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| Perfect
Use |
Typical Use
1st 12 Months |
Fertility Acceptance Methods 1.
| Calendar rhythm | Calculates fertile phase from menstrual history. | 9 | 20 | Still widely used but far less reliable than modern methods of Natural Family Planning. |
| Sympto-Thermal (STM) |
Observation of cervical mucus, BBT, cervical changes and secondary signs. | 0-2 | 2-8.9 | None |
| Ovulation Method (OM) |
Observation of cervical mucus. | 3 | 2.5-14.9 | None |
Fertility Suppression Methods 2. Adults
| Withdrawal | Interrupts sperm entry into the vagina. | 4 | 19 | Frustration of partners. |
| Barriers and Devices | ||||
| Female Condom Male Condom |
Prevents sperm entry into the vagina. | 5
3 |
21
14 |
Aesthetic objections, decreased sensitivity, possible latex allergies . |
| Diaphragm Cervical Cap | Blocks sperm entry into the cervix. | 9 9 |
26 18 |
Aesthetic objections, possible latex allergy, bladder infections. Weight gain or loss can require refitting of device. |
| Spermicides | Kills sperm in vagina. | 6 | 26 | Occasional allergies. |
| Vaginal sponge | Provides barrier to cervix and spermicidal agent kills sperm. | 9-20 | 20-40 | Problems with removal are common; vaginal dryness; and toxic shock syndrome reported when left in place beyond recommended time. |
| IUD
All Types |
1. Inhibits sperm
function and survival. 2. Prevents implantation of early embryo if conception occurs. 3. Disturbs tubal motility. |
0.1-1.5 | 0.1-2.0 | Infection of the uterus and tubes leading to infertility; ectopic pregnancy; increased menstrual bleeding; uterine perforation; and septic abortion. |
| Tubal Ligation | Mechanically blocks the Fallopian tubes to prevent the egg and sperm from uniting. | 0.5 | 0.5 | Risks of any surgery; 3-5% experience menstrual disturbance or pelvic pain; some require hysterectomy. |
| Vasectomy | Blocks vas deferens to prevent sperm from leaving scrotum. | 0.1 | 0.15 | Ligation of vas deferens causes sperm to be forced into scrotum resulting in rise of sperm antibodies which persist in 25% of men. The implications are still in the process of study. Increased risk of prostate cancer described in 2 studies: also increase in lung cancer if surgery was over 20 years ago. |
| "The Pill" (oral contraceptives) |
1. Prevents ovulation
by blocking luteinizing
hormone surge. 2. Alters cervical mucus to block sperm entry. 3. Alters uterine lining to prevent implantation (early abortion). 4. Inhibits capacitation of sperm. |
0.1 | 5 | Increased risk of cervical cancer; blood clots; high blood pressure; benign liver tumors, migraine headaches; gallbladder disease; cervicitis; heart disease; depression, weight gain, acne, loss of libido and more. |
| Progesterone- only
pill (mini pill) |
1. Inhibits ovulation 2. Alters cervical mucus to block sperm entry. 3. Alters uterine lining to prevent implantation (early abortion). 4. Diminishes function of corpus luteum. |
0.5 | 0.5 | Menstrual irregularity; breast tenderness; certain breast cancers; liver conditions; cardiovascular conditions; migraine headaches and many of the same risks associated with the combined pill. Requires strict adherence to dosage schedule. |
| Injections (Depo-provera) |
1. Inhibits ovulation by
suppression of the
luteinizing hormone
surge. 2. Thickens and decreases cervical mucus preventing sperm penetration. 3. Alters uterine lining to prevent implantation (early abortion). |
0.3 | 0.3 | No immediate discontinuation; weight gain; depression; breast tenderness; menstrual irregularities; delay of up to one year in return to fertility; bone density decrease; decrease in HDL cholesterol levels; allergic reactions; premenstrual tension; repeated, painful headaches. |
| Norplant system | 1. Suppresses
luteinizing hormone
surge necessary for
ovulation. 2. Thickens and decreases cervical mucus. 3. Prevents implantation should fertilization occur (early abortion). |
0.5 | 0.5 | Surgical procedure to insert and remove. Over half the users discontinue, mostly due to irregular bleeding or no menses. Removal or rods is sometimes difficult. Higher rate of pregnancy among heavy women; increased risk of ovarian cysts; blurred vision; migraine headaches; nervousness; weight gain; arm pain; infection or inflammation at site of implants; nausea; hair growth or loss and many of the other side effects of oral contraceptives. The five year cumulative pregnancy rate is 3.9%. |
| Anti-Nidation
Methods
RU-486 (mifepristone), Preven, (combined estrogen and progestin), Ovral, Levlen, Levora, Lo-Ovral, Nordette, Alesse, Levlite (progestin-estrogen combined oral contraceptives) Ovrette (progestin-only oral contraceptive). Copper-bearing IUD |
Emergency
Contraception
1. Alters endometrium
inhibiting implantation. |
If treatment initiated within 72 hours of intercourse, the risk of pregnancy is reduced by at least 75% | Abortion if conception has occurred; nausea; vomiting; breast tenderness; headaches; dizziness; any other potential risks of oral contraceptives. Potential for causing developmental abnormalities should embryo survive. |
|
Some Definitions Natural Family Planning: Methods for achieving and avoiding pregnancy that are based on the observation of the naturally occurring signs and symptoms of the fertile and infertile phases of the menstrual cycle. Couples using natural family planning methods to achieve pregnancy, engage in intercourse during the fertile phase of the woman's cycle while those wishing to avoid pregnancy abstain from intercourse and genital contact during the fertile time. No drugs, devices, or surgical procedures are used to avoid pregnancy. Natural Family Planning reflects the dignity of the human person within the context of marriage and family life, promotes openness to life and the value of the child. By complementing the love-giving and life-giving nature of marriage, Natural Family Planning can enrich the bond between husband and wife. Sympto-Thermal Method (STM): STM utilizes the woman's observation of her primary (cervical mucus, basal body temperature, cervical changes) and secondary signs of fertility (breast tenderness, mid-cycle pain, etc.). Differences surface among the schools of STM in how the temperature is recorded as well as with regard to the definition of the basic STM rule. Ovulation Method (OM): OM utilizes the woman's observation of one sign of fertility (cervical mucus). Differences surface among the schools of OM with regard to emphasis. Some schools emphasize "sensation," others "observation" of the cervical mucus. Perfect Use: The percentage of method effectiveness for pregnancy avoidance without factoring in human error. Typical Use: The percentage of method effectiveness for pregnancy avoidance factoring in human error. In contraceptive research, the person's intention to achieve pregnancy or not will separate them into groups of those who "plan" to become pregnant and those who do not". Because NFP is the only method of family planning which can be used to achieve a pregnancy, these definitions do not sufficiently represent NFP user related pregnancies. NFP researchers therefore separate user rates as follows: (A) Informed choice: A couple who had previously indicated that they were using the method to avoid pregnancy and chose to have intercourse on a day of recognized fertility. [Similar to this category is that of "achieving pregnancy" as defined by NFP researchers of the Pope Paul VI Institute for the Study of Human Reproduction. They define pregnancies which result from couples who have intercourse on a day of known fertility (regardless of intent) as "achieving pregnancy" and therefore tabulated in the "planned pregnancies" rate.]
(B) Teaching Related: Misunderstanding of the rules of the method. (C) Unresolved: No or inadequate information to categorize the unplanned pregnancy. The purpose of this Focus series is to serve the Roman Catholic diocesan NFP programs of the United States through providing them with up-to-date information on research within the field of fertility, family planning, and related issues. Fertility acceptance methods are morally acceptable according to the Roman Catholic Church's teaching on conjugal love and responsible parenthood. Fertility suppression and anti-nidation methods are not morally acceptable according to these same teachings. The diocesan NFP teacher should be equipped to understand the various methods of contraception and be able to explain their incompatibility with the practice of the natural methods of family planning. Copyright @ 1999, 2002, Diocesan Development Program for Natural Family Planning, United States Conference of Catholic Bishops. The text and illustrations may be reproduced in whole without alteration or change by Catholic dioceses, parishes, schools, organizations, and newspapers, provided such reprints include the following notice:
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| Reprinted from FOCUS NFP Series, Copyright @ 1999, 2002, Diocesan Development Program for Natural Family Planning, United States Conference of Catholic Bishops, Washington, D.C. All rights reserved. |
1. Effectiveness rates taken from: Klaus, H. Natural Family Planning: A Review. OB-GYN Survey 37 (February 1982): 128-150; 2nd edition 1995, published, NFP Center of Washington, D.C., Bethesda, MD; and Fu, et al. Contraceptive Failure Rates: New Estimates from the 1999 National Survey of Family Growth. Family Planning Perspectives 31 (March/April 1999): 56-63. For a thorough discussion of the difficulties regarding scientific studies on the effectiveness of NFP see Kambic, R.The Effectiveness of Natural Family Planning Methods for Birth Spacing: A Comprehensive Review in Girotto, S. & Bressan, F. (eds.) Human Fertility Regulation: Demographic and Statistical Aspects. Verona, Italy: Edizioni Libreria Cortina Verona, 1999 (pp.63-90). 2. Effectiveness rates and general information taken from: Fu, et al. Contraceptive Failure Rates: New Estimates from the 1999 National Survey of Family Growth. Family Planning Perspectives 31 (March/April 1999): 56-63. See also Hatcher, R., et al. Contraceptive Technology. New York: Ardent Media, Inc., 1998. 3. See Hatcher, R., et al. Contraceptive Technology. New York: Ardent Media, Inc., 1998. Grou, F., Rodrigues, I. The Morning-After Pill: How Long After? American Journal of Obstetrics and Gynecology 171 (1994): pp.1529-34. Moore, Keith L.; Persaud, T.V.N. The Developing Human, Clinically Oriented Embryology, 6th edition. Philadelphia: W.B. Saunders Company, 1998. p.58. Glasier, Anna. Emergency Postcoital Contraception. The New England Journal of Medicine 337 (1997): pp.1058- 64. Couzinet, B., LeStrat, N., Silvestre, L., Schaison, G. Late Luteal Administration of the Antiprogesterone RU-486 in Normal Women: Effects on the Menstrual Cycle Events and Fertility Control in a Long-Term Study. Fertility Sterility 54 (1990): 1039-44. Spinnato, J.A. Mechanism of Action of Intrauterine Contraceptive Devices and its Relationship to Informed Consent. American Journal of Obstetrics and Gynecology 176 (1997): pp. 503-6. Beck, W.W. (ed.) Obstetrics and Gynecology 4th edition. Baltimore: Williams & Wilkins, 1997: pp.241-52. Larimore, Walter, Stanford, Joseph. Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent. Archives of Family Medicine 9 (Feb., 2000): pp.126-133. Kahlenborn, C., Stanford, J., Larimore, W. Postfertilization Effect of Hormonal Contraception. Annals of Pharmacotherapy (Mar., 2000): www.theannals.com |