Managing Fertility

I wanted to write something about my experience with contraception - my life centres around pregnancy, birth and babies and I've never written about this important aspect of reproduction.

I still find it hugely unfair that most of the onus is on the woman to adjust her body in some way, usually hormonally, to be able to prevent an unplanned pregnancy. I read an article last week that said trials of male contraceptives have largely been abandoned due to intolerable side effects....!

Last year I read a fantastic book called 'Taking Charge of Your Fertility' (I highly recommend it to every woman) which is all about our cycles and how if you really take notice of what is going on in your body, you soon realise you are only technically fertile for a few days out of the month. You can discover when this time is with temperatures and examining cervical fluid which is fascinating. Men, on the other hand, are constantly fertile and sperm can survive up to 7 days in a woman's body. Yet women are expected to change their whole bodies, even suppress their natural cycles, to protect against those few days when pregnancy is a possibility.

I love the idea of fertility monitoring as contraception and I am pretty in tune with my body and aware of what is going on day to day anyway. I wish I had the confidence to practise it fully but when it comes to contraception I still err on the side of caution. When I was a young teenager I was convinced I would fall pregnant instantly, after my mother's dire warnings, and in my job I hear some incredible stories of contraception failure and babies who were determined to be born!

When I was 19 I assumed I would use the Pill, like everybody else I knew. This pill was essential to the feminist movement, taking away the fear of pregnancy and finally allowing us to have sex with who we wanted, when we wanted. Doctors even prescribe it for heavy periods. One thing I find worrying about the Pill is that it suppresses ovulation, essentially making the body think it is pregnant. This can cause lots of unwanted side effects, some of which can be long-term and serious.

I also read some interesting information about how it affects women sexually and their choice of partner. Women are attracted to different kinds of men at different stages in their cycle and there has been documentation of women going off the Pill in order to conceive no longer finding their partner sexually attractive as their body resumes ovulation. The bleeding that women experience on the Pill mimics a period but is actually a withdrawal bleed. There is something that makes me really uncomfortable about completely suppressing my cycle. I know of friends who had to stop taking it as they'd reached their ten years and were at high risk of blood clots. Having your body in a constant state of imagined pregnancy for years must have consequences. It can take longer for women when they do want to conceive if they have been on the Pill.

My experience of it was nothing but negative. I was given Microgynon (aka the Devil), which is the cheapest and most basic version of the Pill. I still feel cross that is was given to me, as they could clearly see on my file that I'd had mental health issues in the past. I don't feel that it was appropriate for me at all. There was no follow up to check I was okay. After weeks of depression and tearful, jealous rages at Luke and near-constant bleeding that turned out to be the perfect contraceptive he told me not to bother with it anymore. I will always feel grateful to my ex-husband that he put my wellbeing first in this matter and I didn't feel any pressure to find another hormonal contraceptive.

I used barrier methods for two more years before we decided to conceive Judah. It turns out my teenage fears surrounding pregnancy were not unfounded - I conceived first time which meant I ended up six months pregnant at our wedding which was definitely not what I had planned! I truly thought that it would take a few months of trying and I'd be 'discreetly' pregnant on the day. I am so very aware of how lucky we were to be immediately blessed in this way.

Pregnancy was interesting in that I found it a massive relief for the first time in my life not to be worried about contraception. That seems obvious writing it down, but it had constantly been in the back of my mind and I felt the weight of that pressure having been lifted by already being pregnant.

In the time after Judah's birth I prevented but would not have been unhappy to conceive again. I loved motherhood and would have welcomed another. Life after divorce, however, is tumultuous, and I needed something non-hormonal and very very effective.

After lots of research, I decided on the copper IUD or non-hormonal copper coil. How it works is that the copper inhibits the mobility of sperm along with changing the environment of the uterus to be inhospitable. It the unlikely event of an egg being fertilised, the IUD prevents it from implanting. They are more than 99% effective. The risks are mainly to do with ectopic pregnancy, where an egg implants outside the womb, perforation of the uterus and expulsion which is not always detected. They last for ten years so it is not recommended as short-term contraception. To fit it, the cervix is dilated slightly and the coil put in - as it goes in the arms open which anchors it in the uterus. 

My experience of having it fitted wasn't great - I had Judah with me and felt very judged by the doctor. She rudely stated that I would have to prove to her I knew the risks and benefits before she would approve me and fit it and when I stated the above she attributed my knowledge to reading a leaflet beforehand. She made it very clear that she had the power in the situation. In a way it was helpful for me to have this experience of being treated this way by a medical professional (powerless, judged, of lesser intelligence). I regularly speak to women about their experiences with care providers. I was knowledgeable and still easily belittled. So it was a learning experience.

The fitting itself wasn't pleasant at all, particularly as they forgot to get the IUD ready so once they got me ready I had to lie there talking to Judah about the seaside while the nurse ran around the room looking for one. It was stressful and if I could do it again I would have found anybody I could for childcare! Truthfully, I have never felt more like a mother than when I held Judah's hand and tried to comfort him and distract him, while I was the one going through an unpleasant procedure, all to prevent upheaval in his little life that an unplanned pregnancy would mean.

In terms of aftercare, I expected to have some cramping and spotting. I had what felt like mild labour contractions for two days along with bleeding. This faded to spotting which I had on and off for over a month. It wasn't anywhere near as bad as on the Pill, but it was inconvenient. I put up with it because I knew it would pass. 

When I complained to my mother about it she said perhaps my symptoms were worse as I was subconsciously rejecting the IUD. There is some element of truth in that and it was difficult to make the decision and modify my fertility in such a long-term way when my heart really wasn't in it. My desire for another baby has never subsided. The mind/body connection with pregnancy and birth is something I am hugely passionate about and I believe this works in the same way.

So I have a love/hate relationship with the IUD. We have become unlikely allies. It is so convenient and I can't believe I never thought to get it before I tried to conceive Judah. The only downside is spotting just before menstruation and heavier cycles, but those two things are easy trades for the considerable benefits. The risks when they do occur are severe and worrying but I am confident that they are rare. I wouldn't say the IUD was for everybody, especially having it fitted, but I found that more than worth it for the length of cover you get from it. It's an investment.

I've always believed in my mind that babies who are meant to be find their way to be born (if the mother decides it is right for her). As it stands I feel comfortable that I did everything I could and if I did manage to fall pregnant, this particular child just wants to be born and be part of this unusual family.

These are just my experiences and yours may well be different - that is why having so many contraceptive options is important as all women have different needs, as well as different reactions to certain methods. This is why I believe proper discussion of the risks and benefits needs to be had before women are just prescribed what is cheapest and most convenient for the health professional.


NB: Since writing this my alliance with the IUD broke down.. read about what happened here