Birth control pills before fertility treatment

05 Dec Birth control pills before fertility treatment

Have you been prescribed birth control pills before your fertility treatment? It may seem counter-intuitive, but an initial course of birth control pills (or BCPs) is common for many fertility patients. Here’s why.

Birth control pills prevent pregnancy – we all know that. But BCPs before a fertility cycle allow the clinic to control your cycle and your subsequent, pre-stimulation bleed.

For fertility patients travelling to another country for treatment, the use of birth control pills is good for logistics. They enable you to book your treatment and trip well in advance, saving you money on costly last-minute flights.

Once your bleed is controlled by the birth control pills, the clinic tells you when to stop them. Your bleed arrives three or four days after that. You then start your stimulating medication, often on day 2 of that bleed.

Only the combined birth control pill will do. These contain a balanced amount of synthetic estrogen and progesterone. You’ll need to take the birth control pills for a minimum amount of time – 18 days.

This means you need to start birth control pills at least six weeks before a frozen embryo cycle or at least five weeks before an IVF cycle using your own eggs. For donor-egg cycles, five weeks will also do. Any less and the clinic needs to organise your treatment in a different way. So your bleed pattern is relevant.

Birth control pills aren’t suitable for all fertility patients. If you’ve got high blood pressure, a history of aura migraines or other haemotological issues, BCPs may not agree with you.

Doctors are sometimes wary of prescribing birth control pills to fertility patients over 40. But as the BCPs are for short-term use only, the risk to older patients without any ‘red flag’ conditions isn’t that great. But speak to your doctor about this.

Since donor-egg fertility patients are often in their 40s, there’s also a non-BCP option. The timing of your bleed pattern in relation to your donor’s estimated egg-retrieval day might allow the clinic to avoid the use of BCPs altogether. Instead, your down-regulation injection may be used to start off your treatment cycle.

But most donor-egg recipients will be on birth control pills. The timing of the injection in relation to the end date of the BCPs helps bring on your bleed when required. Then you start your stimulation. Birth control pills are the optimal way to synchronise your cycle with your donor’s cycle.

It’s slightly optimal not to take birth control pills before IVF using your own eggs. A body without made-made hormones is more ‘natural’ than one with them in. But the advantages of using BCPs prior to treatment, particularly those planning IVF trips to other countries, easily outweigh this. (A 2019 study into BCPs and IVF actually found no issue using the pills.)

If you’ve had unsuccessful fertility cycles, there’s an argument for doing repeat cycles without using birth control pills. That applies to IVF and FET cycles, but it’s not so relevant to donor-egg cycles.

If birth control pills don’t agree with you, an alternative approach to controlling your cycle before a fertility cycle is to use Norethisterone. This progesterone-only medication works in a different way to BCPs, prolonging your bleed from roughly mid cycle. Since these pills can’t be taken for too long, they’re less flexible than birth control pills. But they can have less side effects.

For fertility patients travelling abroad for treatment, your clinic will advise on the use of birth control pills. Most of the time, they’re indispensable. Occasionally, not so much. Just follow the advice.