marriage – part six: birth control

marriage – part six: birth control

In our final essay for the series on marriage, we treat the area of birth control as this is clearly relevant to marriage.  (This topic is always an emotionally charged one as well.)

We only present the reality of the dilemma.

As blog subscribers know, we try to address a wide range of contemporary issues at this blog.  We are aware of a wide and diverse readership of the essays.  No doubt, many of you will disagree with parts of this essay.  We humbly ask that you think about what is discussed below.  You don’t have to change your mind, but you may benefit from considering other perspectives.  If you decide to continue, we recommend you read the entire essay to get the proper context and complete thrust before drawing your conclusions.  (This essay, lengthy as it is, really is an all or nothing essay.  You can always set it aside for reading when you have more time for doing so.)  (We provide several links to credible sources to back up what is discussed, and include extensive quotes giving proper attribution to these sources.  As well, we avoided those sources that clearly have a vested interest in their position(s) on this issue, and hence may not be objective.  We avoided Planned Parenthood’s website and we also did not look to religious articles for information in this area.)

Each couple must make their own decisions in this area, but we believe that informed decisions generally tend to be better decisions.

“Intelligence is the sensitivity which understands, and therefore avoids, the extremes.”

The above quote was written down in an old journal of ours, but, truth be told, we do not know who said it (or where we came across it), and hence cannot give proper credit for it.  It is a meaningful quote and cautions us to beware of extremes in our thinking.

As mentioned in an earlier essay in this series, we believe that sex is not solely for procreation.  (That view, that sex is exclusively for procreation, actually dehumanizes sex.)  As you may recall, we said that within marriage it is not even primarily for procreation (see essay “part two” for our reasons for this conclusion).  Therefore, we believe wives and husbands not only have the right to limit the size of their family, but also the responsibility to do so.  The desired end is fine, but the means employed to achieve the desired end are often times problematic.  Please note:  We do not believe the ends justifies the means.  The end may be moral and acceptable and highly desired, but it cannot be morally obtained by the use of immoral means.  (This was the basic thrust of one of our earliest essays, “Wars, Just Causes, War Crimes, Civilian Non-Combatant Casualties, World War II, Moral Philosophy”, filed under the Philosophy category.)

We believe one must consider the means as well as the ends, and not let ends, by default, necessarily win out.

We are familiar with many (not all) of the arguments in favor and against many of the different birth control (or “family planning”) methods, regimens, and devices.

We decided to specifically address the IUD (intra-uterine device) in this essay because we have, in our recent research, encountered much conflicting information about this device.  There appears to be some confusion or inconclusiveness on all the actions and effects of these devices.  (We have provided some extensive quotes (with links) to show this inconclusiveness or even confusion.)  In an Internet world with so much misinformation and even, at times, disinformation circulating, perhaps a little clarity can be helpful to some concerned individuals.  (Also, there is already plenty of information out there on other methods and regimens.  It is now common knowledge that hormonal birth control pills do have some unwanted side effects and health risks that many women do not want to endure.)

Some readers may be very pro-IUD and “huge fans” of these devices for both their menstruation regulating effects and their ability to prevent unwanted pregnancy.  (There certainly are many blog posts applauding or cheerleading for these devices.  As well, there are many pro-IUD comments on various discussion forums on several websites.)  But, consider for a few moments how these devices work and here we begin to see the confusion and inconclusiveness.  Please note:  We will show several quotes (w/o italics or emphasis) with links to demonstrate this.  Albeit redundant, this is necessary.  Many young women, who are currently using (or are considering) IUDs, are not aware of all the actions and effects of the IUD as it works to prevent pregnancy.

2 types of IUD

The hormone-releasing IUD
The copper IUD

How does an intrauterine device (IUD) work?

It is not fully understood how IUDs work.  They are thought to prevent conception by causing a brief localized inflammation that begins about 24 hours after insertion.  This causes an inflammatory reaction inside the uterus that attracts white blood cells.  The white blood cells produce substances that are toxic or poisonous to sperm.  The progesterone-releasing IUDs also cause a subtle change in the endometrial environment that impairs the implantation of the egg in the uterine wall.  This type of IUD also alters the cervical mucus, which, in turn, inhibits sperm from passing through the cervix.

The above quote is found at  http://www.medicinenet.com/iud/page2.htm

From http://www.netdoctor.co.uk/sex_relationships/facts/contraceptivecoil.htm  we read this:

How do IUDs work?

They sit in your womb and prevent you from getting pregnant. They do this in three main ways:

they prevent your partner’s sperm from getting through your womb and into your tubes

they alter the secretions (mucus) in your cervix, creating a further barrier for sperm

they affect your womb lining – making it less likely to ‘accept’ an egg.

Here is another source with another quote:

Types of IUDs

Hormonal IUD. The hormonal IUD, such as Mirena, releases levonorgestrel, which is a form of the hormone progestin.  The hormonal IUD appears to be slightly more effective at preventing pregnancy than the copper IUD. The hormonal IUD is effective for at least 5 years.

Copper IUD. The most commonly used IUD is the copper IUD (such as Paragard).  Copper wire is wound around the stem of the T-shaped IUD. The copper IUD can stay in place for at least 10 years and is a highly effective form of contraception.

How it works

Both types of IUD prevent fertilization of the egg by damaging or killing sperm.  The IUD also affects the uterine lining (where a fertilized egg would implant and grow).

Hormonal IUD. This IUD prevents fertilization by damaging or killing sperm and making the mucus in the cervix thick and sticky, so sperm can’t get through to the uterus.  It also keeps the lining of the uterus (endometrium) from growing very thick.1 This makes the lining a poor place for a fertilized egg to implant and grow.  The hormones in this IUD also reduce menstrual bleeding and cramping.

Copper IUD. Copper is toxic to sperm.  It makes the uterus and fallopian tubes produce fluid that kills sperm.  This fluid contains white blood cells, copper ions, enzymes, and prostaglandins.1

The above quoted material was found at:  http://www.webmd.com/sex/birth-control/intrauterine-device-iud-for-birth-control

The leading (popular) hormonal IUD (in the USA) is the Mirena Coil.  (Bayer appears to be the parent company.)  It is also refered to as an IUS (intra-uterine system).

Mirena is a hormone-releasing IUD that releases small amounts of progestin hormone locally into the uterus. Mirena lasts for as long as you want, for up to 5 years.

The quote above is from the Mirena website: http://www.mirena-us.com/index.jsp?WT.mc_id=MIS119497&WT.srch=1

How does Mirena work to prevent pregnancy?

Mirena releases small amounts of the hormone levonorgestrel directly into your uterus.

There is no single explanation for how Mirena works. Mirena may:

Thicken cervical mucus to prevent sperm from entering your uterus

Inhibit sperm from reaching or fertilizing your egg

Make the lining of your uterus thin

Mirena may stop the release of your egg from your ovary, but this is not the way it works in most cases. Most likely the above actions work together to prevent pregnancy. Like other forms of birth control, Mirena is not 100% effective.

This quote directly above is found here:  http://www.mirena-us.com/just-the-facts/index.jsp#jump_a4/  (Note that the website of Mirena admits that there is no single (and clear) explanation for how their product works.)

Note that making the lining of the uterus thin makes implantation difficult, even not possible.  Also, the presence of the IUD may cause the woman’s body to produce antibodies within her uterus that could attack and destroy a fertilized egg.

The leading copper IUD (in the USA) is the ParaGard.  (ParaGard is a registered trademark of Teva Women’s Health, Inc.)

From http://www.paragard.com/what-is-paragard/How-it-Works.aspx  we read this statement:

ParaGard® works primarily by preventing the sperm from reaching and fertilizing the egg, making it one of the most effective forms of birth control, with or without hormones.  But because it’s hormone free, ParaGard® will not stop your body’s natural menstrual cycle.  Generally your doctor places it in your uterus within minutes during a routine office visit.  And when used as directed, ParaGard® has been demonstrated to be safe and effective for pregnancy prevention in numerous clinical trials for as long as you wish—two, five, even up to 10 years

From another source, http://www.uptodate.com/contents/long-term-methods-of-birth-control-beyond-the-basics   we read this quote:

Copper-containing IUD (Paragard®) (picture 1) prevents pregnancy by preventing sperm from reaching the fallopian tubes.  Copper-containing IUDs last for at least 10 years; the pregnancy rate in women who use a copper-containing IUD is less than one percent in the first year of use (table 2).  Some women who use a copper-containing IUD have heavier and longer menstrual periods.

No mention is made in the above 2 quotes of preventing implantation of a fertilized egg.

From this website: http://www.americanpregnancy.org/preventingpregnancy/iud.html  we get this:

How do intrauterine devices work?

The progesterone intrauterine device releases a constant low dose of a synthetic hormone continually throughout the day.  Both the progesterone IUD and copper IUD prevent pregnancy in one of two ways:

The released progesterone or copper creates changes in the cervical mucus and inside the uterus that kills sperm or makes them immobile. Changes the lining of the uterus, preventing implantation should fertilization occur. Ethical Consideration.

We clicked on “Ethical Consideration”  http://www.americanpregnancy.org/preventingpregnancy/ethicalconsiderations.html/

and here is what came up on screen:

It is possible that you may not have been aware that any ethical questions existed concerning contraception. The contraceptive methods that involve the changing of the lining of the uterus to prevent implantation from occurring create an ethical or moral consideration for some people.

Some people believe that life begins at conception whereas others believe it begins at implantation. The ethical consideration develops for individuals who believe that life begins at conception.

When contraceptive methods fail to prevent ovulation or fertilization, the changing of the uterine lining is used to prevent the fertilized egg or “life” from implanting in the uterine wall. It is this action that leaves people believing they have crossed an ethical boundary

Science does show us that at conception there is a new and unique human being present at the earliest stage of development.  The conceptus’ (or alternatively “zygote” or fertilized egg) DNA is unique, and not that of either the mother or the father.  Of course, as alluded to in the above quote, some people choose not to believe that life begins at conception.  Some do not believe that it starts with implantation within the womb either.  And there is even an academic at Princeton University, Professor Peter Singer, who assets that we ought to make the bestowal of human rights only upon children age 5 and above.  (A couple of random links if you are interested in reading more on this “enlightened” professor and his odious views are here:  http://www.inclusiondaily.com/news/advocacy/singer.htm,  and http://www.freerepublic.com/focus/f-religion/2852456/posts

Let’s view some more quotes from related medical websites.

From http://www.emedicinehealth.com/birth_control_intrauterine_devices_iuds/article_em.htm  (part of the webmd network):

How an IUD Works

Hormonal and copper IUDs work in different ways. With a copper IUD, a small amount of copper is released into the uterus. This type of IUD does not affect ovulation or the menstrual cycle. Copper IUDs prevent sperm from being able to go into the egg by immobilizing the sperm on the way to the fallopian tubes. If an egg does become fertilized, implantation on the wall of the uterus is prevented because copper changes the lining of the uterus.

With hormonal IUDs, a small amount of progestin or a similar hormone is released into the uterus. These hormones thicken cervical mucus and make it difficult for sperm to enter the cervix. Hormonal IUDs also slow down the growth of the uterine lining, making it inhospitable for fertilized eggs

More from emedicine  http://www.emedicinehealth.com/birth_control_intrauterine_devices_iuds/page6_em.htm

Copper IUDs

The copper IUD is the most commonly used type of IUD. It can be left in the body for up to 10 years. It can be removed at any time if a woman wishes to become pregnant or if she does not want to use it anymore.

The arms of this IUD contain some copper, which is slowly released into the uterus. The copper prevents sperm from making their way through the uterus into the tubes and prevents fertilization. If fertilization does occur, the copper prevents the fertilized egg from implanting on the wall of the uterus

As you can see from the several above quotes from various sources, sometimes the prevention of implantation of a fertilized egg is mentioned and some times it is not indicated.

As well, there are women IUD users, as per the comments on various websites and per their blog essays, who believe that the only action is to make the sperm swim in circles and wear themselves out prior to reaching the fallopian tubes (where conceptions can occur).  Much confusion out there folks.  These devices may cause millions of sperm cells to swim in circles and never reach the woman’s fallopian tubes.  But, even when that is so, some sperm cells may make it up into the fallopian tubes and thus conceptions can (and do) occur.  The IUD prevents implantation either by the hormones it releases into the womb (that serve to thin the lining), or by the copper (toxicity) it releases into the uterus, and/or mechanically by its foreign physical presence in the uterus.  This is what we gleaned from the above cited quotes.

In our research, we came across articles put out by the American Medical Association (AMA) in the 1970s that addressed how the IUDs of those years prevented pregnancy.  At that time, the prevention of pregnancy was acknowledged to be by prevention of implantation.  As this was using an older technology, prior to the development of the Mirena hormonal IUD and the Paragard copper IUD, we do not cite those sources here.

Let’s address another claim or assertion that has been inserted into the debate in the past several years or more.  In various online articles, we came across the assertion (not being doctors, nor having access to the data, we cannot speak to its veracity) that in the natural course of events (i.e. no IUD in place) a not insignificant percentage of fertilized eggs fail to implant and therefore die and breakdown and are washed out of the uterus.  We saw the figure of 50 percent used in one article.  Please note that these assertions are coming in some instances from doctors whose specialty is in the area of in-vitro fertilization or IVF.  The process whereby they culture and insert fertilized eggs via IVF is different from how fertilization and implantation naturally work inside the woman’s reproductive tract.  These doctors readily admit this and due to the constraints of the current medical technology, they must move to implant sooner (earlier) than occurs naturally.  So, one must be cautious here as these doctors may be basing their estimated percentages on their experiences with the high failure rate for successful implantation with the IVF procedures and be inferring from those experiences as to what a failure rate is for natural fertilization and implantation.  (We did not pursue the literature far enough in this area to see if this is clarified or properly explained and this assertion is really tangential, at best, to the actions of the IUD.)

Here is the link for the 50% figure, but you have to read down to a little past halfway through the article to get to it.  (In this article, it is not really clear how they arrived at this estimated figure.)

http://ucdavismagazine.ucdavis.edu/issues/su96/Feature/Feature-The_Facts_of_Life.html

It is reasonable to assume there is some truth here for a number of seemingly valid and plausible reasons.  As the literature indicates, not all fertilized eggs implant successfully as some are not developed sufficiently and in the correct way several days after conception to successfully implant.  If a woman is ill with a virus or other bacterial infection when she conceives, the changes within her body during the illness (due to immune system responses) may make her uterus less hospitable to a fertilized egg’s possible attachment.  As well, we think there is another possible reason that is not given sufficient, if any, attention in much of the medical literature.  In some cases, perhaps many, the woman’s womb may not be hospitable to fertilized eggs due to scarring from prior surgical abortions, and/or damage done by various STDs.

Even if you accept the postulate that many (estimated by some fertility researchers as 50 per cent of all) fertilized eggs fail to implant naturally (w/o any IUD in place), there are many that will.  The IUD, once inserted, will act to prevent any and all implantations.  So you will not know (as there is no way to know) when you conceive and have a fertilized egg, that without the presence of the IUD, would have naturally, successfully implanted.  If you keep the IUD in for five years or so, as many women do, and you have sex frequently throughout each month, you no doubt will have conceived at least a few times where successful implantation, followed by healthy pregnancy, would have occurred if the IUD had not been there.  Of course, one can argue that if you had gotten pregnant, that would have shut down the ovulation process for several months naturally.  So, over the course of five years, you may have actually only become pregnant once or twice.  As well, these estimates will not reflect the reality for all women for a number of reasons.  Some women IUD users may have had more fertilized eggs that would have been able to achieve successful implantation.  Other women might have had none that would have successfully implanted for various reasons unknown to them during their use of the IUD.  (Again, women who have suffered damage to their uterus because of certain STDs, and/or previous surgical abortion(s), may have many more failures of implantation even if the current IUD was not in place.  Also, on a related fertility concern, some STDs can cause scarring in the area where the fallopian tubes enter the uterus such that conceptions cannot occur because sperm cannot gain access to the fallopian tubes.)

But, at least be aware or cognizant of this.  If it does not matter to you that human life begins at conception, then you will have no difficulty (nor likely any second thoughts) with using an IUD.  However, if you do value actual human life that is present once conception has occurred, then you may want to err on the side of life and opt for another method of postponing and/or avoiding pregnancy (one that does not purposely prevent implantation in the womb).

If these IUDs were truly and exclusively contraceptive in the literal sense of the term (of preventing conceptions), we could embrace them without reservation.  But, as per above, they are not.

We recognize the difficulty that many people have with seeing the humanity of the “blastocyst” (that is the stage of the fertilized egg, several days after conception, and about to implant in the womb).  When you view photos of aborted babies, and you clearly see the skulls, arm, legs and torsos amidst all the blood, you clearly (and undeniably) see the remains of very small human bodies.  That “clump of tissue” that was ripped out was not a dog or a cat or a fish.  But, consider that each and every one of you who are reading (suffering?) through this long essay was at one time a “blastocyst” very, very early in your very human development and life.  (So were we.)

What is a Blastocyst?  From http://www.ivf.com/blastocyst.html we read this:

A blastocyst is a highly developed embryo that has divided many times to a point where it is nearly ready to implant on the walls of the uterus.  A blastocyst has come a long way from its beginning as a single cell.

Women and men, you need to be aware of these facts and consider them carefully when making your joint decisions as to which approaches, methods, regimens, and/or devices you make use of to regulate your fertility throughout your adult, reproductive lives.  (It is best to make informed decisions.)

If you do not want the (minor) inconvenience of putting on a condom (that many men and women do not care for using or even hate the latex or rubbery feel of them) even during the fertile times, then consider these simple alternatives (briefly listed below) to avoid conceptions.

Natural has its advantages.  If you are aware of how to note your natural ovulation (do an Internet search, the info is out there), then you and your husband could for the few fertile days each month opt for fellatio (see parts 3, 4, and 5 of this series).  Another option that some married couples practice during the few days the wife is fertile is for the man to withdraw, pull out, from her vagina prior to ejaculating.  (For some men this is difficult to do, but for others it is not difficult to know when to exit and be able to do so).  This can be risky as the man has to be decisive with himself, and get out when it is time to get out!!  You can choose to abstain from sex for a few days, too.  As well, using some  combination of these 3 options during the fertile time works effectively. (Abstaining for a day, then opting for fellatio, etc.)  Avoiding conception can be easily achieved.

Some readers may be thinking to themselves:  “Why bother writing this essay?  People’s minds are mostly already made up and not many readers are going to be open to the content.”  Fair question.  We respond:  “Yes, we were aware of that prior to drafting the above essay.  We decided to go forward on the assumption that not many will change their minds either way, but a few young women and men, who are not yet so set and rigid in their thinking or views, may make use of the contents and think these issues through.”  That really is the target audience – those who are open to considering facts that they may not have previously been aware of.  And, by the way, we will certainly never know how many readers (from all sources: search engine visitors, WordPress tag page(s) readers, blog email subscribers, and those who have bookmarked the site in their browser) may forward this essay (or a link to it) on to those young friends and/or relatives that they know who are (currently) confronting and grappling with these important decisions as they begin their marriages (or cohabitations).  If this essay proves to be helpful to even just one couple, and they opt for a more natural and life respecting approach to their family planning, then the few hours of effort on our part were not wasted at all.

Here is a recent, thoughtful essay by Sheila G that also has many comments from wives:

http://tolovehonorandvacuum.com/2014/02/husband-doesnt-want-birth-control/

Thanks for reading.

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