive hormone kit) may work at times by interfering with implantation. 37 

Q-A5T: Some emergency rooms give "hormones" to women who have recently been raped. Can use of these cause an early abortion?

Yes. The woman who has been raped within a few hours of going to the emergency room, may or may not have already conceived. Some emergency rooms will give such a woman high dose estrogen and progestin hormones very similar to the "morning after pill" (the exception is often found in Catholic hospitals whose physicians are not supposed to give the "post-rape pill"). Even if the woman is near the time of ovulation, the hormones do not consistently stop ovulation. Therefore, informed practicing Christian physicians will not give the "post-rape pill" in any circumstances.

Q-A5U: Does artificial fertilization cause early abortion(s)?

Every method of artificial fertilization that this author is aware of, whether it be in vitro fertilization, or ZIFT (zygote intrafallopian transfer) or GIFT (Gamete intrafallopian transfer) involves the death of many unborn children during the process. Fewer than 1 out of 20 conceived children "survive" the process of in vitro fertilization. Even GIFT involves the exposure of more than one egg to multiple sperm -- a situation in which multiple early abortions are extremely likely to occur. In addition to these methods, it is possible that women who take fertility pills such as Clomido (which work by causing the ovaries to "super-ovulate") may be experiencing early abortion(s) because some studies 38 39 40 41 , but not all [15], indicate that this drug thins the lining of the uterus, theoretically making it more difficult for the conceived child(ren) to implant.

Q-A5V: Can the estrogens that women take "after menopause" cause an early abortion?

Often women are started on estrogen replacement near the time of menopause. This usually has a beneficial effect of reducing the risk of osteoporosis while increasing the risk of uterine and breast cancer. Unfortunately, many women are now starting estrogen replacement before they have completely stopped their cycles -- that is, they are not always in true menopause, but are still having occasional cycles. If a woman were to start estrogen at a time in which she were still having an occasional cycle, she could still conceive and have an early abortion. This is something to be aware of and women who wish to avoid this effect should not start hormonal replacement therapy until they have not had a cycle for a 1-year period.

Q-A5W: Why was the term "contraceptive" placed in quotations when referring to the various artificial hormones?

Oral contraceptives, Norplant, Depo-Provera, the IUD, the "morning after pill," the "post-rape pill," all work by causing an early abortion at least part of the time. The word "contraceptive" was consistently placed in quotations because all of the evidence points to these hormones or procedures as being abortifacient -- that is, their use causes an early abortion either some or part of the time. Contraception technically means "to prevent conception" -- clearly use of the hormones which were alluded to cause the deaths of unborn children after conception and cannot accurately be solely called "contraceptive."

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