Term Pare Essay

8160 Words Jul 11th, 2012 33 Pages

Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent
Walter L. Larimore, MD; Joseph B. Stanford, MD, MSPH


he primary mechanism of oral contraceptives is to inhibit ovulation, but this mechanism is not always operative. When breakthrough ovulation occurs, then secondary mechanisms operate to prevent clinically recognized pregnancy. These secondary mechanisms may occur either before or after fertilization. Postfertilization effects would be problematic for some patients, who may desire information about this possibility. This article evaluates the available evidence for the postfertilization effects of oral contraceptives and concludes that good evidence exists to support
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Although postfertilization effects have been cited as a secondary mechanism of OCs,10-12 the evidence for

From the Department of Family Medicine, University of South Florida, Kissimmee
(Dr Larimore), and Department of Family and Preventive Medicine, University of Utah, Salt Lake City (Dr Stanford).

such effects has not been systematically reviewed. The purpose of this article was to review and grade the available evidence for postfertilization effects of OCs and discuss the implications for informed consent, based on the premise that patients to whom postfertilization effects are important have the right to make decisions based on the best available evidence.13-15

For Author’s Comment see page 133
Our analysis of the evidence involved a review of the abstracts of all studies of OCs published since 1970 available on MEDLINE that discussed the commonly used OCs, including low-dose ( 50 µg of estrogen) phasic combined oral contraceptives (COCs), low-dose monophasic COCs, and progestin-only OCs (progestin-only pills [POPs]). We also reviewed the patient handouts provided by OC manufacturers and the most recent editions of several medical textbooks and reference books.
Since there is variability in the definitions and use of terminology in

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