Myths of Contraception and Fertility
Dr. Alan Martinez discusses the many contraception choices available, the right way to use them, and whether they'll affect your ability to get pregnant in the future.
Featured Speaker:
After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Alan Martinez, MD
Dr. Alan Martinez is a specialist in reproductive endocrinology and infertility. He was drawn to this specialty because it is an ever-evolving field of medicine that allows him to partner with patients and provide personalized treatment plans. He also appreciates that the field is filled with the latest laboratory technology, which continues to advance success rates.After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Transcription:
Myths of Contraception and Fertility
Melanie Cole: There are many myths floating around regarding the impact of contraception on fertility. And if you are a couple and you're thinking about getting pregnant, it can be quite confusing. And here to discuss the many contraception choices available, the correct way to use them, and whether they'll affect your ability to get pregnant in the future is Dr. Alan Martinez. He's a specialist in Reproductive Endocrinology and Infertility at the Reproductive Science center of New Jersey.
The Reproductive Science center of New Jersey combines a commitment to sensitive care with a state-of-the-art program. We proudly present Fertility Talk with RSCNJ. Here's Melanie Cole.
Melanie Cole: Welcome to Fertility Talk with RSCNJ. I'm Melanie Cole. Dr. Martinez, it's a pleasure to have you join us today. Tell us a little bit about birth control today. What's going on in the world of birth control? What are the different kinds that are out there? The different kinds that you've seen people using? Tell us a little bit about that..
Alan Martinez: Okay. Thank you for having me today, Melanie. I appreciate it as always. So contraception can be used and there's many different methods. Traditionally, we have the combined oral contraceptive pill, which is usually taken for a period of three weeks, the active pills and you take an inactive different color pill, and then you would have a monthly menstrual cycle.
This has worked and continues to be a good option for most patients. We have a lot of patients that are still on that. And it could be taken for an unlimited amount of time. Birth control pills that suppress the ovaries, which most of them do, can have benefits on decreasing ovarian cancer, uterus cancer and colon cancer risks. So they do have some benefits. And the side effects tend to be minimal for overall oral contraceptives.
In addition to the oral medications, patients can also more recently coming back into vogue compared to, you know, 30 or 40 years ago with the IUD devices of the past, there were potential complications with that. But now, the IUDs, there's a hormonal IUD that is used and there's various medication doses and variations. And then there are mechanical IUDs that work with a metal agent versus the hormones.
Melanie Cole: Dr. Martinez, with so many types available. Which ones do you think cause the most confusion?
Alan Martinez: I think primarily both the oral contraceptives, many patients feel as if those side effects, meaning blood clots causing them heart disease and things like this, there's a lot of misconceptions about taking these in young and healthy patients. In addition, many patients feel with the oral contraceptive pills that it decreases their overall fertility or affects their cycle. But in actuality, you stop these medicines and you can resume ovulating as soon as the next month. There's no diminished chance of getting pregnant or infertility in any way. So they are safe and they often regulate cycles which have more health benefits.
The other is the IUD. We use IUD for pelvic pain patients, endometriosis. And also many patients are on that, they think that they're going to get an infection. It's going to do damage to their uterus and they're going to have complications. But in actuality, this is a very effective medicine for decreasing pelvic pain, for protecting you from endometriosis and helping out with those symptoms. And the IUDs can be taken out at any time. They have less side effect profile than the oral medicines even though those are very low and you can resume fertility right away.
I would have to say that the only medication that there's maybe a known decrease in the interval to achieving pregnancy are with the injections of medication of a progesterone nature, specifically injectable. Depo-Provera is what this is called. And for that particular one, it may keep an individual from ovulating for a period of about six months, so it can be the slowest that one.
Melanie Cole: So are there any red flags, things you'd like women to think about if they are taking any of these types of birth control and if hormonal contraception induces artificial cycles, Dr. Martinez? Is there anything we might miss, something whether it's like PCOS or any of these issues that you see in your practice all the time? Can birth control mask any of those?
Alan Martinez: Yes, absolutely. We see many patients that are later on in their life after stopping birth control pills, who might've been placed on there as adolescents for irregular cycles or painful periods or for protection against pregnancy as a teenage adolescent and it resumes normal periods. And then they stop it at 25, 27, 31 years of age, and all of a sudden their periods are very irregular. So we see, yes, anovulation, which is most commonly seen with polycystic ovary syndrome, PCOS patients. And so a lot of patients will come off of the medicine. They will then have irregular cycles. They will have some of those symptoms, which is like adult acne, maybe some abnormal hair growth in like a male pattern, chin, chest, abdomen. And then we have to address those things and we give them a diagnosis at that time. So sometimes it is masked.
Melanie Cole: So what would you like women to know as they're in their 20s, maybe early 30s, and they've been on various forms of contraception? How soon before they start trying to get pregnant should they be going off of all forms of contraception? And when should they start to concern themselves and possibly see a fertility specialist?
Alan Martinez: Okay. So anybody that's been on a contraceptive agent, if it's oral injections, IUD, pills and such, implants, when you want to conceive you want to talk to your general OB-GYN about stopping these. They can answer some initial questions and allay any concerns that the patients may have. Then shortly after that, when the menstrual cycles resume after stopping the medicines, then it's pretty much safe to attempt to achieve pregnancy.
For a patient that's young and has regular cycles, you can wait up to one year less than 35 age before you would seek infertility evaluation. If you're over 35 or if you don't have regular cycles, if you have some other conditions, maybe polycystic ovaries syndrome, maybe endometriosis, then, you know, you can seek care even earlier. But generally, it's anywhere from 12 months less than 35 years of age and then six months for greater than 35 or sooner if you don't ovulate, you have irregular cycles or some other conditions.
Melanie Cole: Do any of these affect ovarian reserve? Is this something you advise women to get checked out or screened before they either go on contraception or when they're done, when they're trying to get pregnant?
Alan Martinez: No, there is not evidence that this causes the reserve of the ovaries to decrease, that being on birth control pills will cause an earlier menopause or advanced ovarian aging. So I actually spent quite a lot of time with patients that are concerned about their birth control pills and what they did to their body. And I actually talk with them about the positive benefits of it. And I said, "That did a good job for you at that point in your life. So now we're going to switch gears and we're going to focus on trying to get you pregnant." And a lot of them are very happy to learn about, you know, that they have decreased rates of ovarian, uterus cancer and such, and that it was a safe thing for them to be on. And no, it does not impact negatively the ovarian function.
Melanie Cole: This is great information and very important for people that are nervous and couples trying to have babies. As we wrap up, what's the single biggest thing you would like couples to know about contraception, the many myths that are out there and really what you'd like them to know about fertility and contraception right there?
Alan Martinez: Okay. So I counsel the patients that, if you've been on any form of contraception and you stop whatever form that you're on, if your periods do not resume, that would be a reason to reach out to your OB-GYN and/or to seek infertility evaluation. That's first and foremost. Second, I reassure them of the positive benefits and I also explain to them that patients that have irregular cycles, that have PCOS, to protect the lining of the uterus, to protect them if they're not trying to conceive in the future, if they're taking a break from trying to achieve pregnancy, they need to really be back on some sort of contraception or an agent that will regulate their cycles or protect them hormonally. And I think that if it's explained in that way, the patients really see the potential benefits when used at different points in their lives and they're very much reassured by that and they're happy with that education.
Melanie Cole: Well, it certainly is informative and you're a great educator, Dr. Martinez. You explain everything so well. Thank you so much joining us today and really clearing up some of those myths for us.
And that concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information, please visit fertilitynj.com to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Reproductive Science Center of New Jersey podcasts. I'm Melanie Cole.
Myths of Contraception and Fertility
Melanie Cole: There are many myths floating around regarding the impact of contraception on fertility. And if you are a couple and you're thinking about getting pregnant, it can be quite confusing. And here to discuss the many contraception choices available, the correct way to use them, and whether they'll affect your ability to get pregnant in the future is Dr. Alan Martinez. He's a specialist in Reproductive Endocrinology and Infertility at the Reproductive Science center of New Jersey.
The Reproductive Science center of New Jersey combines a commitment to sensitive care with a state-of-the-art program. We proudly present Fertility Talk with RSCNJ. Here's Melanie Cole.
Melanie Cole: Welcome to Fertility Talk with RSCNJ. I'm Melanie Cole. Dr. Martinez, it's a pleasure to have you join us today. Tell us a little bit about birth control today. What's going on in the world of birth control? What are the different kinds that are out there? The different kinds that you've seen people using? Tell us a little bit about that..
Alan Martinez: Okay. Thank you for having me today, Melanie. I appreciate it as always. So contraception can be used and there's many different methods. Traditionally, we have the combined oral contraceptive pill, which is usually taken for a period of three weeks, the active pills and you take an inactive different color pill, and then you would have a monthly menstrual cycle.
This has worked and continues to be a good option for most patients. We have a lot of patients that are still on that. And it could be taken for an unlimited amount of time. Birth control pills that suppress the ovaries, which most of them do, can have benefits on decreasing ovarian cancer, uterus cancer and colon cancer risks. So they do have some benefits. And the side effects tend to be minimal for overall oral contraceptives.
In addition to the oral medications, patients can also more recently coming back into vogue compared to, you know, 30 or 40 years ago with the IUD devices of the past, there were potential complications with that. But now, the IUDs, there's a hormonal IUD that is used and there's various medication doses and variations. And then there are mechanical IUDs that work with a metal agent versus the hormones.
Melanie Cole: Dr. Martinez, with so many types available. Which ones do you think cause the most confusion?
Alan Martinez: I think primarily both the oral contraceptives, many patients feel as if those side effects, meaning blood clots causing them heart disease and things like this, there's a lot of misconceptions about taking these in young and healthy patients. In addition, many patients feel with the oral contraceptive pills that it decreases their overall fertility or affects their cycle. But in actuality, you stop these medicines and you can resume ovulating as soon as the next month. There's no diminished chance of getting pregnant or infertility in any way. So they are safe and they often regulate cycles which have more health benefits.
The other is the IUD. We use IUD for pelvic pain patients, endometriosis. And also many patients are on that, they think that they're going to get an infection. It's going to do damage to their uterus and they're going to have complications. But in actuality, this is a very effective medicine for decreasing pelvic pain, for protecting you from endometriosis and helping out with those symptoms. And the IUDs can be taken out at any time. They have less side effect profile than the oral medicines even though those are very low and you can resume fertility right away.
I would have to say that the only medication that there's maybe a known decrease in the interval to achieving pregnancy are with the injections of medication of a progesterone nature, specifically injectable. Depo-Provera is what this is called. And for that particular one, it may keep an individual from ovulating for a period of about six months, so it can be the slowest that one.
Melanie Cole: So are there any red flags, things you'd like women to think about if they are taking any of these types of birth control and if hormonal contraception induces artificial cycles, Dr. Martinez? Is there anything we might miss, something whether it's like PCOS or any of these issues that you see in your practice all the time? Can birth control mask any of those?
Alan Martinez: Yes, absolutely. We see many patients that are later on in their life after stopping birth control pills, who might've been placed on there as adolescents for irregular cycles or painful periods or for protection against pregnancy as a teenage adolescent and it resumes normal periods. And then they stop it at 25, 27, 31 years of age, and all of a sudden their periods are very irregular. So we see, yes, anovulation, which is most commonly seen with polycystic ovary syndrome, PCOS patients. And so a lot of patients will come off of the medicine. They will then have irregular cycles. They will have some of those symptoms, which is like adult acne, maybe some abnormal hair growth in like a male pattern, chin, chest, abdomen. And then we have to address those things and we give them a diagnosis at that time. So sometimes it is masked.
Melanie Cole: So what would you like women to know as they're in their 20s, maybe early 30s, and they've been on various forms of contraception? How soon before they start trying to get pregnant should they be going off of all forms of contraception? And when should they start to concern themselves and possibly see a fertility specialist?
Alan Martinez: Okay. So anybody that's been on a contraceptive agent, if it's oral injections, IUD, pills and such, implants, when you want to conceive you want to talk to your general OB-GYN about stopping these. They can answer some initial questions and allay any concerns that the patients may have. Then shortly after that, when the menstrual cycles resume after stopping the medicines, then it's pretty much safe to attempt to achieve pregnancy.
For a patient that's young and has regular cycles, you can wait up to one year less than 35 age before you would seek infertility evaluation. If you're over 35 or if you don't have regular cycles, if you have some other conditions, maybe polycystic ovaries syndrome, maybe endometriosis, then, you know, you can seek care even earlier. But generally, it's anywhere from 12 months less than 35 years of age and then six months for greater than 35 or sooner if you don't ovulate, you have irregular cycles or some other conditions.
Melanie Cole: Do any of these affect ovarian reserve? Is this something you advise women to get checked out or screened before they either go on contraception or when they're done, when they're trying to get pregnant?
Alan Martinez: No, there is not evidence that this causes the reserve of the ovaries to decrease, that being on birth control pills will cause an earlier menopause or advanced ovarian aging. So I actually spent quite a lot of time with patients that are concerned about their birth control pills and what they did to their body. And I actually talk with them about the positive benefits of it. And I said, "That did a good job for you at that point in your life. So now we're going to switch gears and we're going to focus on trying to get you pregnant." And a lot of them are very happy to learn about, you know, that they have decreased rates of ovarian, uterus cancer and such, and that it was a safe thing for them to be on. And no, it does not impact negatively the ovarian function.
Melanie Cole: This is great information and very important for people that are nervous and couples trying to have babies. As we wrap up, what's the single biggest thing you would like couples to know about contraception, the many myths that are out there and really what you'd like them to know about fertility and contraception right there?
Alan Martinez: Okay. So I counsel the patients that, if you've been on any form of contraception and you stop whatever form that you're on, if your periods do not resume, that would be a reason to reach out to your OB-GYN and/or to seek infertility evaluation. That's first and foremost. Second, I reassure them of the positive benefits and I also explain to them that patients that have irregular cycles, that have PCOS, to protect the lining of the uterus, to protect them if they're not trying to conceive in the future, if they're taking a break from trying to achieve pregnancy, they need to really be back on some sort of contraception or an agent that will regulate their cycles or protect them hormonally. And I think that if it's explained in that way, the patients really see the potential benefits when used at different points in their lives and they're very much reassured by that and they're happy with that education.
Melanie Cole: Well, it certainly is informative and you're a great educator, Dr. Martinez. You explain everything so well. Thank you so much joining us today and really clearing up some of those myths for us.
And that concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information, please visit fertilitynj.com to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Reproductive Science Center of New Jersey podcasts. I'm Melanie Cole.