Birth control measures are supposed to do exactly that, prevent pregnancies. But what happens when the method fails?
?Six weeks after the birth of her second child, Winnie opted to fit the coil contraceptive for two reasons: she had previously been on the Norplant implant and thought it made her gain too much weight and this was her last child. She felt getting the coil would give her peace of mind about contraception for five solid years. But two years after the coil was fitted, the unexpected happened.
Naturally, any woman on a contraceptive would expect that it will serve its purpose of preventing a pregnancy. This is not always a guarantee, however.? Our choice of contraception can sometimes fail and/or work against us: condoms break, we forget to swallow the pill, we miscalculate safe days, and hormonal alternatives make us ?fat? and imbalanced? To counteract most of these incidences, more women like Winnie opt for methods that are thought to be more convenient, effective and long lasting. One such option is the Intra Uterine Device (IUD), or more popularly, the coil. The question is, can one conceive while on the coil???
The Device
The IUD is referred to by several names: the coil, the loop (earlier devices were coil or loop shaped) or the copper T (they are now made of copper and are T shaped). Most IUDs are designed to last five to 10 years (some brands up to 12). They are reversible (meaning fertility is restored immediately after removal) small (can comfortably sit in your clasped palm) flexible and made of plastic and copper (some have a little silver too). Some devices contain hormones.
?IUDs are inserted into a woman?s uterus, with one or two strings left hanging down a short distance into the cervix to facilitate checking if the device is in place or for extracting it,? explains Dr Allan Muli, an Obstetrician/Gynecologist based at the Upper Hill Medical Centre. ?They mainly work by ?sitting? in the womb and preventing sperm from getting through into the tubes, by thickening the cervical mucus thus creating a further barrier for the sperm and by affecting the womb lining, making it inhospitable for egg implantation.?
?The Conce-ption
For Winnie however, things didn?t quite work out as promised. ?I have a very regular 28 day cycle but this time, I was a week late,? she recalls. ?Two more weeks came and went but it never occurred to me that I might be pregnant; after all, I was on the coil. I thought something was wrong with me and went to see my gynae, the same one who had fitted the coil. Imagine my surprise when he announced that I was pregnant.?
This was not a pleasant surprise. Diagnosed with a weak cervix, therefore both of her previous pregnancies had been high risk, leaving her confined to full-term bed rest. She worried whether she was ready to go through it all over again. Similarly, with the children now a little older, she?d felt that the long awaited time to focus on advancing her career as a diplomat had finally come. She felt betrayed. Where had the lapse occurred?
?The Chances
According to Dr Muli, most IUDs are about 98 to 99 per cent effective, so generally, there?s a one to two per cent chance of conception. ?Most contraceptives exhibit the same chances,? he adds, ?The pill, for example, has a two per cent conception chance?however considering the chances of missing a daily pill dose the scale probably tips in favour of the coil.?
Nevertheless, this slight slip in efficacy is not the only reason why women on the coil may conceive. As it turns out, it is possible for the device to either slightly dislodge or be completely expelled without one?s knowledge. In fact, it?s said two to 10 per cent of women expel their IUD within the first year of insertion, especially in the first three months or during their period. This is more common in women who have never given birth and thus their uterus is small, and those who?ve had it inserted immediately after birth or abortion.
As in Winnie?s case, one of the most obvious warning signs that your IUD could have dislodged or fallen out is a late period; indicating that she could be pregnant. Other signs, Dr Muli reveals, include abdominal pains during sex or strings that seem shorter or longer than usual. ?Essentially, it is normal for a man to feel the IUD?s strings during intercourse. This can be solved by cutting the strings a little shorter but it?ll mean that you will not be able to feel the strings to check the IUD, and removing it may be more difficult. ?Anyway, if the coil has started to come out through the cervix, the man will feel the actual coil as opposed to the strings, an absolute indication that it is out of place. Similarly, if you check with your fingertips, which you should do every month after your periods, it will feel hard to the touch. However, NEVER try to push the IUD back. Go for an immediate check-up.?
?The Pregnancy
Whether it was due to efficacy failure, shifting out of place, or complete expulsion, the main issue here is that conception can and has occurred. So what happens now? ?The first thing we do is a scan to confirm the pregnancy and to establish the position of the IUD,? says Dr Muli. ?If the strings are visible, we will remove the IUD. There?s however a slight risk that removing the IUD will cause a loss in the pregnancy. However, the mother is much more likely to lose the baby to infection and put her own health at risk if we choose to keep the IUD in. If the IUD can?t be easily removed, it will be left in place in which case the pregnancy will be carefully monitored. In such a case, there?s a high risk of miscarriage or preterm delivery. However, if the embryo, despite the IUD, can reach a firm attachment during the first weeks of gestation, the pregnancy usually continues to term.?
Luckily, Winnie never had to worry about her baby cohabiting in the uterus with a foreign object. ?Upon the initial scan, there was no coil to be found,? she says.? ?We never did find it even during and after delivery. To date, the conclusion remains that it must have fallen out without my knowledge before I conceived. All my gynae could say was that ?these things happen? and that I ?was a statistic?.?
The Fears
But one would wonder, wouldn?t leaving the IUD during the duration of the pregnancy have any adverse effects on the baby; such as cause deformations? Dr Muli explains, ?Actually, long term effects of the IUD on the foetus are not known. A recent study conducted by the International Journal of Contraception placed 10 IUD pregnancies under scrutiny. It stated that ?no relevant abnormalities were found in the development of the embryo except for one case of a newborn with an upper lip lesion and a mild deviation of nasal septum, suggesting that foetal abnormalities are not exceptional but neither are they obvious?.?
There?s also a perception that conception while on the coil causes the pregnancy to be implanted on the tubes, what is commonly known as an ectopic pregnancy. Dr Muli dismisses this as a ?half truth?. ?IUDs protect against all kinds of pregnancies, including tubal implantations,? he explains. ?IUD users are therefore less likely to become pregnant at all, in comparison to those not using any contraception. However, in the unlikely event that pregnancy occurs, it is true that the pregnancy is more likely to be ectopic than would be that of a non user. All in all, the important thing to note is that pregnancy for an IUD user is more likely to be normal than ectopic, probably only an estimated 1 in every 20. ?
?The Conclusion
When all is said and done, we should remember that there?s no 100 per cent fool-proof family planning method. The most we can do, especially with devices like the coil, is make sure we go to a trained medical provider that meets recommended standards for insertion and removal. In case conception occurs, seek professional support in how to best take care of the pregnancy. ?I didn?t have a clue that it was possible to conceive while on the coil,? Winnie concludes. ?At first I blamed my gynae, thinking he might have overlooked something when I went for the check up but eventually, it all worked out for the best. My last born is now three years old and I could simply not imagine my life without him.?
Source: http://healthywoman.co.ke/slider/pregnant-with-an-iud/
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