Contraceptive use and subsequent fertility

There is a very small correlation, if any, between the prior use of oral contraceptives and congenital malformations, including Down's syndrome. There are few, if any, recent reports on masculinization of a female fetus born to a mother who took an oral contraceptive containing 1 mg of a progestogen during early pregnancy. However, patients suspected of being pregnant and who are desirous of continuing that pregnancy should not continue to take oral contraceptives, nor should progestogen withdrawal pregnancy tests be used. Concern still exists regarding the occurrence of congenital abnormalities in babies born to such women. The successful pregnancy rate following treatment of this syndrome is low. The incidence of 'postpill' amenorrhea of more than 6 months' duration is probably less than 1%. The occurrence of the 'syndrome' does not seem to be related to length of use or type of pill. Patients with prior normal menses as well as those with menstrual abnormalities before use of oral contraceptives may develop this syndrome. Patients with normal estrogen and gonadotropin levels usually respond with return of menses and ovulation when treated with clomiphene. The rate for achievement of pregnancy is much lower than that for return of menses. If serum prolactin levels are elevated and gonadotropin and estrogen levels are low, patients respond poorly to any treatment regimen. There are no standard, accepted, criteria for defining pelvic inflammatory disease or for categorizing its severity. The incidence of pelvic inflammatory disease appears to be higher among IUD users than among patients taking oral contraceptives or using a barrier method. The effect of infection on future development of pelvic adhesions with resultant infertility is difficult to appraise.