A woman posted a meme on twitter talking about “breakthrough ovulation” and how these eggs fertilized after breakthrough ovulation gets killed by contraceptive pills. I asked her to explain scientifically how does the killing happen, but I never got a reply. My guess was she really did not know what she was talking about and thus the answer (because she just want to instill fear among her readers). How responsible tweet that was huh?
Breakthrough ovulation can happen, especially when the female taking pills is not compliant and does not follow instructions well. According to Dr. Dennis Higginbotham, “failure rates for pregnancy with BCP’s (birth control pills) can be 1% to 5% depending on the particular pill and on the patient compliance. Skipping pills is the usual cause for failure, but ovulation (and pregnancy) can occur even when the pill is taken properly.” (highlight is mine; Reference: https://www.healthtap.com/#topics/breakthrough-ovulation-on-birth-control). Following his statement, it would show that the pills are 95-99% effective in suppressing ovulation.
Pill are composed of synthetic estrogen and/or synthetic progesterone. Some pills are plain progesterone, while some are combined estrogen and progesterone. The hormonal contents of birth control pills are minute as compared to the volume released by the ovary. It mimics the hormone’s action by causing ovary to stop ovulating, thins out the uterine wall, thickens the cervical secretions, all for the purpose of preventing pregnancy.
What are the circumstances surrounding ovulation? When a woman ovulates, there is a high estrogen level in her blood, there is the surge of luteinizing hormone. These two events are important to trigger the eruption of the ovum from the ovary. What are the sequela of elevated levels of estrogen? In the uterus per se, it causes thickening of the walls, increase in blood vessels, as if preparing for a possible pregnancy. That’s what estrogen does to the uterine lining. So, what will happen in cases of breakthrough ovulation, and this egg becomes fertilized? It has a rich uterine lining for implantation. This is contrary to the claim of misinformed anti-reproductive health bill measure that because the woman is taking pills, the uterus is thin and cervical mucus is thick disallowing pregnancy to happen. This is false! Estrogen and progesterone are endocrine hormones. This means that it is secreted by a certain organ, but its effect is transmitted to other organs sensitive to it via the bloodstream. In contrast, paracrine hormones/substances are substances which exert effect to nearby organs by diffusion but not via bloodstream. So in breakthrough ovulation, where the egg gets fertilized, PREGNANCY will take place, NOT ABORTION. As Dr. Higginbotham mentioned, there is 1-5% failure rate.
During the woman’s menstrual cycle, estrogen hormone predominate during the 1st 2 weeks (day 0-14). This hormone prepares the uterus and other reproductive organs for the forthcoming “pregnancy,” assuming that the egg gets fertilized upon its release – uterine lining thickens, there is increase in blood vessels, glycogen, etc. Everything happens in a concerted fashion for the anticipated pregnancy. By around day 14 of the menstrual cycle, the luteinizing hormone surges (released by the pituitary gland) and then triggers the release of the ovum.
Beautiful series of pictures taken by accident by the team of Jacquez Donnez as they were preparing the woman for partial hysterectomy. (source: http://login.totalweblite.com/design/1120/index.asp?pageid=34422&AccId=4049)
Image courtesy of http://www.britannica.com/EBchecked/media/99761/The-steps-of-ovulation-beginning-with-a-dormant-primordial-follicle
Image courtesy of http://ib-biology2010-12.wikispaces.com/Human+Reproduction
When the ovum is released, the follicle is converted into corpus luteum. Estrogen level now declines dramatically. The corpus luteum now releases progesterone to sustain the ovum. If the ovum gets fertilized, there is rapid proliferation of cells until the fertilized ovum will transform into blastocyst. This happens until about 13 days from fertilization. Up to this point, the corpus luteum provides progesterone for this developing embryo.
By around 13th day post-fertilization, the blastocyst implants. It may cause a minor bleeding in some women (post-implantation bleeding) while others may not. The outer layer of the blastocyst now imbeds itself into the rich vascular uterine wall and forms the placenta. Once implanted, the placenta now assumes the role of producing progesterone for nine months until the baby’s birth, as the corpus luteum has already involuted. This predominance of progesterone over estrogen during the period of pregnancy inhibits the ovary to release ovum for nine months as well.
This effect of progesterone predominance during pregnancy is mimicked by intake of contraceptive pills. When the woman takes in hormonal pills, the progesterone becomes elevated thereby inhibiting the ovary to release an ovum, the uterine lining not prepared for pregnancy and the cervical mucus viscid, unfriendly to sperm that might swim up to the fallopian tube. Hence pregnancy will become unlikely.
Now it makes me wonder why these anti-rh bill supporters keep on saying that contraceptive pills are abortifacient. How can abortion happen when no ovum is released? And when there is no ovum released, what is there to fertilize? As of now, majority are in acceptance of the fact that fertilization is when human life begins. In cases of breakthrough ovulation which they repeatedly claim, again, if there is ovulation, then the uterus and the cervix is also prepared for a pending pregnancy because the effect of estrogen that lead to ovulation is also echoed in other parts of the female reproductive organ and not on the ovary alone. It does not happen that estrogen causes ovulation, but uterus remains thin and cervical mucus remains viscid. Estrogen and progesterone effects contradicting at the same time? No, dear anti-rh bill supporters, estrogen effect is endocrine. Again, read the meaning of endocrine as I have mentioned above. And if you insist on this premise that an ovum is released but the uterus and cervix is unprepared for a pregnancy, leading to the abortion of that fertilized ovum, then you should be one who is menstruating while pregnant because you think that estrogen and progesterone effects can happen at the same time. I wonder what subspecies of homo sapiens you are, perhaps Homo sapiens mutatis?