question: ELIF why don’t women ‘save up’ their eggs when they take the pill which stops periods?
comment: In fact when a woman reaches menopause, whether she took the pill or not, she isn't "out of eggs." It's a hormonal thing, not a lack of eggs thing.
passages: Various types of agents are used, with varying success rates and side effects. Some medications are not specifically approved by the U.S. Food and Drug Administration (FDA) for use in stopping uterine contractions in preterm labor, instead being used off-label.
   IUI can be used in conjunction with controlled ovarian hyperstimulation (COH). Still, advanced maternal age causes decreased success rates; women aged 38–39 years appear to have reasonable success during the first two cycles of ovarian hyperstimulation and IUI. However, for women aged over 40 years, there appears to be no benefit after a single cycle of COH/IUI. Medical experts therefore recommend considering in vitro fertilization after one failed COH/IUI cycle for women aged over 40 years.
   The primary mechanism of action of progesterone receptor modulator emergency contraceptive pills like low-dose and mid-dose mifepristone and ulipristal acetate is to prevent fertilization by inhibition or delay of ovulation. One clinical study found that post-ovulatory administration of ulipristal acetate altered the endometrium, but whether the changes would inhibit implantation is unknown. The European EMA-approved labels for ulipristal acetate emergency contraceptive pills do not mention an effect on implantation, but the U.S. FDA-approved label says: "alterations to the endometrium that may affect implantation may also contribute to efficacy."
   Patients usually start progesterone medication after egg (also called oocyte) retrieval. While daily intramuscular injections of progesterone-in-oil (PIO) have been the standard route of administration, PIO injections are not FDA-approved for use in pregnancy. A recent meta-analysis showed that the intravaginal route with an appropriate dose and dosing frequency is equivalent to daily intramuscular injections. In addition, a recent case-matched study comparing vaginal progesterone with PIO injections showed that live birth rates were nearly identical with both methods. A duration of progesterone administration of 11 days results in almost the same birth rates as longer durations.
   The use of fertility drugs and/or invitro fertilization can increase the chances of becoming pregnant at a later age. Successful pregnancies facilitated by fertility treatment have been documented in women as old as 67. Studies since 2004 now show that mammals may continue to produce new eggs throughout their lives, rather than being born with a finite number as previously thought. Researchers at the Massachusetts General Hospital in Boston, US, say that if eggs are newly created each month in humans as well, all current theories about the aging of the female reproductive system will have to be overhauled, although at this time this is simply conjecture.
   These regimens attack rapidly dividing cells in the body, including healthy cells like sperm and those belonging to the ovarian follicle (egg). Depending on the dose and duration of administration, these therapies can have varying effects on reproductive health. Surgery involving reproductive tissue affects reproductive function and fertility.
   Section::::Risks.
  
  Section::::Risks.:Egg donor.
  
  The procedures for the donor and the medication given to her are identical to the procedures and medications used in autologous IVF (i.e., IVF on patients who are using their own eggs). The egg donor thus has the same low risk of complications from IVF as an autologous IVF patient would, such as bleeding from the oocyte recovery procedure and reaction to the hormones used to induce hyperovulation (producing more than one egg), including ovarian hyperstimulation syndrome (OHSS) and, rarely, liver failure.
   However, it appears that repetitive oocyte donation cycles does not cause accelerated ovarian aging, evidenced by absence of decreased anti-Müllerian hormone (AMH) in such women.
  
  Section::::Risks.:Intended parent.
   Hysteroscopy is an essential part of investigating a couple’s RIF pathology and is used as a diagnostic tool to examine the cervical canal and uterine cavity. 
  
  Section::::Management.
  
  In depth reviews of the underlying causes of a couple's infertility should be undertaken with a qualified fertility specialist in order to make decisions regarding further management.
   Finally, calendar-based methods assume that all bleeding is true menstruation. However, mid-cycle or anovulatory bleeding can be caused by a number of factors. Incorrectly identifying bleeding as menstruation will cause the method's calculations to be incorrect.
  
  Section::::Potential concerns.:Embryonic health.
  
  It has been suggested that pregnancies resulting from method failures of periodic abstinence methods are at increased risk of miscarriage and birth defects due to aged gametes at the time of conception. Other research suggests that timing of conception has no effect on miscarriage rates, low birth weight, or preterm delivery.
  
  Section::::Potential concerns.:Destruction of fertilized eggs.
   The suppression of contractions is often only partial and tocolytics can only be relied on to delay birth for several days. Depending on the tocolytic used the mother or fetus may require monitoring (e.g., blood pressure monitoring when nifedipine is used as it reduces blood pressure; cardiotocography to assess fetal well-being). In any case, the risk of preterm labor alone justifies hospitalization.
  
  Section::::Types of agents.
  
  There is no clear first-line tocolytic agent.
   There are no medical conditions in which progestin-only ECPs are contraindicated. Current venous thromboembolism, current or past history of breast cancer, inflammatory bowel disease, and acute intermittent porphyria are conditions where the advantages of using emergency contraceptive pills generally outweigh the theoretical or proven risks.
  
  ECPs, like all other contraceptives, reduce the absolute risk of ectopic pregnancy by preventing pregnancies and there is no increase in the relative risk of ectopic pregnancy in women who become pregnant after using progestin-only ECPs.
  
  Section::::Emergency contraceptive pills.:Safety.:Interactions.
   Another major cause of infertility in women may be the inability to ovulate. Malformation of the eggs themselves may complicate conception. For example, polycystic ovarian syndrome is when the eggs only partially developed within the ovary and there is an excess of male hormones. Some women are infertile because their ovaries do not mature and release eggs. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries.
   Other combined hormonal contraceptives (those containing both an estrogen and a progestin) may also be used in an extended or continuous cycle. For example, the NuvaRing vaginal ring and the contraceptive patch have been studied for extended cycle use, and the monthly combined injectable contraceptive may similarly eliminate bleeding.
  
  Section::::History.
  
  Before the advent of modern contraceptives, reproductive age women spent most of their time either pregnant or nursing. In modern western society women typically have about 450 periods during their lives, as compared to about 160 formerly.
   Insufficient evidence exists on whether changes in the endometrium could actually prevent implantation. The primary mechanisms of action are so effective that the possibility of fertilization during COCP use is very small. Since pregnancy occurs despite endometrial changes when the primary mechanisms of action fail, endometrial changes are unlikely to play a significant role, if any, in the observed effectiveness of COCPs.
  
  Section::::Formulations.
   BULLET::::- Advanced maternal age causes decreased success rates in ovarian hyperstimulation. In ovarian hyperstimulation combined with IUI, women aged 38–39 years appear to have reasonable success during the first two cycles, with an overall live birth rate of 6.1% per cycle. However, for women aged ≥40 years, the overall live birth rate is 2.0% per cycle, and there appears to be no benefit after a single cycle of COH/IUI. It is therefore recommended to consider in vitro fertilization after one failed COH/IUI cycle for women aged ≥40 years.
  
  BULLET::::- Body mass index
  
  BULLET::::- Previous hyperstimulation experiences
   After three months of using, women will need to schedule a follow-up appointment to monitor blood pressure and discuss any concerns. Side effects may include irregular menstrual periods for the first approximately three months, including periods lasting longer than normal, bleeding or spotting between periods, heavy bleeding, or going with no period for the mentioned period of time. Sometimes, pain, itching or infection at the site of the implant will occur. Ovarian cysts may also occur, but usually do not require treatment, although they can cause pain even if benign.
  
  Section::::Technique.
  
  Section::::Technique.:Insertion.
   Section::::Device description.:Fertility after removal.
  
  Within a week of removal, the hormones from the device leave the body and etonogestrel is undetectable in most users. Most women will begin to ovulate within six weeks of removal.
  
  Fertility levels will return to what they were before Nexplanon or Implanon insertion.
  
  Section::::Mechanism of action.
   Insufficient evidence exists on whether changes in the endometrium could actually prevent implantation. The primary mechanisms of action are so effective that the possibility of fertilization during combined hormonal contraceptive use is very small. Since pregnancy occurs despite endometrial changes when the primary mechanisms of action fail, endometrial changes are unlikely to play a significant role, if any, in the observed effectiveness of combined hormonal contraceptives.
  
  Section::::Mechanism of action.:Progestogen-only.
  
  The mechanism of action of progestogen-only contraceptives depends on the progestogen activity and dose.
   There are no side-effects such as ovarian hyperstimulation syndrome (OHSS), bloating, mood changes or other concerns relating to ovarian stimulation. Due to the effect of ovarian stimulation drugs on the body, patients undergoing stimulation cannot pursue consecutive cycles of treatment and need to take 2–3 months break between treatment cycles. In contrast, natural cycle patients can repeat their treatment in consecutive cycles. As only one embryo is transferred in a natural cycle, there is virtually no risk of a multiple pregnancy. Furthermore, ovarian stimulation drugs are expensive and this means that the cost of each cycle is significantly less.
   BULLET::::- They can also thin the endometrial lining and potentially impair implantation but this is not the usual function.
  
  Ovulation is not inhibited
  
  Numerous studies have demonstrated that IUDs primarily prevent fertilization, not implantation. In one experiment involving tubal flushing, fertilized eggs were found in half of women not using contraception, but no fertilized eggs were found in women using IUDs.
  
  IUDs also decrease the risk of ectopic pregnancy, which further implies that IUDs prevent fertilization.
  
  Section::::History.
   If the pill formulation is monophasic, meaning each hormonal pill contains a fixed dose of hormones, it is possible to skip withdrawal bleeding and still remain protected against conception by skipping the placebo pills altogether and starting directly with the next packet. Attempting this with bi- or tri-phasic pill formulations carries an increased risk of breakthrough bleeding and may be undesirable. It will not, however, increase the risk of getting pregnant.
   Women's satisfaction with their contraception, compliance in taking the pills on time, and discontinuation rates are not significantly different between traditional and extended cycle regimens.
  
  Section::::Side effects.
   To find the estimated length of the pre-ovulatory infertile phase, nineteen (19) is subtracted from the length of the woman's shortest cycle. To find the estimated start of the post-ovulatory infertile phase, ten (10) is subtracted from the length of the woman's longest cycle. A woman whose menstrual cycles ranged in length from 30 to 36 days would be estimated to be infertile for the first 11 days of her cycle (30-19=11), to be fertile on days 12-25, and to resume infertility on day 26 (36-10=26). When used to avoid pregnancy, the rhythm method has a perfect-use failure rate of up to 9% per year.
   Progestogen-only contraceptive pills (sometimes called the 'mini pill') are taken continuously without a 7-day span of using placebo pills, and therefore menstrual periods are less likely to occur than with the combined pill with placebo pills. However, disturbance of the menstrual cycle is common with the mini-pill; 1/3-1/2 of women taking it will experience prolonged periods, and up to 70% experience break-through bleeding (metrorrhagia). Irregular and prolonged bleeding is the most common reason that women discontinue using the mini pill.
  
  Section::::Ovulation suppression.:Birth control.:History.
  
presuppositions: Women run out of eggs when they reach menopause. When women reach menopause they are out of eggs.
corrections: Women do not run out of eggs when they reach menopause. Whether a woman takes the pill or not, she is not out of eggs.
raw_presuppositions: Women run out of eggs when they reach menopause. When women reach menopause they are out of eggs.
raw_corrections: Women do not run out of eggs when they reach menopause. Whether a woman takes the pill or not, she is not out of eggs.