Tampa Obstetrics, Fertility & Gynecology

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Adam S. Levine, M.D. recently finished his fellowship in reproductive endocrinology and infertility within the department of gynecology and obstetrics at the Johns Hopkins University School of Medicine. His areas of expertise include reproductive endocrinology, infertility, assisted reproductive technology, reproductive surgery, pediatric and adolescent gynecology, and menopause.

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birth control

Q:   I am contemplating undergoing tubal ligation after the birth of my fourth child (within the next few weeks). How do I choose the procedure - general anesthetic or spinal? What is the possibility of having an allergic reaction to the 'fluid?'
A:   There are several different methods that may be used for tubal ligation that should permanently prevent pregnancy. Tubal ligations performed immediately or soon after delivery are usually done through a small incision below the umbilicus (belly button). You should know that although a tubal ligation is considered a form of permanent sterilization, there is a small chance (about 1 in 250) that the tubal ligation can fail, and you may become pregnant.
   In order to minimize discomfort, different types of anesthetic are used. General anesthesia is where medications are used to induce a state of temporary unconsciousness and paralysis. Regional anesthesia, such as spinal or epidural anesthesia, essentially blocks the nervous system at a certain level (usually right around the umbilicus). During regional anesthesia, you may remain awake and aware of what is going on. You will feel no pain, but you may experience some pressure. It usually takes far less time to recover from regional anesthesia than general anesthesia. Depending on the actual procedure used, regional anesthesia is usually safer than general anesthesia.
   Every time a medication is administered in any form, there is a small chance of an allergic reaction. Allergic reactions occur during both regional and general anesthesia. The best option in this case is to discuss the type of anesthesia with your obstetrician and the anesthesiologist who covers labor and delivery. In many cases, women who have epidurals (regional anesthesia) to help manage pain during their labor, can use the same epidural for their post-partum tubal ligation.

Q:    I've been reading about IUDs and considering them as a birth control option. I am married, monogamous and have not had any children. Is the IUD an appropriate option for me?
A:    Intrauterine devices (IUDs) are generally recommended for contraceptive use in women that are engaged in a mutually monogamous relationship, who have had at least one child, and who have no past or current history of pelvic inflammatory disease. The primary reason for these recommendations is that women using IUDs have a greater chance of developing pelvic infections than women who do not use IUDs. Theoretically, pelvic infections may predispose a woman to developing infertility.
    There are two different types of IUDs currently available in the United States. The most common is the ParaGard IUD. It is composed of copper wire wrapped around a plastic 'T' and is approved for 10 years of use. The other type releases the hormone progesterone and is called the Progestasert IUD. It is approved for 1 year of use. In most cases, IUDs are a safe and effective means of contraception. Typically, 0.8% of women using ParaGard will become pregnant within the first year of use. This compares favorably to 85% of women who do not use contraception and become pregnant and 0.4% of women who become pregnant following a permanent tubal sterilization.
    There are some reasons that IUDs should not be used. These include: 1) A known or suspected pregnancy; 2) A uterine abnormality or abnormal PAP test; 3) An allergy to copper or a disease which is affected by copper such as Wilson's Disease; 4) Any past or current history of pelvic infection; and 5) Patients with decreased immunity such as patients receiving chemotherapy, radiation therapy, transplant patients, or patients with HIV or AIDS. A woman that becomes pregnant while using an IUD is more likely to develop an ectopic (tubal) pregnancy. She is also more likely to have a miscarriage or a pre-term delivery than a woman that does not have an IUD in place. Women using IUDs have a slightly greater blood loss at menstruation and may have an increase in cramping. There is also the possibility that the IUD may fall out, become embedded in the uterus, or perforate through the uterus.
    There are few absolutes in medicine and patients require individualized care. Contraceptive choices should be made by well-informed patients in conjunction with their health care provider.

Q:   What is the morning after pill? How does it work? How effective is it? Are there any contraindications?
A:   The morning after pill is one of several commercially available oral contraceptives. The only differences between the morning after pill and commonly used oral contraceptives are the dosage and timing of the medication used. The dose used for a morning after pill is approximately four times greater than the dose of an oral contraceptive. Morning after pills only need to be taken twice over 24 hours as compared to the daily use of oral contraceptives. The morning after pill is a method of emergency contraception which is used by a sexually active woman that is either already using some method of contraception that has failed (broken condom, missed pills), or is not using contraception, or has been sexually assaulted. The morning after pill must be used as soon as possible but no later than 72 hours after an episode of unprotected intercourse. If it is used correctly, it will reduce the chance of pregnancy by approximately 75%. It is important to understand that the chance of becoming pregnant after one episode of unprotected intercourse varies between 0% and 26% The morning after pill will decrease the chance of becoming pregnant after one episode of unprotected intercourse to between 0% and 7%.
    Exactly how the morning after pill works is unclear. The morning after pill should not be used by women that may already be pregnant, have undiagnosed vaginal bleeding, have a history of stroke or blood clots in their arteries or veins, or who have active liver disease. A common side effect of the morning after pill is nausea and vomiting which may be treated. Other side effects may include breast tenderness, abdominal discomfort, headaches or dizziness. These side effects are temporary and generally resolve within 24 hours. Your health care provider should be able to provide you with further information about emergency contraception or refer you to a specialist.

©1999 Tampa Obstetrics, P.A. All rights reserved. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.

Q: I am contemplating undergoing tubal ligation after the birth of my fourth child (within the next few weeks). How do I choose the procedure - general anesthetic or spinal? What is the possibility of having an allergic reaction to the 'fluid?'	A: There are several different methods that may be used for tubal ligation that should permanently prevent pregnancy. Tubal ligations performed immediately or soon after delivery are usually done through a small incision below the umbilicus (belly button). You should know that although a tubal ligation is considered a form of permanent sterilization, there is a small chance (about 1 in 250) that the tubal ligation can fail, and you may become pregnant. In order to minimize discomfort, different types of anesthetic are used. General anesthesia is where medications are used to induce a state of temporary unconsciousness and paralysis. Regional anesthesia, such as spinal or epidural anesthesia, essentially blocks the nervous system at a certain level (usually right around the umbilicus). During regional anesthesia, you may remain awake and aware of what is going on. You will feel no pain, but you may experience some pressure. It usually takes far less time to recover from regional anesthesia than general anesthesia. Depending on the actual procedure used, regional anesthesia is usually safer than general anesthesia. Every time a medication is administered in any form, there is a small chance of an allergic reaction. Allergic reactions occur during both regional and general anesthesia. The best option in this case is to discuss the type of anesthesia with your obstetrician and the anesthesiologist who covers labor and delivery. In many cases, women who have epidurals (regional anesthesia) to help manage pain during their labor, can use the same epidural for their post-partum tubal ligation.
Q: I've been reading about IUDs and considering them as a birth control option. I am married, monogamous and have not had any children. Is the IUD an appropriate option for me?	A: Intrauterine devices (IUDs) are generally recommended for contraceptive use in women that are engaged in a mutually monogamous relationship, who have had at least one child, and who have no past or current history of pelvic inflammatory disease. The primary reason for these recommendations is that women using IUDs have a greater chance of developing pelvic infections than women who do not use IUDs. Theoretically, pelvic infections may predispose a woman to developing infertility. There are two different types of IUDs currently available in the United States. The most common is the ParaGard IUD. It is composed of copper wire wrapped around a plastic 'T' and is approved for 10 years of use. The other type releases the hormone progesterone and is called the Progestasert IUD. It is approved for 1 year of use. In most cases, IUDs are a safe and effective means of contraception. Typically, 0.8% of women using ParaGard will become pregnant within the first year of use. This compares favorably to 85% of women who do not use contraception and become pregnant and 0.4% of women who become pregnant following a permanent tubal sterilization. There are some reasons that IUDs should not be used. These include: 1) A known or suspected pregnancy; 2) A uterine abnormality or abnormal PAP test; 3) An allergy to copper or a disease which is affected by copper such as Wilson's Disease; 4) Any past or current history of pelvic infection; and 5) Patients with decreased immunity such as patients receiving chemotherapy, radiation therapy, transplant patients, or patients with HIV or AIDS. A woman that becomes pregnant while using an IUD is more likely to develop an ectopic (tubal) pregnancy. She is also more likely to have a miscarriage or a pre-term delivery than a woman that does not have an IUD in place. Women using IUDs have a slightly greater blood loss at menstruation and may have an increase in cramping. There is also the possibility that the IUD may fall out, become embedded in the uterus, or perforate through the uterus. There are few absolutes in medicine and patients require individualized care. Contraceptive choices should be made by well-informed patients in conjunction with their health care provider.
Q: What is the morning after pill? How does it work? How effective is it? Are there any contraindications?	A: The morning after pill is one of several commercially available oral contraceptives. The only differences between the morning after pill and commonly used oral contraceptives are the dosage and timing of the medication used. The dose used for a morning after pill is approximately four times greater than the dose of an oral contraceptive. Morning after pills only need to be taken twice over 24 hours as compared to the daily use of oral contraceptives. The morning after pill is a method of emergency contraception which is used by a sexually active woman that is either already using some method of contraception that has failed (broken condom, missed pills), or is not using contraception, or has been sexually assaulted. The morning after pill must be used as soon as possible but no later than 72 hours after an episode of unprotected intercourse. If it is used correctly, it will reduce the chance of pregnancy by approximately 75%. It is important to understand that the chance of becoming pregnant after one episode of unprotected intercourse varies between 0% and 26% The morning after pill will decrease the chance of becoming pregnant after one episode of unprotected intercourse to between 0% and 7%. Exactly how the morning after pill works is unclear. The morning after pill should not be used by women that may already be pregnant, have undiagnosed vaginal bleeding, have a history of stroke or blood clots in their arteries or veins, or who have active liver disease. A common side effect of the morning after pill is nausea and vomiting which may be treated. Other side effects may include breast tenderness, abdominal discomfort, headaches or dizziness. These side effects are temporary and generally resolve within 24 hours. Your health care provider should be able to provide you with further information about emergency contraception or refer you to a specialist.