Does the Pill Im­pact Your Fer­til­ity + Can You Vac­ci­nate Against HIV?

Dr Lindi Mur­ray and Dr Ilana John­son are our COSMO gy­nae gu­rus. To­gether, these clued-up ladies own Lila, an ob/gyn prac­tice in Cape Town – and they’re here to an­swer your ques­tions

Cosmopolitan (South Africa) - - HEALTH -

Can I do any­thing to in­crease my chances of hav­ing a boy or a girl?

The truth is that meth­ods aimed at in­creas­ing the suc­cess of con­ceiv­ing ei­ther a boy or a girl are not much bet­ter than na­ture’s own odds of 50:50. Strate­gies in­volv­ing diet, sex­ual po­si­tions and tim­ing of in­ter­course in re­la­tion to ovu­la­tion have found no re­li­able im­prove­ment in suc­cess. The only way to en­sure you have a boy or girl is pre-im­plan­ta­tion di­ag­no­sis through the process of in vitro fer­til­i­sa­tion (IVF), where the sex of the em­bryo can be de­ter­mined be­fore it is in­tro­duced back into the uterus. How­ever, IVF should never be used for this rea­son, and sex se­lec­tion is banned in many parts of the world – ex­cept in cases where a cou­ple is known to carry a se­vere chro­mo­so­mal ab­nor­mal­ity af­fect­ing ei­ther boys or girls specif­i­cally, and sex se­lec­tion could pre­vent the birth of an af­fected child. Our ad­vice? Let na­ture de­cide.

Does be­ing on the Pill or us­ing a hor­monal IUD im­pact my fer­til­ity in the long term?

Long-term use of oral con­tra­cep­tive pills does not lead to im­paired fer­til­ity over time. Some stud­ies have seen a three-to-five-month lag in restora­tion of ovu­la­tion af­ter stop­ping the Pill, but this lag is mainly a con­cern in women on high-dose con­tra­cep­tives – which is un­com­mon. Stud­ies that have looked at preg­nancy rates in women who have stopped the Pill in or­der to be­come preg­nant have found that the av­er­age time it takes to con­ceive is four months. If you were on the Pill to sort out trou­ble­some pe­ri­ods, there may be an un­der­ly­ing prob­lem pre­vent­ing you from fall­ing preg­nant that has noth­ing to do with the Pill. There are also some fer­til­ity ben­e­fits to us­ing the Pill: the risk of pelvic in­fec­tion is slightly re­duced, as is the risk of ovar­ian can­cer and ec­topic preg­nancy. What’s more, some women ac­tu­ally ex­pe­ri­ence a fer­til­ity surge af­ter stop­ping the Pill.

The Mirena also doesn’t have an im­pact on longterm fer­til­ity. How­ever, if the Mirena was in­serted for a med­i­cal rea­son (and not for pure con­tra­cep­tion), un­der­ly­ing gy­nae is­sues may af­fect fer­til­ity, and help should be sought if you’re not preg­nant within six to 12 months of reg­u­lar try­ing.

Is there a vac­ci­na­tion for HIV?

At the mo­ment, no: we don’t have a vac­cine proven to be fully ef­fec­tive in pre­vent­ing HIV in­fec­tion, and re­search for the last 20 years has been dis­ap­point­ing. How­ever, a re­cent study con­ducted in Thai­land showed promis­ing re­sults, with a 31% re­duc­tion in HIV rates – mean­ing we might not be too far away from de­vel­op­ing a global vac­cine to as­sist in the fight against HIV.

A Na­tional Health In­sur­ance trial be­gan last Novem­ber, aim­ing to test 3 200 women in south­ern Africa. Ex­cit­ingly, south­ern Africa will also be part of a se­cond and much-an­tic­i­pated vac­cine trial start­ing this year and in­volv­ing 2 600 women con­sid­ered to be at risk of con­tract­ing HIV. The vac­cine be­ing tested is a new two-vac­cine com­bi­na­tion. Ex­perts pre­dict that if re­sults are promis­ing, a com­mer­cially avail­able vac­cine may be a re­al­ity within three years. Un­til then, pro­tect your­self against HIV by al­ways (re­peat, al­ways) us­ing a con­dom. If you find out you’re HIV-pos­i­tive, en­quire about an­tiretro­vi­ral med­i­ca­tion – and take it re­spon­si­bly.

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