Abstract

PIP: According to the associate medical director of the Planned Parenthood Association of Sacramento, clinicians in family planning and sexually transmitted disease (STD) treatment should be concerned with future fertility in 3 areas: the impact of contraceptive choices on future fertility, sexual lifestyle choices, and age of the 2 partners and its relation to fertility. With some oral contraceptives (OCs), a delay of up to 18 months can occur before fertility is resumed, but pregnancy rates subsequently equal those for women discontinuing use of diaphragms or other barrier methods. OCs reduce the risk of hospitalization from pelvic inflammatory disease (PID) and the risk of ovarian cysts, but may also increase susceptibility to Chlamydia trachomatis and dysplasia. Women using IUDs have increased risks of PID and ectopic pregnancy, and IUDs have been directly linked to infertility in several studies. IUDs should be thought of as an alternative to surgical sterilization: with the rise in STD rates, IUD use is not the same as it was years ago. Barrier methods have no negative effect on future fertility and they offer protection against STDs. Fertility awareness methods have no obvious negative effects on future fertility, and women using them have more knowledge of their cyclic fertility patterns. Sterilization can cause significant problems if the patient later regrets the procedure. Abortions and term pregnancies carry risks of infection and cervical or uterine trauma. 54% of patients seen in a private practice for in vitro fertilization had irreversible tubal damage because of their contraceptive choices--history of IUD use, tubal ligations, or ectopic pregnancy. Few clinicians or patients can accurately appraise the risks, and clinicians must explain the connection between the patient's sexual behavior and medical problems. The risk of irreversible tubal damage increases from 11% with the 1st attack of PID to 54% at the 3rd. Clinicians can teach patients to identify the symptoms of STDs and should be aggressive in diagnosis and treatment. The question of age, or how long a couple can safely wait to have a baby, has no definite answer. Risks to the woman and fetus do not change as drastically with age as fertility does. Social and economic factors also play a role in decisions about childbearing.