When is human life, "life"? That is the first major question to this debate. Does human life begin when a sperm meets a egg to fertilize it? Does it begin when the fertilized egg implants into the uterus? When the baby's heart starts beating? When the mom can feel the baby move?
One of the biggest parts of the birth control debate stems from how a person answers this question. Birth control sometimes stops a fertilized developing embryo from implanting into a mother's uterine wall. Most people assume or are taught that birth control simply prevents an egg from being fertilized in the first place. That is not the case. And is especially not the case with many of the forms of birth control on the market today.*
I've done a lot of research about the science and facts about how birth control works. On multiple occasions I've taken my questions to practicing obstetricians and been told I'm not correct only to have further research show that the doctor didn't know their facts. On one occasion, my doctor actually came back into my patient room after printing off and reading the "small print fact sheet" to the birth control we were discussing and conceded that I was correct in my explanation to her about the mechanisms of birth control.
I've also spent a lot of time thinking and praying about when I am "convicted" that life begins and at which stage I am responsible for protecting that life. I put convicted in quotations because I know that this is a gray area when it comes to right versus wrong. I would argue out loud all day long against abortion and do whatever I could to convince another person not to have one. But, I understand there is a complexity to the ethics of this less obvious definition of life involving birth control. I just wish for everyone to have to accurate facts about how it works so that they can efficiently evaluate for themselves what they feel is right. Secondly, it is an everyday life impacting kind of decision, not some hypothetical debate. Choosing not to use "traditional" birth control leaves you with less common options, but they take a lot more work, planning, and foresight to effectively pursue than taking a pill or having a patch on your arm. Plus, I'm only even considering the birth control options for a married, committed couple who are able to support a child. I have no idea what the best answer is for sexually active partners who aren't in a family situation. Like I said, this is more about what I feel "convicted" is my personal responsibility in light of my views about sex and the life it creates and not a political or cultural suggestion.
*Ok, want a fact check?
First, lets review the story of conception:
A woman's egg is released from her ovary and sperm swim all the way up her fallopian tube where they fertilize the egg.-This is Day One of Conception- Chromosomes from the mother and father combine this day to form one unique, new life. The zygote or single-cell embryo completes the first cell division approximately 24 to 30 hours after fertilization. http://www.ehd.org/dev_article_unit1.php As early as 24 to 48 hours after fertilization begins, pregnancy can be confirmed by detecting a hormone called “early pregnancy factor” or EPF in the mother’s blood. http://www.ehd.org/dev_article_unit1.php
From there, the egg floats slowly down the fallopian tube where it implants around 5 days later. (between days 6-9). It should be noted that some pregnancies at the stage of implantation do not thrive due to genetic abnormalities. However, this natural occurrence is not the same as failure to implant because of chemical changes in the mothers uterine lining brought on by artificial contraception.
In the middle of week 3, only 18 days after fertilization, (11 days after implantation) the embryo’s heart appears. A mere 14 days later after implantation, the formed heart begins to beat. This is day 21. A woman has most likely only just realized that her period is late, and yet deep in her protected womb a tiny heart is already beating strongly.
Mechanisms for Various Forms of Birth Control
Nuvaring, The Pill, and the Patch
These forms of birth control work by slowly releasing hormones into a woman's body resulting in three main effects. Mechanism One is to prevent ovulation from occurring. Mechanism Two is to change the cervial mucus so that sperm have less success making their way towards the egg. At times, these mechanisms fail and "breakthrough ovulation" occurs. Mechanism three is a thinned uterine lining. On average, a fertilized egg needs the mother's uterine lining to be between 5-13mm thick. However, a woman taking birth control pills or on nuvaring usually has a uterine lining of 1.1mm.
A women choosing to use these forms of birth control has altered her body in a way that makes it extremely difficult for a fertilized embryo to implant and continue to grow. The difficulty in this scenario is the lack of research and absolute data showing how often "breakthrough ovulation" occurs in women using these forms of birth control as well as the frequency with which these post-fertilized eggs are lost due to the changes in the women's lining. It is plausible that a women taking these forms of birth control may never have break through ovulation, but it is also plausible that she may have fertilized eggs lost multiple times over the course of using birth control such as the Pill and Nuvaring.
http://www.spfiles.com/pinuvaring.pdf
This is the small print for NuvaRing. Look at the paragraph titled "Clinical Pharmacology" for the statement about the mechanisms such as changes to the uterine lining.
http://www.thepill.com/sites/default/files/pdf/Tri-Cyclen_Lo_PI.pdf#zoom=100
Same thing on this information for Ortho Tri-Cyclen
http://orthoevra.com/sites/default/files/assets/OrthoEvraPI_0.pdf
Same thing, see Clinical Pharmacology paragraph for statement about the changes to the uterine lining.
IUDs (Inter Uterine Devices) such as Mirena
This form of birth control works mostly by thinning the lining of the uterus and changing the cervical mucus to prevent sperm from reaching the egg. That means that in most cases women will release eggs as usual, and fertilized eggs will not implant due to the thinned uterine lining. IUD's main mechanism is to prevent implantation via a thinned uterine lining. It is much more likely that a women using these forms of birth control will loose multiple fertilized eggs due to the changes in her uterine lining.
http://berlex.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf
You will need to scroll to page 10 to review the mechanisms of action paragraph. You should also read the next paragraph "pharmacodynamics" that states after 1 year on the Mirena IUD 45% of cycles are ovulatory and 75% after 4 years. That means at least half the time, an egg is released by the women using this form of birth control. The primary mechanism for IUDs is not preventing ovulation, but preventing implantation of fertilized eggs.
Copper IUDs such as Paragard
Similar looking to the mechanisms of the above mentioned methods of birth control. However, these IUDs do not ever interfere with ovulation. Every cycle a woman can expect to release a egg. Again, the primary mechanism for IUDs is not preventing ovulation, but preventing implantation of fertilized eggs.
http://www.paragard.com/images/ParaGard_info.pdf#page=4
The Morning After Pill, Emergency Contraception, Plan B One Step,
This form of birth control contains a high dose of progestin, one of the same hormones used in regular birth control pills. The higher dose of the hormone is meant to work using the same three mechanisms. (preventing ovulation, thickening mucus to make it difficult for sperm to get to the egg, and thinning the lining of the uterus to prevent a fertilized embryo from implanting). Ironically many people who are opposed to the morning after pill do not realize that it contains the same chemicals as the birth control they are already taking. In fact, the planned parenthood website even posts a chart illustrating how you can take extra amounts of routine birth control to mimic the effect of the morning after pill.
http://ec.princeton.edu/questions/dose.html#dose
http://www.morningafterpill.org/how-does-it-work.html
The Abortion Pill, RU-486
This is not considered at all to be labeled as "birth control", but is instead a form of chemical abortion available for use up to 9 weeks of pregnancy. Basically, the pill blocks a pregnant mother's body from making progesterone which cuts the baby off from receiving what it needs to live. The growing baby will eventually die and more drugs are given to the mother causing the uterus to contract and deliver the body of the baby.
http://earlyoptionpill.com/section/what_is_mifeprex/
So after all of that if you find yourself convicted about the way that chemical birth controls work, you may feel discouraged about your options besides having a family of 12. I remember being in that place. However, I believe there are successful methods of family planning that do not involve chemical birth control. I'd love to share what I've learned about that, but this post is way too long...I promise to write about that soon.
If you'd like to do more research on the facts about birth control, I recommend starting here:
http://www.epm.org/resources/2010/Feb/17/short-condensation-does-birth-control-pill-cause-a/
There is a lot of information out there regarding the question of uterine lining and post fertilization implantation, but its really hard to find a bottom line. I find myself rethinking and sorting through my thoughts on this difficult issue every time I look at the facts. The bottom line for me was that there is way too much ambiguity and lack of definitive research by the drug companies for me to feel comfortable taking birth control. If they can't rule out with more certainty the possibility that I will alter my body in a way to prevent fertilized eggs from continuing to develop and grow, then its not an option for me.
32 comments:
I could see you having a family of 12. ;) So the best method, in my book, is abstinence. I'm pretty sure none of these issues would be a factor then. haha
Noelle, is Collin smiling in this vision because he promises me that he is not meant to have 12 kids. But if you and our 2 other playdate friends all went for 12, we could have 48 kids! Now that would be impressive-
Just for you I will make sure to mention abstinence in my follow post about non-traditional birth control... and then I'll direct them to your blog for follow up questions about Evan and lucs emmaculate conceptions :)
By the way, Collin published and deleted his own silly comment... I promise I'm not censoring
Very well written! Of course, I am in complete agreement. I think the info should be made more readily available.
V-A-SECT-OMY, vasecotomy, vasecotomy, that's my cry!!! :)
so well written and researched. i learned a lot! you should post a link to this on The View facebook page and maybe they could have you in as a special guest reporter.
What a sweet compliment Kristen and Stephanie! I would love to go on The View, ugh, they are one of the major culprits of my "where is my button to interrupt with my opinion?" crisis. And they walk all over Elizabeth all the time and make her look ridiculous even though she is the one that I think represents the majority opinion of the viewing audience. I almost (as in typed up and tried to email) her a letter of support the season that she was on there with Rosie. Terrible. Glad my mornings at the gym are about the only time I have to get upset about them anymore!
Sis, this was really interesting to read but seeing as how I really enjoy my white furniture, unstained carpets, sleeping in, and baby free life I am going to have to try and poke some holes in what I have to admit is a very well written and even more well cited post.
So if our goal is to prevent the loss of fertilized eggs I was thinking...
Have you ever looked into or come across any statistics about the number of fertilized eggs being lost due to not being on any form of contraception? For example I found this, "It is estimated that up to half of all fertilized eggs die and are lost (aborted) spontaneously, usually before the woman knows she is pregnant. Among those women who know they are pregnant, the miscarriage rate is about 15-20%." (http://www.nlm.nih.gov/medlineplus/ency/article/001488.htm)
So is it possible that by using birth control to prevent ovulation and or fertilization, fewer fertilized eggs are being lost even though breakthrough ovulation may be occurring a very rare % of the time?
Lets use an example to find out:
Sally and her friend Wendy are trying to avoid pregnancy. Sally uses the pill and according to this pro life website "Life Issues Institute" (who admits using the highest numbers possible in their data) says that due to the properties of oral contraception which you already explained very well, there is a 20% chance of breakthrough ovulation, and of that 20% there is a 2% chance of that egg becoming fertilized and not attaching to the uterine wall (http://www.lifeissues.org/abortifacients/pill.html). So if Sally is on the pill for one year she has a .04% chance or 1 out of 250 probability of losing a fertilized egg due to breakthrough ovulation. However, her friend Wendy uses Natural family planning in which she regularly ovulates every month and which the CDC says has an effective rate of preventing pregnancy 75% - 99% of the time (http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm). For our purposes we will say that Wendy is really good at natural family planning and is 99% effective with it. Therefore, if Wendy uses Natural Family Planning for one year there is a 2% chance that an egg will be fertilized and because 50% of fertilized eggs are miscarried there is a 1% chance that a fertilized egg will be lost or 1 in 100 probability that Wendy will lose a fertilized egg every 12 months.
So in conclusion Wendy who practices natural family planning at a 99% effective rate is 250% or 2 and a half times more likely to lose a fertilized egg than Sally who is on the pill every year.
Hope this makes sense lol, Looking forward to hearing your response!!
Love,
Your genius number crunching baby avoiding brother.
Ok, Gray, I'm super impressed with your research and interest in the discussion. I have heard the argument for contraception because it prevents natural miscarriages through stopping ovulation and you demonstrated that side really well.
Although I find myself very jealous of your white sofa and lack of crumbs underneath it I still have disagreements with that argument both numerically and principally when it comes to the rational behind my choice.
I started a response explaining why and I'll try to finish it soon as I can...
Thanks for the stimulating adult discussions, my brain feels healthier using other parts than the "what's for dinner/ don't pee on the floor" mommy lobes. :)
Love,
Jennifer
I think that the public, in general, is greatly lacking in an understanding of how birth control works. Many people you speak with think that the birth control pill simply prevents ovulation. That is not the case. Medical professionals do not always bring up the 3 way it works. Sometimes, like the doctor Jennifer spoke with, I think they are not fully educated.
I think giving people the information to make an informed decision is the most important thing that can come from an open discussion about birth control. Every woman and couple has to make that decision on their own. I was not fully informed when I started taking birth control. I know I would have declined using it, if I had been given all the information. When I did learn how it worked, I stopped taking it and sought other means of preventing pregnancy. For me, it was the best choice. Now, I always read the pamphlet provided when I take or give my children medication.
I do not use hormonal birth control or a copper IUD, because I do not want to create a hostile environment that would cause a fertilized egg to abort. Seeing a fertilized egg turn into a baby and losing a fertilized egg through miscarriage have both confirmed my decision to forgo using a contraceptive method that will make my uterus inhospitable for a fertilized egg.
I still believe that it is a personal decision. I just feel that getting everyone the information they need to make an informed decision is crucial.
I enjoy the stimulating conversation, too! Much better than a million questions about cockroaches and mosquitoes!
Ok, sorry it took so long! Here we go- the question is whether more fertilized eggs are at risk using the traditional pill versus natural family planning.
From the article you quoted, (I put the quote at the bottom) there is an estimated 20% breakthrough ovulation rate on the pill/patch/nuvaring. (I agree this is a high estimate for this kind of contraception.) Sidenote- IUDs have a much higher rate of breakthrough ovulation (75% after 5 years on Mirena and 100% chance of ovulation all the time with cooper IUDs) Back to the 20% breakthrough ovulation on pill/patch/nuvaring-There is also documentation to show a full term “accidental” pregnancy rate of 1% using this contraception. The question is of the remaining 19% of the released eggs, what happens? The article suggests that only 2-3% are fertlized, but there is a huge lack in research to support this theory, but there is virtually no research showing anything at all about how many eggs are fertilized, how many naturally die, and how many healthy viable fertlized eggs simply cannot implant because the mother’s uterine lining is compromised due to her being on birth control.
Even the drug companies that make the birth control don’t/can’t/won’t say the actual number. They know that mechanism one (stopping ovulation) works sometimes because they can see it on the ultrasounds of woman’s ovaries, they think that mechanism two (unfertil cervical mucus/cervial changes) works sometimes to stop sperm from reaching eggs- but can’t or haven’t shown any numerical data, and they think that mechanism three works (thinned uterine lining)- but no one can say how often this happens either b/c its impossible (as far as I can tell) to track fertlized embryos and see how often they are failing to implant. All we know is that 20% of the time these birth controls fail at preventing ovulation and 1% of the time a women carries a healthy baby to full term pregnancy. To me it is pretty clear that in that 19% window some fertilized eggs are lost due to the third mechanism.
Why did the article from the pro life website quote that 2-3% fertilization rate and 1-3% loss of fertlized egg due to thinned lining? From everything I’ve read, people are trying to guess how much the third mechanism works, but there is a wide range of possibility because there are no studies showing us how often it happens that way. That’s why the pill manufactorers list the mechanisms as theoretical, there’s no proof on either side. (making the moral/ethical dimlema even harder I feel)
As far as the natural loss of fertilized eggs using Natural Family Planning, I agree with the assesment that there is a 1% chance that a fertilized egg will be lost, but it will be due to natural reasons. Natural Family Planning doesn’t in any way alter a women’s body. It only uses the natural cues from a women’s body to indicate fertility so that the couple can use barrier methods or abstinence to prevent pregnancy during those times.
To use your example given my perspecitvie, Wendy (NFP) has a 1% chance of losing a fertilized egg due to natural reasons. Sally (birth control), has a 19% chance that an egg will be released but she will have no way of knowing if it was never fertilized, or fertilized and lost due to natural causes, or fertilized and lost due to the changes in her womb because she is taking birth control.
Lets just say the statisics were solid and less significant, though. Only a .05% proven chance that a fertilized egg is lost to a women on the pill because of a thinned uterine lining. Is that significant? Normally, I would say that .05% risk is not relavant. But in this debate, for me, we are talking about a new growing and developing life and I weigh the risk of that scenario heavily. If I were to take birth control I would need a guarantee that it functioned 100% of the time to prevent fertilization of an egg and not ever interefere after that…
Quote from the article you cited:
“How frequent is breakthrough ovulation in a woman taking a low-estrogen contraceptive pill? Well, let’s take a high estimate—20%. Probably lower than that. How frequently does pregnancy occur when there is an egg or an ovum waiting? Probably not much more than two or three times out of the twenty. So if we use a high figure, a 20% breakthrough ovulation, that would mean a two or three percent fertilization rate. But, as a matter of fact, pregnancy occurs only about 1% or less of the time, so, in the other 1 or 2%, fertilization does occur, implantation cannot occur, and the little embryonic baby dies. The bottom line, then, for the commonly used contraceptive pill is this: In 97 or 98% of the time, the effect is one of preventing pregnancy. But, in perhaps two or more percent of the time, the effect is abortifacient. There is no way in the normal clinical practice of obstetrics of knowing which is happening, or when.” http://www.lifeissues.org/abortifacients/pill.html
A few more discussions on the topic to sift through:
http://www.epm.org/static/uploads/downloads/bcpill.pdf
Another article:
http://www.epm.org/resources/2010/Feb/22/growing-debate-about-abortifacient-effect-birth-co/
I have a test tomorrow that I have to study for which is far less important than this conversation; however, I must divert my attention for just a few hours so hopefully I will have a detailed reply by tomorrow night.
Initially though, I am disappointed by your lack of concern for the statistical data, errors in calculation and failure to address the actual question of which method prevents the fewest amount of fertilized eggs to be lost.
In regards to Stephanie, the lack of awareness for the abortifacient properties of the pill/patch/nuvaring is most likely due to the fact that when compared to the natural miscarriage rate there is very little difference. NFP 1% vs. PPNV (pill/patch/nuvaring) .04%
I guess I am just not seeing a difference in how the fertilized egg is lost. natural miscarriage vs. chemically induced miscarriage.
All very interesting discussion though and I am really enjoying the conversation.
I think it may be better to look at actual research by MD's rather than speculated numbers from non-medical websites.
According to AAPLOG, an organization of pro-life OBGYN's, (paper linked below)there isn't any evidence of oral contraceptives actually creating an inhospitable environment for fertilized eggs. (The reason being that the act of ovulation actually thickens the uterine lining, so the pill's effect on the uterine lining would be irrelevant in the event of breakthrough ovulation.)
Furthermore, statistically there is no reason to believe that fertilized eggs are lost at any greater rate on the pill than on no contraceptive at all.
"The available data referenced in this discussion has, then, yielded this information: 13,000 cycles of compliant COC use results in 15.5 ovulations, and one ongoing pregnancy. The basic question in the entire “pill” controversy is, “What happened to the other 14.5 eggs?” Were they the victim of an “inhospitable endometrium”(whose existence in an ovulatory cycle is very questionable), or can they be accounted for in other ways? Let us start with the 15.5 ovulations noted above. Available data indicate that 10 to 15% of our population is infertile.(41, p 809) Of the original 15.5 eggs, This leaves 13.5 eggs available for possible fertilization and ongoing pregnancy. One could simply take the 13.5 eggs available for fertilization, apply the normal human fecundity table of 25% per cycle (the fecundity table requires optimum conditions: normal fertility in the man and woman, and correct timing of coitus). (28) We would expect 3.3 pregnancies, IF the cervical mucus is favorable, the viable sperm are present, and the timing is right. Referencing the previous paragraph, cervical mucus factors block sperm 80 to 90% of the time in non-ovulatory studies. IF adequate numbers of viable sperm can get free and make it to the waiting egg within the 36 hour receptivity window just 33% of the time, one egg might be fertilized to become an ongoing pregnancy. We don’t know about the sperm and timing, and the cervical mucus is probably not optimum. If one of these 3.3 remaining eggs is fertilized and thrives, this equals the known ongoing pregnancy rate seen in compliant COC users: One per 1,000 woman years (13,000 cycles) of use. The fate of the l5.5 eggs can also be considered from other available data. Again, the 10 to l5% infertility rate leaves 13.5 eggs available for possible fertilization. Recent critically reviewed data indicates that from fertilization to 6 weeks, spontaneous pregnancy wastage is 73%. (26, 27) This leaves 3.5 eggs available for fertilization and ongoing pregnancy. As above, considering mucus, sperm, and timing factors, one egg might be fertilized to become an ongoing pregnancy. This again equals the known pregnancy rate on compliant COC usage: per 1,000 woman years (13,000 cycles) of use. This exercise in arithmetic is not meant to be a statistician’s scientific proof text. It is rather an overview of COC unintended ovulation rates and subsequent ongoing pregnancy rates using available peer-reviewed data to account for the eggs in question."
"Considering the above information on ovulatory related hormone influences on the endometrium, “on pill” ovulation rates and pregnancy rates, the cervical mucus factor, and known data on human fecundity, fertility, and spontaneous loss rates, it can be appreciated that there is no need to postulate a pill-induced preimplantation abortion phenomenon to explain why 15.5 eggs produce one ongoing pregnancy. Known and natural causes can account for the numbers."
http://www.aaplog.org/position-and-papers/oral-contraceptive-controversy/hormone-contraceptives-controversies-and-clarifications/
http://www.youtube.com/watch?v=lvjpm1mJXlE
If I am willing to take the time to post a blog titled
"The Truth About Birth Control...", I better be on board to defending myself. Even if its in reply to L3 brother. I feel somehow unprepared for this debate.
I am intrigued by the numbers quoted in their article and would like to look through their citations. First, they quote 13000 COC cycles results in 13.5 ovulations. That is a breakthrough rate of 0.1% as compared with 9-20% I have seen in other research.
I've read information about the theory that breakthrough ovulation causes the uterine lining to rebound so that by the time an egg arrived an egg might be able to implant. However, from what I've read that isn't proven that the lining will rebound that fast. I will look further into their article and see if they have actual been able to document that theory.
I have no idea when I will reply, but I fully intend to check out the link...
I'd be lying if I didn't say an adult conversation with my brothers about cervical mucus wasn't making me laugh a little. Have a good night!
As to whether the pill or natural family planning results in the loss of more fertilized eggs, it is possible to come to some conclusions even if we were to assume (without evidence) that the pill harms a fertilized egg's ability to implant.
Using a yearly breakthrough ovulation rate of 15% (which I think everyone can agree is on the high end of estimated breakthrough rates if using the pill correctly), the pill will result in fewer fertilized eggs being lost.
Fertilized Eggs Lost Using the Pill:
With a 15% yearly breakthrough rate, a group of 1000 women will end up with a total of 150 breakthrough ovulations over the course of one year. (That is 150 eggs which may potentially be fertilized)
The pill's changes to cervical mucus factors have been shown to block sperm from entering the uterus 80-90% of the time. (See studies cited in my previous post) Lets again use the number most favorable to natural family planning and knock off only 80% of those 150 eggs since they won't get the chance to be fertilized. This leave 30 eggs.
Additionally, 10-15% of couples are infertile, with about 1/3 due to the male, 1/3 to the female, and 1/3 unexplained. So again, lets be extra conservative and say only 5% of the eggs will not be fertilized due to infertility issues. (Again this is absurdly low). So 5% of the original 150 takes out 7.5 eggs. This leaves us with a total of 22.5 eggs for possible fertilization.
In any given month, a healthy couple who have regular sex and use no forms of birth control, have a 25% chance of getting pregnant. If we assume that the 25% figure refers to viable pregnancy and not simply fertilization, that means of those 22.5 eggs we should expect 5.625 pregnancies.
Using the statistic that only 50% of all fertilized eggs will result in pregnancy, we get a total of 11.25 fertilized eggs from the original 150 unfertilized eggs. Just to be even more biased towards natural family planning, lets round up to 12 fertilized eggs.
We know that when used correctly, the pill actually results in 3 pregnancies per 1000 women on the pill.
That means 9 fertilized eggs were lost due to what ever reasons (our own use of high numbers, natural causes, or even due to alleged difficulties implanting because of the pill)
Fertilized Eggs Lost Using Natural Family Planning:
Over a one year period, Natural Family Planning is somewhere between 99-75% effective. Again, using the absolute most favorable terms for natural family planning, at 99% effective, a group of 1000 women would result in 10 pregnancies over the course of one year.
Because statistically there is one lost fertilized egg for every pregnancy, that means 10 fertilized eggs were lost compared to the pills 9.
Conclusion:
Even cherry picking the most favorable terms for Natural Family Planning, our statistics estimate that the pill would prevent the loss of 1 more fertilized egg per 1000 women per year.
It isn't hard to see that using less biased numbers would show that a significant number of fertilized eggs could be saved by using the pill.
I'm assuming that ultimate basis for some of the arguments against the pill is that you don't want to contribute to the loss of fertilized eggs because you view them as human life or at least the potential for human life, and would rather leave things up to God, chance, etc.
I can fully respect the logic behind the idea that you would rather let things work out naturally and don't want interfere or bear responsibility for the loss of a fertilized egg.
Personally, I don't view fertilized eggs as human life. However, if I were to assume that they were, and as such felt it was bad for fertilized eggs to die, I can make an ethical argument far stronger for the pill. The situation seems rather similar to a hypothetical vaccine.
Say you have 100 kids and statistically 20 will die from a disease. You can provide a vaccine that provides complete immunity, however statistically 5 kids will have an adverse reaction and die. There's now way to tell which kids will die in either scenario (ie. the vaccine may end up killing a kid who would have died anyway, but maybe not)
I completely see "I don't feel like I should/want to interfere in this; let god work out what he will." as a valid response to the hypothetical.
Personally, I just think it's better to give each kid a 95% chance at life rather than an 80% chance.
RE: Figures from the AAPLOG Paper
I swear last reply... I just wanted to explain a few things you mentioned in your reply to the AAPLOG paper.
The breakthrough rate seems low to you for two reasons. One the author is using per cycle break through rates and the 9-20% rates you mention are per year.
For example 9% breakthrough rate would equal 90 ovulations per 1000 women per year. Which equals 90 ovulations per 12,000 cycles. The author used a figure of 15.5 ovulations per 13,000 cycles.
So you can see this number isn't nearly as far off as it originally sounded.
The additional discrepancy is due to the fact that the author was using figures which represent perfect pill use. The 9-20% figures are attempts to gauge typical use breakthrough rates. Typical use considers that many people will forget to take their pill, have other factors interfere, etc. As forgetting to take the pill would be a main contributor to breakthrough ovulation this makes sense.
Truthfully, even though I did it earlier, it isn't really fair to compare typical pill use to perfect natural family planning. (I did earlier to show that even under those circumstances the pill results in the loss of fewer fertilized eggs.)
If typical use of both methods is compared natural family planning ends up looking ridiculous.
Typical use of natural family planning has a yearly failure rate of about 25%.
http://www.youngwomenshealth.org/summarychart.html
http://www.americanpregnancy.org/preventingpregnancy/fertilityawarenessNFP.html
http://en.wikipedia.org/wiki/Birth_control
http://en.wikipedia.org/wiki/Comparison_of_birth_control_methods
That means for ever 1000 women using natural family planning in the real world, there will be 250 pregnancies and an additional 250 lost fertilized eggs every year.
Even using the 20% breakthrough figure for the pill which is higher than probable for typical use, you get a total of 200 ovulations.
So even if every egg was fertilized and lost, you still have fewer lost fertilized eggs.
Even completely ignoring the other contraceptive effects of the pill and infertility rates (which could prevent 80-90% of those eggs from fertilizing), we know that only 25% of those on the pill who are also having regular unprotected sex will get pregnant. So if 25% get pregnant, would mean 50 fertilized eggs were lost.
In short, a very very very conservative estimate shows that in real world use, the pill prevents the loss of 500% more fertilized eggs than natural family planning.
Big brother, making my logic look petty and unfounded since 1985...
Well I had originally jotted some thoughts down about Jennifer's arguments and bad math, but seeing as how James has found some better, more accurate, and sourced data; to use his words, "I think it may be better to look at actual research by MD's rather than speculated numbers from non-medical websites."
I am glad James was able to find some more proven data, but just so that we are being completely accurate James the studies listed in the birth control pamphlets all list there statistics in 100 women-years based on the pearl index and because the average cycle last 28 days 1 women year is equal to 13 cycles or 1300 cycles per 100 women-years. So James' example would be 90 ovulations per 13000 cycles. See http://en.wikipedia.org/wiki/Pearl_Index.
A few things:
1. I think there are a lot of numbers being thrown around so maybe I will make a google spreadsheet later so that we are not jotting down numbers and checking each others math on note cards at our desk...just me?..oh.
2. To keep the conversation on point I would like to remind everyone that the question is- WHICH BIRTH CONTROL METHOD RESULTS IN THE LOSS OF THE FEWEST AMOUNT OF FERTILIZED EGGS
3. I found this research that might help Jennifer when she has time to respond - http://en.wikipedia.org/wiki/Cognitive_dissonance
Finally Madame speaker I would like to forfeit the rest of my time to the gentleman with the fact based data and legal expertise.
really? I think there are a lot of numbers out there, and it is confusing. Gray, the only numbers I used were the ones from the pamphlets that the manufacturers provide and the numbers from the article that you cited.
My issue is not which method causes the least amount of eggs to be lost. In fact, I concede that because BCPs inhibit most ovulation, they are most likely going to prevent many eggs from being fertilized and lost-even ones lost naturally. A couple using nothing at all for birth control will loose more eggs naturally because they will have many more chances to ovulate. MY issue is that if I am going to be a consumer of, or take a prescription drug that interferes with the natural process of my body, THEN I have a problem if that product interferes in a way to cause fertilize eggs to be lost and only then. The fertilized eggs lost using NFP or nothing at all aren't part of my equation, so you have to put a star by those in your spreadsheet...
Now, like I said in the text. Fertilized egg +5 years in my house currently has hand, foot, and mouth disease. Fertilized egg +3 years is about to go to the doctor b/c his thumb might be broken from slamming it in a door today, and fertilized egg +1 year is really fine except almost needing stitches from a cut above his eye from falling in the bath last night. I will respond in a more professional way after that is handled. :) And after Survivor of course.
love ya'll!
Just keeping it real.
That is a fine position to take, but the original discussion was that since you view a fertilized egg as "new and developing life" preventing the loss of that life is your goal and that's why you don't use birth control.
Then we had a discussion concerning 1) that there is no good evidence to suggest that the pill prevents implantation in the case of breakthrough ovulation, and 2)that in either case the pill will actually result in far less loss of "new and developing life" than natural family planning.
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But just to be clear, you now agree with the following positions correct?:
"Many more fertilized eggs die when using Natural Family Planning than compared to birth control."
"I don't care how many fertilized eggs are lost, so long as those eggs are lost naturally."
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My questions to you then are:
1) Why are fertilized eggs lost through natural family planning less valuable than eggs lost on the pill? (That is, why do you see one group as expendable while the other is not? There is absolutely no difference between them. Why should one be protected and the other not?)
2) How do you answer the vaccine question? If 25% of a group of children will die from a disease, or 5% will die from the vaccine, would you not provide the vaccine because the will 25% die naturally?
If fertilized eggs are life, is it not better to minimize the loss of life?
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Ultimately, the birth control a person uses is a very personal choice. If you don't FEEL like birth control is something you want to take that is your business and no one else's.
However, I do think it is fair to ask for honesty in that when this issue is presented, that no one pretends the issue is about something it isn't. The original post was about how birth control actually results in the loss of fertilized eggs and that wasn't something you were morally okay with. Now we have seen that the pill results in less loss of fertilized eggs, but that is not the issue anymore.
If I understand you correctly, your argument against the pill is not based on a concern for fertilized eggs in the least.
The issue is that you FEEL it is better to lose fertilized eggs naturally rather than the possibility of losing them unnaturally, even if this results in many many more fertilized eggs being lost. (not to mention the lack of evidence for this happening)
Again, that is a fine position to take, but let's just not go through medical diagrams about birth and conception and talk about the how fertilized eggs are life which needs to be protected.
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PS- I feel like that reads angry or something. I'm not, I just can't figure out how to write that less "rant-y"
https://docs.google.com/spreadsheet/ccc?key=0Aj-UTOba3JdNdDlKTzAtREdWejRBQzZFdHJyWGloT2c#gid=0
OMG! I just read through all of this discussion and while I m extremely impressed by the intelligent discussion and the evidence of indepth research, could all my married children just hush up and have more babies please??!!! Love, mom
James, thank you for writing “rant-y”, now I know there is a limit to your lawyer speak.
The original discussion for me was never about just preventing the loss of life. In fact in my original post directly underneath the diagram you mentioned I wrote, “It should be noted that some pregnancies at the stage of implantation do not thrive due to genetic abnormalities. However, this natural occurrence is not the same as failure to implant because of chemical changes in the mothers uterine lining brought on by artificial contraception.” In replying to Gray’s original comment I said, “I agree with the assesment that there is a 1% chance that a fertilized egg will be lost, but it will be due to natural reasons. Natural Family Planning doesn’t in any way alter a women’s body. It only uses the natural cues from a women’s body to indicate fertility so that the couple can use barrier methods or abstinence to prevent pregnancy during those times.”
I feel that I have been clear all along as to my definition of the issue which is not the loss of embryos in general. Miscarriages happen, once a mom knows she is pregnant they are devastating, but even at the 6 day post fertilization stage it is sad. It was a growing life that stopped growing. For me, a comparison of naturally miscarried embryos is not the same as embryos that are lost because a women is taking a form of chemical birth control.
It comes down to not which one causes the greatest loss of life numerically, but what my responsibility is as a potential consumer of chemical birth control. Theoretically, I have no problem with spacing children or preventing pregnancy as long as the method of doing so has no biological interference with the process of life once fertilization occurs. Nothing about practicing Natural Family Planning interferes with this process.
What it came down to for me as I was making the decision was this: If I choose to get a prescription and take birth control pills after researching and evaluating my personal convictions about when a life begins, how will I feel every month when I have a period? Will I be ok wondering if I may have ovulated that month, not being sure if I accidentally got pregnant and never knew? At that point, and with natural planning as an alternative I just decided that for me it wasn’t worth wondering.
So to answer you questions-
1. The difference I see between eggs lost through nfp and eggs lost on the pill is that losing eggs on nfp is a naturally occurring, although sad, part of the normal process of life. Eggs lost on the pill due to the third listed mechanism of a hostile endometrium (uterine lining) are failing to implant because the effects of the birth control pill render her uterine lining inhospitable to growing and nurturing the newly created life. It’s a passive role in the loss of life versus an indirect yet active role.
2. Your second question, “If fertilized eggs are life, is it not better to minimize the loss of life?”
I understand that birth control minimizes potential for loss of life because it stops the life from ever beginning via inhibition of ovulation. I don’t see any reason to stop myself from ovulation just to protect the loss of potential embryos. I am more comfortable with letting my body’s natural processes stay unaltered.
Finally, you said that in our discussions we have found, “that there is no good evidence to suggest that the pill prevents implantation in the case of breakthrough ovulation”
I agree that the paper you cited presents some strong arguments for this case. I find it perplexing that drug companies still clearly list the third mechanism on the pamphlet of their products. I am wondering what response the community might have for the arguments in the paper you cited and would like to look into it. In particular as they said, “Research regarding endometrial histology on the sixth day after escape ovulation in “on pill” cycles would add useful information to the current discussion.” I wonder if anything has been researched since the paper was published? I would like to follow up on this question, as I feel it is truly the most relevant part of the discussion.
Now, I doubt that you will have time for reading this as I’m sure you are being wined and dined with celebrities all weekend.
Love,
Your not so fancy or famous sister
One more thing worth mentioning which is that all of the above statistics and discussion have only focused on the potential rate of breakthrough ovulation and implantation miscarriages for the pill/patch/nuvaring.
There is an entirely separate statistical likelihood that fertilized eggs are lost when looking at IUDs. I'm assuming that you don't disagree with my conclusions or information regarding this part of the topic which I believe is still relevant.
My mistake Sis. I misunderstood the basis for your post.
Specifically, I think I assumed some of your points were asserting arguments that you weren't actually making, and I'm still not sure I understand.
I guess, to help clarify, (ignoring issues of evidence) why is losing more eggs through a passive role better than losing less eggs through an active role?
Lets make this more personal. I’ve been married for 8 years this summer. Imagine that 8 years ago I decided to go on the pill. Even though you have argued that there is no hostile endometrium effect, lets just say that 1 of those cycles produced a fertilized healthy egg that failed to implant because the pill I was taking created a thinned uterine lining. And for the sake of arguing the point we will pretend that I miscarried 10 fertilized eggs for natural reasons during the same 8 years if I was using NFP the whole time. (which obviously I haven’t evidenced by the huge mess on my kitchen floor this morning…oh I mean, because I had 3 kids)
For which loss am I morally accountable? The miscarriages? Certainly not. The egg lost because I used chemical birth control even though I was aware of the possibility that my body may be unprepared to receive a fertilized egg? I say yes.
If we magnify the moral question past a 6 day old embryo does it change your feeling? Lets say that twice a mom is 8 weeks pregnant, but has a miscarriage from natural reasons. Compare that to a mom who one time takes RU-486 at 8 weeks pregnant and causes a miscarriage. Would you agree in this situation that it isn’t the number of lives lost, but the reason they were lost?
This comes back to my point that you do not treat both sets of fertilized eggs the same.
If fertilized eggs are life, you cannot simply state that you are not morally responsible for the loss of eggs through natural family planning, but are morally responsible for the loss of eggs due to birth control. There is no passive fertilization of eggs. People choose to have sex. If you choose to have sex, you are morally obligated to do so in a way which will result in the least amount of harm to human life. Why would a person not be morally responsible for the loss of life (which by your definition includes failed implantation) which they could have prevented.
If three children were drowning in a lake, and I could jump in and save two of them but choose not to, would I not be morally responsible for their deaths? Is it okay because I passively let them drown? Where are the ethics in that?
My ultimate point is that if un-implanted fertilized eggs are going to be identified as human life worthy of protection, then I don't think the ethical choice so simple.
In your scenario you said you could lose 10 fertilized eggs naturally, or one egg because of birth control. If those eggs are life, are you responsible for the extra 9 eggs lost? I would say certainly so! You could have prevented nine deaths.
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(Of course the logics and ethics of this whole scenario make far greater sense if you were to simply identify life as beginning at the moment of implantation. The choice to identify life as beginning at post fertilization/pre-implantation is rather arbitrary. And the high natural rate of loss of eggs preimplantation seems to make the moment of implantation a more rational identification of the beginnings of life. (No one mourns the millions of sperm that are lost every day... well maybe some Catholics) But I would argue that at whatever point we are going to identify something as life, we are then under an obligation to protect and minimize the loss of that life.
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