How Does Emergency Contraception Work - FAQ's


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How does emergency contraception work?

Does emergency contraception work?
How does Plan B work?
How does emergency contraception prevent pregnancy?
Is Plan B a contraceptive?
Can Plan B be used as birth control?
Is Plan B the Abortion Pill?
Does the Intrauterine Device (IUD) cause abortion?
Is there a contraception abortion pill?
How is the abortion pill (Mifeprex, Mifepristone, RU486) different from emergency contraceptive pills (morning after pill, day after pill, post coital contraception, day after contraception, Plan b)?
Does Plan B interfere with sperm migration?
Does the Intrauterine Device (IUD) interfere with sperm migration?
How does Plan B interfere with ovulation?
Does the Copper T Intrauterine Device (IUD) interfere with ovulation?
Does Plan B prevent fertilization?
Does the Intrauterine Device (IUD) prevent fertilization?
Does Plan B interrupt fallopian tube function?
Does the Intrauterine Device interrupt fallopian tube function?
Does Plan B affect significant changes in endometrial structure or physiology such to prevent implantation of a fertilized ova?
Does Plan B cause Luteolysis or Luteal Dysfunction?
Does Plan B interfere with implantation of the ova into the Uterus?
Why are so many people against emergency contraception?

Does Emergency Contraception Work?

More Frequently Asked Questions

Emergency contraception (morning after pill, day after pill, post coital contraception, day after contraception) has been found to effectively reduce the incidence of pregnancy if taken immediately up to 120 hours after unprotected intercourse. The sooner the Emergency Contraceptive is taken from the time of unprotected intercourse the more effective it is a reducing the incidence of unwanted pregnancy. If taken in 24 hours of less, the incidence of pregnancy is reduced 95%; 0 to 72 hours it is reduced by 84%percent; 733 to 120 hours the incidence is 63%. .

Levonorgestrel works by interrupting follicular development and ovulation. It also prevents fertilization by altering tubal transport of sperm and ova and may cause changes in corpus luteum function. There is no evidence of effect on implantation, but there is much to support that Emergency Contraception does not prevent implantation.

The Copper T IUD prevents pregnancy primarily by an inflammatory process of the endometrial cavity spreading towards the cervix ant the uterus and fallopian tubes. It is this inflammatory process that is spermicidal and ovaricidal. The incidence of pregnancy is reduced over 99% if inserted within 120 hours after unprotected intercourse.

Emergency Contraception (morning after pill, day after pill, post coital contraception, day after contraception) is not the abortion pill. Emergency contraception methods work prior to implantation of a fertilized egg which means that legally and officially they are a form of contraception. The Abortion Pill (RU486, Mifeprex, Mifepristone) causes early abortions to occur which are methods that remove an attached viable pregnancy from the attached uterine wall. Mifeprex (RU486, Mifepristone) is an anti-progesterone that competes with progesterone attaching to progesterone receptors in the uterus. Progesterone is responsible for causing uterine quiescence (preventing the uterus from contracting) and therefore preventing miscarriages. RU486 in small dosages can be used as Emergency Contraception as it inhibits ovulation.

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How does plan b work?

Plan B works by preventing or delaying, or reducing the peak of the Lutenizing Hormone (LH) Surge. Without the LH surge, ovulation does not occur. If Plan B is taken after the LH Surge occurs, the incidence of reduction in pregnancy does not occur. There have been two studies that have documented the fact that Plan B does not reduce the incidence of pregnancy after the LH Surge occurs and therefore it has no effect on fertilization, implantation, or post implantation effect (abortion).

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How Does Emergency Contraception Prevent Pregnancy?

There are several mechanisms of action where emergency contraception (morning after pill, day after pill, post coital contraception or day after contraception) prevents pregnancy. Emergency contraception is not the abortion pill, nor does emergency contraception cause abortion.

  1. Progestin only pills. Plan B one step, and Next choice which contain the progestin hormone Levonorgestrel.
    a. Plan B or Progestin-only pills when taken immediately up to 120 hours after unprotected intercourse reduces the incidence of unwanted pregnancy by inhibiting ovulation prior to the LH Serge. Once the follicle enlarges to between 18 mm to 20 mm (at or near the time of ovulation), ovulation takes place between 24 to 36 hours from that point. Levonorgestrel does not appear to inhibit ovulation once the follicular size reaches the 18mm to 20 mm size. Early studies suggested that progestin only and combined estrogen and progesterone oral contraceptive methods prevented implantation from occurring. Recent studies show no evidence of the decrease in incidence of pregnancy if ovulation is not prevented and there are studies in primates and rats that show that Emergency Contraceptive Pills have no effect on the lining of the endometrium which is important for implantation of the fertilized egg to occur.
    b. If taken 72 hours or less after unprotected intercourse, the chance of pregnancy decreases by 89%
  2. Combined estrogen and progesterone oral contraceptive pills.
    a. Mechanism of action is the same as the Progestin only pills as described above to decrease the incidence of pregnancy.
    b. If taken 72 hours or less after unprotected intercourse, the chance of pregnancy decreases by 75%.
  3. RU486 (Mifeprex, mifepristone). Progesterone receptor blocker. Only used in China for Emergency Contraception.
    a. Inhibit ovulation from taking place even after the LH Surge has occurred which means that 18 to 20 mm follicles are prevented from being released from the ovary.
    b. If taken 72 hours or less after unprotected intercourse, the chance of pregnancy decreases by 90 to 94 percent
    c. In higher doses of RU 486 (Mifeprex, Mifepristone), it can disrupt implantation and is effective in terminating established pregnancies.
  4. Ella (Ulipristal Acetate or Ellaone) is a progesterone modulator and received FDA approval in the US in 2010 for use as Emergency Contraception. It has been approved for use since 2009 in Europe.
    a. It is to be taken up to 5 days after unprotected intercourse. Studies show that the incidence of pregnancy is lowered an additional 50% in head to head comparison to Plan B (levonorgestrel).
    b. It works (mechanism of action) by inhibiting ovulation, even after the LH surge.
  5. Meloxicam and Indocin which are Nonsteroidal Anti-Inflammatories (NSAID). When taken over a 3 to 5 day period of time it reduces chance of ovulation, fertilization, implantation and decidualization of the lining of the uterine endometrium.
    a. 30 mg of Meloxicam taken for 5 days within 72 hours of unprotected intercourse inhibits ovulation 88 percent of the time versus 60% of the time for Plan B within 72 hours of unprotected intercourse.
    b. Meloxicam seems to decrease the incidence of pregnancy by inhibiting ovulation, fertilization, implantation, and decidualization of the uterus.
    c. Adding 30 mg Meloxicam for three days to 1 dose of Plan B one step reduced the incidence of ovulation 2 fold over just giving Plan B alone.
  6. Histamine Blocker (Ranitidine). Histamine important for implantation of the fertilized egg.
    a. 70mg/kg of Ranitidine and 5mg/kg Meloxicam in a certain strain of rat, has been shown to inhibit ovulation 100%
  7. Intrauterine Device (IUD).
    a. The copper IUD causes an inflammatory reaction in the uterus where the noxious effect extends to the entire genital tract (Fallopian Tubes, Uterus and Cervix) through luminal transmission. The mechanism of action of how IUDs work are to cause a toxic effect by decapitating the head of the sperm (spermicidal) and egg (ovicidal) leading to affecting the function and viability of gametes. This leads to a decreased rate of fertilization and lowers the chance of survival of any embryo that may be formed before it reaches the uterus. The bulk of the data indicate that if any embryos are formed in the chronic presence of an IUD, it happens at a much lower rate than in non-IUD users. The common belief that the usual mechanism of action of IUDs in women is destruction of embryos in the uterus is not supported by empirical evidence.
    b. Anywhere from 5% up to 57% of early pregnancies do not implant into the uterine cavity. Under the most sensitive immunoradiometric assay, hCG was only detected in only .9% of cycles in IUD users. Normally the first migration of sperm can reach the oviduct 2 hours and remain viable as long as 85 hours. With an IUD in place, several searches recovered no sperm in the tubes; presumably they were phagocytosed (destroyed). Copper IUDs reduce the number of sperm, and those that are found often had heads decapitated from their tails. The ova if found were not developing normally and the others were abnormal in some manner. They were without vitellus and surrounded by macrophages. This suggests that IUD effects events prior to implantation specifically ovum development in the tubes, sperm migration, and ovum transport in the tubes.
    c. When IUD Emergency Contraception is used within 5 to 7 days after unprotected intercourse, there is reduction in the incidence of pregnancy by more than 99%. This is the most effective way there is of reducing the incidence of an unintended pregnancy. The IUD is approved in the U.S. for 12 years. It is the most common method of reversible birth control used in the world today and has minimal side effects after the first 20 days of insertion where the incidence of pelvic infection is increased 6 fold but this still is a very small percentage. After the first 20 days, the incidence of infection is decreased to the same as the general population of people who do not use any method of birth control.

Emergency Contraceptive pills are not the same or be confused as an abortion pill. According to the International Federation of Gynecology and Obstetrics, Emergency contraception does not cause abortion or an abortifacient because it has its effects prior to the earliest time of implantation whereas medications or procedures that cause abortion are methods that work after implantation in the uterus of a fertilized egg. Once pregnant, Emergency Contraception (morning after pill, day after pill, day after contraception, post coital contraception) does not affect the pregnancy. Emergency Contraception is medically and legally considered forms of contraception.

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Is Plan B a Contraceptive?

Yes. Plan B is a contraceptive. The intentional prevention of conception through the use of various sexual practices, chemicals, surgical procedures, or drugs becomes a contraceptive if its intent or behavior is to prevent a woman from becoming pregnant. Several types of contraceptives have been labeled as such because they have shown reliability in preventing conception from occurring.

Plan B works by inhibiting ovulation from occurring within 120 hours (5 days) of having one episode of unprotected intercourse in the woman’s present cycle. The pill should be taken as soon as possible after the incidence as it is most effective when taken immediately.

Plan B and other forms of Emergency contraception is not the same thing as an abortion. Plan B is often confused with the abortion pill or RU486 (Mifeprex, mifepristone, medical abortion). The two medications serve two different purposes and work completely different from one another. RU486 blocks the hormone progesterone that is needed to maintain a pregnancy. RU 486 is used to terminate pregnancies in the U.S. up to 9 weeks gestation. In the U.K. it is routinely used to terminate pregnancies up to 13 -14 weeks gestation. Once progesterone is blocked and the uterine lining begins to shed, there is an increase in uterine pressure and uterine contractions can occur leading to vaginal bleeding and miscarriage. A second pill (misoprostol) is generally taken 24 to 96 hours after taking the RU486 pill that increases uterine contractions. When RU486 and misoprostol are used in combination they are 97 to 98% effective in terminating a pregnancy.

Neither Plan B nor other forms of Emergency Contraception end pregnancies or affect an existing pregnancy. Medical and Scientific authorities (American College of Obstetrics and Gynecology, FDA, National Institutes of Health) are in agreement that emergency contraception reduces the risk of pregnancy and helps prevent the need for abortion and will not harm an existing pregnancy. A pregnancy does not exist until the fertilized egg has implanted into the lining of the woman’s uterus. Abortion is defined as the disruption of an implanted fertilized egg. Therefore it is impossible for Plan B to terminate a pregnancy since by Medical and scientific authorities that pregnancy does not exist until implantation occurs.

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Can Plan B be used as birth control?

Plan B contains levonorgestrel which is a progestin only pill. It has been studied for over 20 years as an Emergency Contraceptive pill (morning after pill, day after pill, post coital contraception, day after contraception) that is used within 120 hours after unprotected intercourse. It inhibits or delays ovulation by preventing or reducing the peak of the LH surge. Without the LH surge, ovulation does not take place. Unwanted or unintended pregnancies are reduced by 89% if taken in 72 hours or less. The sooner Plan B is taken after unprotected sex the more effective it is in preventing pregnancy. Plan B is not effective enough to be uses as a primary form of birth control. Out of 100 women who take Plan B, 1 out of 8 calculated pregnancies will still occur. Over a year period of time, 20 percent of patients will become pregnant if Plan B is used as a primary form of birth control. Therefore it is not very effective as a primary birth control method and should only be used as a backup method to continuous long term birth control when it fails.

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Is Plan B the Abortion Pill?

No. Plan B (morning after pill, day after pill, post coital contraception, emergency contraceptive pills, the day after contraception) is not the Abortion Pill. Abortion is defined by the FDA, International Federation of Gynecology and Obstetrics, World Health Organization, American College of Obstetrics and Gynecology as methods that are used to cause disruption or removal of a pregnancy that has already implanted into the wall of the uterus. Plan B appears to have no effect after ovulation takes place (fertilization, implantation, or decidualization are not affected). Plan B prevents ovulation from occurring if given prior to the follicular size of the ovary becoming too large which is 18mm to 20mm in size that indicates that ovulation will occur within 24 to 36 hours. In12 percent of patients ovulation was inhibited once the follicle reached 18 to 20 mm (13% placebo) On the other hand, Ulipristal inhibited ovulation in 60% of cycles when the follicles reached 18 to 20 mm in size. For follicles that are between 15 to 17mm in size, which indicates that ovulation is a few days away, Plan B prevents ovulation from occurring in approximately 90% of patients. If the follicle is 18mm or greater in size, ovulation does not occur in 58% of patients. Whereas by combining Plan B with meloxicam (NSAID), ovulation is prevented in 84% of patients when the size of the follicle is 18 mm or greater in size. The addition of meloxicam to levonorgestrel when the follicular size was 18 mm or greater prevented follicular rupture by more than double (16 verses 39%). The importance of this finding shows that women who take Plan B (levonorgestel) late in the follicular phase of the cycle (day 12 or 13 of a 28 day cycle), are less protected from this mechanism. Thus doubling the efficacy to prevent follicular rupture in these cases could save an additional number of women from getting pregnant. The combination of meloxicam and Plan B double the incidence of no follicular rupture compared to Plan B used alone thus the addition of meloxicam could have a significant impact on the number of unwanted pregnancies prevent by Plan B (levonorgestrel) when women need Emergency Contraception.

RU486 (Mifeprex, mifepristone) is called the abortion pill. It is an anti-progesterone pill (progesterone modulator) where it competes with progesterone to attach to progesterone receptors. Progesterone is important to maintain uterine quiescence (prevent uterine contractions) in early pregnancy. Without the uterine quiescence there is an increase in intrauterine pressure and uterine contractions that can lead to spontaneous abortion. RU486 has been studied and found to reduce the incidence and treat breast cancer, reduce the size of large uterine fibroids, treat severe depression, and even in small dosages of 10 to 50 mg be used as an Emergency Contraceptive pill by primarily inhibiting ovulation.

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Does the Intrauterine Device (IUD) Cause Abortion?

Abortion is defined as any method that removes a viable pregnancy from the attached uterine wall. There is no evidence that the IUD works after the implantation process has occurred and therefore does not cause abortion.

The IUD causes an inflammatory reaction to take place within the intrauterine cavity and those that contain copper are able to spread it throughout the genital tract creating a noxious environment to the sperm (spermicidal) and the ova (ovaricidal). The sperm count is diminished in the intrauterine environment and there is usually little to no sperm that are found in the fallopian tubes. There are normally millions of sperm that are found in the fallopian tube which normally are able to remain viable up to 85 hours. In the presence of an IUD, there are generally no sperm present in the fallopian tube. If sperm are noted they are decapitated or immobile which means they are unable to fertilize an ova. The ova that are recovered from the fallopian tube are in low numbers and the ones that cannot be fertilized due to the toxic environment caused by the IUD which makes them not viable or incapable of becoming fertilized. The incidence of a chemical pregnancy found in the presence of an IUD is less than .9 percent which is far less than normal incidence of chemical pregnancies which is approximately 10 to 30%. Over 40% of eggs that become fertilized do not implant into the intra-uterine wall with not exposure to any Emergency Contraceptive procedure.

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Is There A Contraception Abortion Pill?

There is no contraceptive method that causes abortion. Emergency Contraceptives by definition decreases the incidence of pregnancy and are not abortifacients. Abortion procedures are methods that cause abortion as they cause detachment of a viable pregnancy from the uterine wall. In old literature b birth control pills and Emergency Contraception pills 1) inhibit ovulation, 2) thicken the cervical mucus preventing sperm from traveling to the egg and 3) thinning of the lining of the endometrium that is unable or less able to facilitate the implantation of the newly fertilized egg. It is the latter mechanism that is of concern for many ethical, moral, religious, and personal reasons in that many people feel that it is an abortion.

The most difficult parameter to assess with certainty is endometrial receptivity. Endometrial markers of receptivity have been established so far with certainty only in rodents. Even if endometrial receptivity is shown to be altered by EC, other steps that precede implantation may also be altered enough to interrupt the process at an earlier stage. Recent studies show that neither birth control pills nor Emergency Contraception change the lining or thin the endometrial or cervical tissue in any significant manner. Therefore the primary mechanism of how Emergency Contraception or oral contraception pills work is to inhibit ovulation.

RU486 (Mifeprex, Mifepristone) in high enough dosages are able to terminate pregnancies by changing the intra-uterine environment which causes decidual necrosis and sloughing (shedding) of the lining of pregnancy tissue along with increase in intrauterine pressure and uterine contractions leading to bleeding and expulsion of pregnancy tissue. A second drug is usually taken 24 to 72 hours after the initial RU486 tablet that causes a pregnancy termination success rate of 94 to 98% for pregnancies up to 9 weeks.

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How is the abortion pill (Mifeprex, Mifepristone, RU486) different from emergency contraceptive pills (morning after pill, day after pill, post coital contraception, day after contraception, Plan B)?

RU486 (Mifeprex, Mifepristone, abortion pill) is an antiprogestin or progestin modulator drug. Its mechanism is to stop the growth of a pregnancy that has already implanted into the wall of the intrauterine cavity through compromising blood flow and uterine contractions which causes termination of pregnancy from 3 to 9 weeks in the U.S. In the U.K. Mifeprex is used to terminate pregnancy up to 14 weeks gestation.

Plan B, Next Choice (levonorgestrel) are progestin only pills and several brands of regular oral contraceptive pills (birth control pills) are approved and sold in the U.S. as Emergency Contraceptive Pills (morning after pill, day after pill, post coital contraception, day after contraception). They decrease the incidence of pregnancy by inhibiting ovulation prior to the LH surge which occurs mid-cycle of menses in women who have a 28 day cycle, but they do not appear to work after the surge which corresponds a few hours before ovulation. Once the primary ovarian follicle reaches 18mm to 20 mm, neither Plan B nor regular birth control pills seem very good at inhibiting rupture of the follicle which is important in the ovulatory process.

Other forms of Emergency Contraception (meloxicam, and indocin, which are non-steroidal anti-inflammatories seem to not only have an effect on the ovulatory process, but in addition prevent fertilization, implantation, and decidualization of the uterus from taking place. Combining 15 mg meloxicam orally for 3 days along with taking Plan B was noted to double the chance that the primary ovarian follicle will not rupture. This should correlate into a higher prevention of unwanted pregnancies as meloxicam works to prevent follicular rupture and delays ovulation after the LH surge has occurred. Human studies need to be carried out to show that indeed the combination of meloxicam and Plan B can significantly reduce the pregnancy rate over taking Plan B alone.

There are 3.1 million unintended pregnancies that occur in the U.S. every year including 25,000 that result from rape alone which translates into some of the more than 1 million elective abortions that occur in the U.S. every year. Despite the fact that Plan B or Next Choice Emergency Contraceptive Pill (morning after pill, day after pill, post coital contraception, day after contraception) and oral contraceptive pills used for Emergency Contraception has been found to be highly effective, safe, and essentially no contraindications, there are hundreds of thousands of young women less than 17 years old who are exposed to unprotected intercourse which results in thousands of unintended or unwanted pregnancies.

If it truly is the goal of government, politicians and citizens in this country and around the world is to reduce the incidence of unwanted pregnancies, we must make Emergency Contraception readily accessible and available to all women as soon as possible after unprotected intercourse and no delay as all studies show that the sooner the medications are taken, the higher the success in preventing a unwanted pregnancy from occurring. There are over the counter medications that people less than 17 years old can go in a purchase without a prescription so why is it that the government has only approved Plan B and Next Choice for purchase over the counter for women and men over 17 without a prescription, but if less than 17, a prescription is required. Even though Plan B can be bought without a prescription if 17 or older, it is being stocked behind the counter where if the Pharmacy is closed, or even having to speak to the Pharmacist can be a deterrent for many to purchase Emergency Contraception. Embarrassment and invasion of privacy are issues that are most commonly given by patients who hesitate to purchase Emergency Contraception pills at a pharmacy.

When used immediately after unprotected intercourse, Plan B’s contraceptive activity is evident within hours. Delaying taking Plan B by 12 hours increases the chance of pregnancy by almost 50%. The efficacy decreases linearly with time and though this effect is mostly gone at 72 hours after sexual exposure, there is a World Health Organization study that shows that it is effective up to 120 hours. Clinical studies have given a range of its effectiveness to be between 50 and 94% with the package insert stating a 89% reduction in pregnancy rate if used 72 hours or less after exposure to unprotected sex. Emergency Contraception is not to be used as a primary method of contraception as the combined estrogen and progesterone birth control pills are effective in reducing pregnancy over 99% if taken properly. Neither Emergency Contraception nor the taking of combined oral contraceptives prevent Sexually Transmitted Disease or HIV where female or male condoms are able to do so.

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Does Plan B Interfere With Sperm Migration?

Plan B (emergency contraceptive pill, morning after pill, day after pill, post coital contraception, day after contraception) does not directly interfere with the sperms ability to fertilize an ova. Plan B is able to alkalinize the intrauterine cavity fluid after 5 hours of ingestion which is turn reduces the number of sperm recovered and immobilizes sperm so that they can no longer swim towards the fallopian tube. In approximately 9 hours after ingestion of levonorgestrel, significant thickening to the cervical mucus takes place which prevents further sperm from able to penetrate the cervix. It is obvious that alkalinization of the uterus and thickening of the cervical mucus develop too late to prevent the onset of the initial migration of sperm and therefore cannot be the primary mechanism of how Plan B reduces the pregnancy rate. Ejaculated mammalian spermatozoa reside in the female genital tract for several hours before gaining the ability to fertilize the egg. The sperm cells undergo physiological and biochemical changes collectively called capacitation which renders the spermatozoa capable of fertilization. This process seems to involve molecules absorbed on or integrated into the sperm plasma membrane during epididymal maturation and on contact of spermatozoa with the seminal plasma. Sperm capacitation begins approximately 10 hours after intercourse and continues for several days thereafter. Until sperm are capacitated, they are unable to bind to and fertilize the ova.

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Does the Intrauterine Device (IUD) Interfere with Sperm Migration?

Yes the IUD interferes with sperm migration by creating an inflammatory reaction in the intrauterine cavity that spreads towards the cervix, all of the uterus, and the fallopian tubes. The copper is toxic to the sperm (spermicidal) and the ova (ovaricidal). When the sperm come in contact with the cervix in presence of an IUD, they are exposed to the noxious inflammatory environment and are destroyed almost immediately. Ones that are seen (though the numbers are low) are decapitated and separated from their tails. There is generally no sperm noted in the fallopian tubes where they normally remain mobile and viable for up to 85 hours without the presence of an IUD.

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How Does Plan B Interfere With Ovulation?

Timing in the menstrual cycle determines whether or not Plan B interferes with the ovulatory process. The size of the follicle and when the LH surge occurs are the determinate factors of whether or not ovulation is affected. Plan B taken 24 hours before the LH Serge generally suppresses the surge completely in which ovulation does not occur. When the dominate follicle reaches 18 to 20 mm is size the incidence of pregnancy is rather high due to the fact that ovulation still occurs in a high percentage of those patients and follicular rupture is only delayed in a small percentage of those patients who take Plan B. When Plan B (morning after pill, day after pill, post coital contraception, day after contraception) is used closer to the LH surge, it can delay or reduce the peak of the LH surge, or may not affect the surge at all. Ova released after a delayed or partially depressed LH surge are resistant to fertilization.

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Does the Copper T Intrauterine Device (IUD) Interfere With Ovulation?

There is no evidence that The Copper T IUD interferes with the ovulatory process. The primary effect of the IUD is to induce a local inflammatory reaction of the endometrium that’s cellular and humoral components are released into the uterine cavity. Copper IUDs are able to enhance the inflammatory response and reach concentrations in the luminal fluids of the genital tract that are toxic for sperm (spermicidal) and ova (ovaricidal). The viability of eggs are decreased along with affecting their function such that they are not able to be fertilized. This appears to be the major function of the IUD. It is unlikely that if spermatozoa are able to reach the distal segment of the fallopian tube, those that encounter an egg may be in poor condition. Thus the few eggs that are fertilized have little chance for development and the possibility for survival in the altered tubal milieu become worse as they approach the uterine cavity. Chemical pregnancies appear to only occur in .9 percent of patients who have an IUD in place with the number of those pregnancies never being able to implant in the intrauterine cavity.

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Does Plan B Prevent Fertilization?

There is no data that shows that Plan B (morning after pill, day after pill, post coital contraception, day after contraception) directly interferes with the fertilization process. There is a lot of data that shows that Plan B works only prior to the LH surge and ovulation. The theoretical incidence of pregnancy does not decrease when taking Plan B after ovulation which is turn suggests that it has no effect on the fertilization process.

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Does the Intrauterine Device (IUD) Prevent Fertilization?

The IUDs major effect is to induce a local inflammatory reaction in the endometrium where cytokines, macrophages and other cellular and humoral components are released into the uterine cavity which disturbs the functioning of the endometrium and myometrium and changes the microenvironment of the uterine cavity. The Copper IUD accentuates the inflammatory response which disturbs the physiology of the gametes in the female genital tract, or destroys the viability of the embryos or endometrial receptivity to implantation. Studies on the recovery of eggs reveal that embryos are formed in the tubes of IUD users at a significantly lower rate compared to non-users.

The IUDs primary effect is ovicidal (death of the ova) or dysfunction of the ovary that prevents fertilization from occurring.

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Does Plan B Interrupt Fallopian Tube Function?

Fertilization takes place in the fallopian tube. There are studies in animals that show that estrogen and progesterone can speed up or slow down the transport of ova in the fallopian tube. Therefore; Plan B could indirectly prevent pregnancy by interrupting the transport of fertilized ova through the fallopian tube and by the time the ova arrives in the uterus, it is not able to implant or undergo the decidualization process. If Plan B (morning after pill, day after pill, post coital contraception or day after contraception) does slow down movement of the ova through the oviduct there should be an increased risk of ectopic pregnancy. Combined data from several clinical trials involving nearly 6000 women showed the actual rate of ectopic pregnancies in women who had used Plan B to be 1.02%, which is slightly lower than overall national ectopic pregnancy rates (1.24%-1.97%). This does not show that Plan B prevents normal movement of the fertilized ova through the fallopian tube.

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Does the Intrauterine Device Interrupt Fallopian Tube Function?

There is no evidence that the IUD speeds up or slows down the movement of an oviduct or fertilized egg through the fallopian tubes. The incidence of pregnancies are significantly decreased. Chemical pregnancies occur in .9% of patients who have an IUD in place. Not only does the IUD decrease the number of pregnancies, but the incidence of ectopic pregnancy rate with the IUD in place is less than 1% which is less than the overall incidence of ectopic pregnancies in national studies of between 1.24% and 1.97%. This does not show that IUDs prevent normal movement of the fertilized ova through the fallopian tube.

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Does Plan B affect Significant Changes in Endometrial Structure or Physiology such to prevent implantation of a fertilized ova?

There are several studies that address this question to determine what changes occur in the endometrial mileau when Plan B (Emergency contraception, morning after pill, day after pill, post coital contraception, day after contraception) is given. Even if significant changes do occur, it really does not mean that Plan B’s affect at other previous steps prior to the ova entering the uterine cavity is not the prime reason or only reason for how Plan B works. Endometrial biopsies were taken 8 to 9 days after Plan B was taken which corresponded to ovulation. The endometrium revealed either minimal or no changes in microscopic appearance or biochemical markers. Another study found diminished amounts of endometrial glycodelin A in a few women who had received Plan B. Since glycodelin A appears to play a role in adhesion of the embryo to the endometrial surface, such an effect could be a mechanism by which Plan B interferes with implantation. However, in this study endometrial glycodelin A was affected only in those women who took Plan B prior to ovulation which it primarily prevents. Thus the effect of inhibition of ovulation by Plan B may be the reason for the diminished amounts of glycodelin.

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Does Plan B Cause Luteolysis or Luteal Dysfunction to occur?

Plan B decreases circulating levels of progesterone and, possibly, estrogen during the luteal phase of the cycle. The corpus luteum produces a significant amount of progesterone which is important to help prepare the ova to mature and differentiate for implantation to occur but also helps to prepare the lining of the endometrium to accept the ova for implantation where the process of angiogenesis occurs which is the formation of new vasculature, arterioles, glandular structures, and increased permeability of the vasculature. The decrease in progesterone and estrogen partially explains the intermenstrual bleeding that occurs prior to time of the normal menses. The earlier Plan B is used in the cycle (prior to ovulation and the LH surge) there is a higher incidence of intermenstrual bleeding. The earlier Plan B is taken in the menstrual cycle, the greater the chance that the LH surge does not occur. Ovulation and luteal function both depend on the LH surge. Without the LH surge, neither ovulation nor appropriate luteal function occurs. If conception takes place in the cycle, there seems to be no effect on luteal function when Plan B is used in the cycle.

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Does Plan B Interfere with Implantation of the ova into the uterus?

If Plan B interferes with implantation, it should be capable of preventing pregnancy when it is used after the process of fertilization. In a recent clinical studies in which timing of ovulation was determined quite precisely using hormonal criteria (FSH, LH, progesterone and estrogen), no pregnancies occurred in the 34 women who had unprotected intercourse 2 to 5 days before ovulation occurred and took 1.5mg of levonorgestrel before or right at the time of ovulation, no pregnancies occurred. 4 or 5 pregnancies would have been expected in this group. For those women who had intercourse 24 hours before or the day of ovulation and took Plan B 48 hours or longer after ovulation had taken place, 3 pregnancies occurred in 17 women which 3 or 4 were expected to get pregnant without the use of Emergency Contraceptive pills. These studies strongly suggest that Emergency Contraception does not interfere with implantation.

If Plan B interferes with implantation, its efficacy should not decrease with short-term delay in use as long as it is taken just before or during implantation. In fact, delay in use causes Plan B to lose its effectiveness progressively in the 72 hours after unprotected intercourse. There is a 50% increase in the pregnancy rate if Emergency contraception is delayed 12 hours (.9% 0-12 hrs; 1.8% 13-24 hrs; 4.3% -72 hrs).

Progestational drugs, including levonorgestrel, are used therapeutically in assisted reproduction because they increase that Plan B interferes with implantation; it even raises the counterintuitive but undocumented possibility that Plan B used after ovulation might actually prevent the loss of at least some of the 40% of fertilized ova that ordinarily fail spontaneously to implant or to survive after implantation.

Women should also be informed that the best available evidence indicates that Plan B's ability to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with post- fertilization events.

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Why are so many people against emergency contraception?

Many people think that emergency contraception (morning after pill, day after pill, day after contraception, post-coital contraception) is wrong from a moral, ethical, religious, and family point of view. There are many religious that believe that having intercourse should only be between husband and wife and procreation is its sole and only purpose. Anything beyond this they consider immoral and inappropriate. This not only is the belief for emergency contraception, but all forms of contraception. Despite studies showing no evidence of people there being an increase in the frequency of intercourse or the incidence of Sexually Transmitted Disease, there is the popular belief that contraception promotes promiscuity. There is no evidence of the number of times women have sex increase due to them having access to Emergency Contraception or other forms of contraception. Emergency Contraception does not prevent Sexually Transmitted Disease (STD). Women and men are taught that abstinence and condoms prevent STDs including HIV.

Emergency contraception is an approach to pregnancy prevention that should ideally be available as a “back-up” method for women who have unplanned or unprotected sexual intercourse. This is a method for emergency use and not for regular use and should be available to women who have had forced intercourse (rape), women who have had unexpected intercourse without contraceptive protection, or have had a contraceptive failure such as condom breakage. We believe it is every woman’s right to have rapid access to an effective method of emergency contraception (morning after pill, day after pill, post coital contraception, day after contraception) if she believes she needs it. It includes any method that can be used after an episode of unprotected intercourse to prevent or reduce the risk of pregnancy.

There are many people that conscientiously object to Emergency Contraception because they consider it to be the equivalent to abortion. Abortion is defined by the FDA, American College of Obstetrics and Gynecology, and the World Health Organization (WHO) as any method of interrupting a pregnancy after it has implanted into the uterine wall. Prior to this point, a pregnancy test does not yield a positive pregnancy test nor does a fertilized egg that has not implanted into the uterine wall meet the definition of pregnancy. The majority of eggs that are fertilized do not implant into the intrauterine cavity. Out of 100 women on a monthly basis that are exposed during the most fertile period of a woman’s cycle (6 days prior to ovulation), there are only 8 patients who become pregnant who use no method of contraception.

Although there is no evidence that the use of Emergency Contraception prevents implantation of a fertilized egg, religious groups who believe that life begins at fertilization oppose the availability of Emergency Contraception on this theoretical possibility equating it with abortion. All women should have the right to regular contraceptive methods and emergency contraception.

A delay of a few hours can be the difference between Emergency Contraception being effective at reducing the incidence of an unwanted pregnancy. Pregnancy rates related to the duration of delay between unprotected intercourse and ingestion of levonorgestrel (1.5mg) Plan B pill in one study is summarized below:

    1. 0-12 hours - .9% pregnancy rate
    2. 13-24 hours - 1.8% pregnancy rate
    3. 25-36 hours - 2% pregnancy rate
    4. 37-48 hours - 2.8% pregnancy rate
    5. 49-60 hours - 3.1% pregnancy rate
    6. 61-72 hours - 4.3% pregnancy rate

The above numbers clearly show that the sooner after intercourse ingestion of the morning after pill occurs, the more effective it is in reducing the incidence of an unwanted pregnancy.

All couples and individuals have the right to decide the number and spacing of their children and to have the information, education and means to do so. The consequences of unintended pregnancies can be profound and are very serious. They can impose a serious burden on the women, men, families, other children, and society as a whole. There are studies that show the consistent negative impact of an unintended pregnancy on prenatal care, breast feeding behavior, and childhood nutrition. There is also the negative psychosocial development and mental well-being as adults that occurs with a child that is unwanted.

Most unintended pregnancies occur after an immediate contraceptive failure: i.e. failure to withdraw in time when practicing coitus interruptus, rape, missing several consecutive oral contraceptive pills, failure to use any contraceptive method, or broken condom. The goal for all couples who have intercourse and do not want to become pregnant should be to use regular and effective contraceptive methods. Engaging in the act of sexual intercourse is not always predictable nor consensual which in many cases leads to unprotected sexual intercourse. In religions and countries that abortions are illegal, it is essential that women have access to Emergency Contraception.

All women should have the right to obtain Emergency Contraception (morning after pill, day after pill, post coital contraception pill, day after contraception) over the counter without invasion of privacy or questioning about their sex lives since there are no contraindications to Emergency Contraception. There should be no minimum age for access where the over the county supply is unavailable to young women in the US if less than 17 years of age. Timely access is obstructed for many women who are most at risk of unintended or unwanted pregnancy. The mean age of first intercourse in most developed countries is age 16 and continues to decrease. Unwanted pregnancies in young teenagers are likely to result in an adverse pregnancy outcome and reduce the chanceof completing high school and most certainly a reduction of economic status. With Emergency Contraception being kept behind the counter, it restricts use by some women that are uncomfortable in speaking directly to the pharmacist due to lack of privacy and confidentiality issues. Women should be able to choose where and when to obtain their Emergency Contraception whether through a pharmacist, nurse, Physician, another health worker, family planning, or women’s health clinic.

A lot of controversy exists between the rights of women to access Emergency Contraception without medical or legal intervention and the rights of providers who have a conscientious objection to provide these services on religious and or moral grounds. There are many pharmacists, physicians and other medical personnel who refuse to provide women with any contraceptive method on the belief that they prevent fertilized eggs from implanting into the intrauterine wall despite much data to the contrary.

There are three ethical principles that must be evaluated to help determine whether or not Emergency Contraception is appropriate:

  1. Patient autonomy versus religious freedom causing conscientious objection is a balance that needs to be looked at. Autonomy is defined as the personal rule of the self that is free from both controlling influence by others and from personal limitations that prevent meaningful choice such as inadequate understanding. In essence, autonomy obligates professionals who are even conscientious objectors to disclose information to ensure that decision making is informed and voluntary. The American College of Obstetrics and gynecology (ACOG) has suggested to its members that they offer patients complete information of choices and refer them to another practitioner if they do not provide a particular service that the patient chooses. The health and safety of patients must be a professional’s priority.
  2. The principle of non-malfeasance imposes an obligation not to inflict harm intentionally. Refusing access to Emergency Contraception inflicts harm on the woman by exposing her to the risks of an unintended pregnancy, possibly abortion, and can also result in harm to the resultant child and place strains on the health and well-being of the remainder of the family. On the other hand, opponents of Emergency Contraception can say that they are protecting the life of the unborn.
  3. Principle of beneficence imposes an affirmative action to benefit an individual, not merely a negative duty to refrain from doing harm. Forcing a woman to have an unwanted child is not only psychologically distressing for the woman, but has the potential to cause psychological and physical permanent disability or even maternal death due to pregnancy complications.

Medical professionals and other medical providers that are conscientious objectors have an ethical duty through the principles of autonomy, non-malfeasance, and beneficence to inform women of emergency contraception and provide treatment when the patient requests it and there should be unrestricted access to all women of reproductive age. It is very important that the mode of action of how Emergency Contraception works which is prevention of ovulation. There are no recent studies that prove Emergency Contraceptive Pills prevent implantation of a fertilized egg.

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