What are the chances of getting pregnant using contraception? – 08/17/2023 – Balance and Health

Easily found on the internet, photos of newborns with tiny fingers intertwined in IUDs can give the impression that the contraceptive method often fails.

The idea that a newborn could overcome the contraceptive method and reach the world holding it like a trophy is hardly feasible.

The reality, experts point out, is that intrauterine devices, whether copper or hormonal, rank among the most reliable methods of preventing unplanned pregnancies.

Both types are indicated by studies as methods with protection rates greater than 99%, something that is comparable to surgical procedures, such as tubal ligation for women or vasectomy for men.

The photos or news of women who got pregnant with the IUD, according to the doctors interviewed by BBC News Brasil, tend to draw attention precisely because of the rarity of these events.

“While the probability of pregnancy associated with this method does not reach one in every hundred women per year, the pill, for example, presents a probability of nine in every hundred women. Pregnancies, even with the use of the pill, are not usually surprising, but a baby born to a woman who used an IUD, as it is very rare, usually arouses interest”, assesses Helga Marquesini, a gynecologist at the Sírio Libanês hospital.

In clinical studies, both contraceptive methods (and others such as injections and patches) show good efficacy. But in practice, the failure rates of fast-acting methods can vary greatly, as you have to remember to use them correctly.

With the “ideal” use of the combined progestogen pill, for example, the risk of getting pregnant is 0.3%. However, the number rises to 8% in so-called “typical” use, in which women eventually forget to take the medicine or end up taking it at different times.

As a result, long-acting contraceptives such as the IUD are up to 20 times more effective in preventing pregnancy, according to data from Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations).

In the rare cases where the IUD actually fails, it’s usually because it’s misplaced, explains the doctor.

“If the IUD moves and is positioned too low in the uterus, it could increase the possibility of contraceptive failure. ultrasound, at least once a year”, explains gynecologist Ilza Monteiro, vice-president of Febrasgo’s National Contraceptive Commission.

Why a Baby ‘Born Holding the IUD’ Is Extremely Unlikely

During fetal development, the baby is surrounded by the amniotic sac, a structure that isolates it from the rest of the uterus and provides protection. At the same time, the IUD remains in the uterine cavity, without having direct contact with the developing baby.

“Even if the membrane ruptures, the baby would have to go get the IUD, which we know doesn’t happen. These photos are mounted, and the method ends up being vilified because of that.”

Furthermore, the birth process involves the baby passing through the birth canal as the uterus contracts to expel the baby. According to the experts, it is extremely unlikely that the IUD was expelled along with the baby, let alone in her tiny hand.

In the rare instances when the IUD fails and pregnancy occurs with the device present, the medical team needs to assess whether the IUD can be removed.

“When we remove the IUD under favorable conditions, we manage to mitigate the main risks, which include infection in the amniotic sac, miscarriage, placental abruption, bleeding during pregnancy and premature labor”, explains Helga Marquesini.

“However, it is important to point out that, regrettably, the data indicate that even after IUD removal, we have not been able to reduce these complications to levels equivalent to those of women who became pregnant without using an IUD. Therefore, the rate of these complications will remain slightly elevated after removal, although removing the device significantly contributes to reducing these risks.”

IUD: what it is and how it works in the body

The IUD is a device designed in a “T” shape that is inserted through the cervix into the uterine cavity in order to prevent conception.

The hormonal version and the copper version of the IUD have different mechanisms of action, but both share the same ultimate mission: preventing sperm from meeting eggs.

In the case of the copper IUD, the object, being a foreign body inside the uterus, causes an inflammatory reaction that makes the spermatozoa slower or even inactive, preventing their progress towards the tubes and the encounter with the egg.

Hormonal devices contain levonorgestrel, a type of progesterone similar to that naturally occurring in the second phase of the menstrual cycle.

Its action is to create a thick and dense plug, making it difficult for sperm to travel from the vagina to the uterus and fallopian tubes.

Most women can use an IUD, but in some situations they are not recommended. Contraindications include cases of uterine problems, recent pelvic infections, unexplained vaginal bleeding, current pregnancy or copper allergy (in the case of the device version made of this material).

Some specific contraindications also apply to types of IUDs that release hormones, such as a family history of hormone-dependent cancers, such as hormone-positive breast cancer and ovarian cancer.

The copper IUD is usually cheaper, is offered by the SUS and lasts longer (ten years, while the hormonal one lasts five years), but it can also increase cramps and menstrual bleeding — symptoms that the hormonal IUD alleviates —, according to experts.

“If there are none of these contraindications, it becomes a woman’s choice. It is especially interesting for young women, who tend to forget to take the pill more often, or for those who have very hectic routines”, says Marquesini.

Despite the high protection against pregnancy, it must be remembered that IUDs do not protect against sexually transmitted infections, and therefore, even with the contraceptive method, the use of condoms is essential.

“It is necessary to break the idea that, with the IUD, the woman is fully protected. In recent years, I have observed an increase in women contracting STIs (sexually transmitted infections) — including pregnant women. Also, for those who want to avoid pregnancy, the condom is an extra layer”, points out the gynecologist Ilza Monteiro.

IUD does not harm fertility of those who want to get pregnant in the future

Both the copper and hormonal IUDs have no permanent effects on fertility, according to experts.

Once removed, the IUD ceases to exert its contraceptive effect, the body returns to the normal functioning of the menstrual cycle and ovulation, allowing conception when the desired moment occurs.

Studies have not shown differences in pregnancy rates after 1 year between former users of the device, implants, other contraceptives or non-users.

In a scientific review that evaluated 17 different studies, the average time to pregnancy was two to four months after using pills or IUDs and two to seven months after using implants.