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I have heard that using OCPS (aka BCPS) can cause over suppression and cause my ovaries not to respond. Why do you use OCPS for some women?

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Some of our patients are given OCPs to regulate their cycles. Over suppression is not a concern, because once FSH starts to stimulate antral follicles, the follicles will grow. OCPs may just slow down the response time. Also, OCPs serve to suppress the ovaries prior to the start of a cycle, making it more likely for follicles to develop together rather than producing a dominant follicle that is ready for ovulation before the other follicles have a chance to mature. In order for an egg to develop in the ovary and then be released, several hormonal events must take place. An area of the brain called the hypothalamus is responsible for regulating the hormonal signals that start the process. The estrogen in the pill shuts off these signals from the brain that tell the ovary to develop and release an egg. Without these signals, the egg does not develop and is not available to be released (ovulated) and pregnancy cannot occur. In addition, the pill has a few other effects on your body that decrease the likelihood of pregnancy. One of the hormones in the pill, progestin, makes the mucous thicker in the cervix and tubes so that it is more difficult for sperm to pass into the uterus and more difficult for the egg to move down the tube. Also, the progestin in the pill causes changes in the uterine lining that hinder implantation of the fertilized egg. When used in fertility care, the pill’s ovarian suppression characteristics serve to “quiet” the ovaries. This is meant to allow a stimulated cycle to begin with all of the follicles at the same stage of development. Hopefully, this prevents a “lead follicle” from developing and increases the chances of having more follicles mature at the same time. BCPs do not negatively affect fertility. There is no evidence to indicate that BCPs have anything but a short-term effect on the body. If someone has been on the pill for an extended period of time, there is no reason to wait after stopping the pill in order to begin fertility treatment. In fact, it is advantageous to begin a stimulated cycle immediately after stopping the pill. Many people express concern about “over-suppression” with the pill. In some women, the pill has a more suppressive effect than in others, but the only result of this is that it may take some more time for the hormone levels to reach the point where stimulation becomes effective.

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