INFERTILITY AND CONTRACEPTION

Both the Pill and the intrauterine contraceptive device (IUCD or IUD) have been shown to damage the female reproductive system, permanently or temporarily.

The Pill is believed to have a number of effects and opinions differ about the problems it causes. Here are some. One of the most widely acknowledged effects is the slow return of periods and ovulation in women who have stopped taking it. One estimate is that it affects some three per cent of women who have taken the Pill and can take up to a year to rectify itself. While most gynaecologists claim the problem will eventually go away spontaneously, an Australian infertility specialist, who reviewed the cases of some 900 women seeking help for infertility after taking the Pill, concluded that such infertility is not always easy to cure.

The 1978 Physicians Desk Reference, an American annual collection of information on drugs compiled by the drug industry, accepted the results of a study in which the fertility of a large group of women who took the Pill was compared with that of a group of women who didn't. It indicated that for up to two and a half years after coming off the Pill, some women's fertility remained significantly reduced. The Pill has been accused of altering the chemical composition of the environment inside the vagina in such a way as to increase the suspectibility of women to venereal diseases such as gonorrhoea.

There is also a suggestion that the Pill may aggravate disease conditions which cause infertility, in particular the growth of fibrous tissue in the ovaries. Evidence for this is limited but it has been taken seriously by the American Food and Drug Administration.

While many doctors claim the Pill has been given a clean bill of health, we still don't know enough about its possible long-term effects, including its effects on fertility. This is particularly the case with women who started taking the Pill when very young. Other hormonal contraceptives such as Depo-provera can cause temporary infertility and are also suspected of causing permanent infertility in some women, although there is as yet no proof of this.

The case against the IUCD is more clear cut. It too can cause a slow return to fertility after it has been taken out but, more seriously, there is a strong association between the IUCD and pelvic inflammatory disease (PID), which is a known cause of infertility. Some doctors believe that the association is now so strong that IUCDs should be used only by women who don't want children.

Barrier methods of contraception like the cap or sheath are far safer. They do not interfere with the body, and they can also provide some protection against VD, particularly together with spermicides. But they have both been relegated to the bottom of the league table ever since the advent of the Pill. If used properly, they are at least as effective as the IUCD and, some would argue, as the Pill as well. Many people may turn their noses up at them - partly because they see them as 'second best' or old fashioned. Yet, increasingly, women are coming to demand methods which don't damage their health, and which put a share of the responsibility for birth control on men. Some men are even beginning to feel that the sheath is quite acceptable. One way of using barrier methods is for partners to share them, sometimes using the cap, and sometimes the sheath. They are available free at family planning clinics. There are several different kinds of caps and sheaths, and it might be worth experimenting with these varieties to find the most acceptable.

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Women's Health