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The risks of an unintended pregnancy are always greater than the risks of any contraceptive. A good possibility exists of normal fertility after a solid-organ transplant. Immunosuppressive agents are associated with substantial teratogenic risk. Pregnancy is associated with a higher than normal risk of fetal and maternal complications, so close monitoring is required. A potentially negative impact of pregnancy on graft function soon after transplant must be considered; waiting 1 year after transplant to become pregnant provides the best chance of a good pregnancy outcome. Two forms of effective contraception should be used until it is safe to conceive Based on information in reference 1.
Medication Pregnancy exposure registry information Pregnancy category Lactation considerations Prednisone Crosses the placenta
Can cause clefts and decreased birth weight when used in the first trimester
When needed: can consider using the lowest effective dose for the shortest possible time in the second and third trimestersC or D, depending on the trimester and dose Excreted in breast milk
Potential for adverse events; risk-benefit assessment neededMycophenolate mofetil Increased risk of first-trimester pregnancy loss and congenital malformations D Little information available, but breast-feeding not recommended Azathioprine Crosses the placenta
Congenital anomalies, immunosuppression, and intrauterine growth retardation have been reported
Pregnancy should be avoided during treatmentD Breast-feeding not recommended, given adverse effects and excretion in breast milk Cyclosporine Crosses the placenta
Can lead to premature birth and low birth weight
Should be avoided during the first trimesterC Excreted in milk; risk-benefit assessment needed Tacrolimus Crosses the placenta
Can cause low birth weight, neonatal hyperkalemia, and neonatal renal dysfunctionC Breast-feeding not recommended, given adverse effects and excretion in breast milk Everolimus Crosses the placenta
May cause fetal harm
Pregnancy should be avoided
Birth control should be continued for 8 weeks following drug cessationC Not known whether it is excreted in breast milk; breast-feeding not recommended Sirolimus Adverse events have been observed in animal studies. C Not known whether it is excreted in breast milk; risk-benefit assessment needed Belatacept Adverse events have been observed C Not known whether it is excreted in breast milk; breast-feeding not recommended Based on information from reference 18.
Type of contraception How it works Failure ratea Advantages Disadvantages Female sterilization Either the tubes are tied and then cut, or a coil is inserted into the tubes < 1% Permanent; no further medicines or procedures required to prevent pregnancy Reversal is seldom successful and is expensive; imaging is required to confirm occlusion of tubes; coils take 3–4 months to be fully effective Male sterilization (vasectomy) Interruption or occlusion of the male tubes < 1% Safer, less costly, and shorter recovery time than tubal ligation Reversal is not always successful; does not work immediately: 3–4 months required with frequent sperm testing Implant Contains a progestin hormone; implanted in the upper arm, slowly releases hormone into the body and lasts 3 years < 1% Provides highly effective, prolonged contraception without estrogen; fertility returns rapidly after removal of the rod Unscheduled bleeding is common; implants can be difficult to remove, and infection or scarring can occur at the insertion/removal site Intrauterine device (IUD) 2 types: hormonal (progestin, lasting 3–5 years) and nonhormonal (copper, lasting at least 10 years) < 1% Highly effective, long-acting; fertility returns within 1 month (copper IUD) or 1 year (progestin IUD) Possible uterine perforation (rare, ≤ 1 in 1,000), expulsion of the IUD, increased risk of pelvic infection in the first 20 days after insertion ↵a Within first year
Based on information in references 21 and 23.
Type of contraception How it works Failure ratea Advantages Disadvantages Injectable contraceptives A long-lasting progestin is injected into the muscle or under the skin every 12 weeks < 1%–6% Provides effective, prolonged contraception with no exposure to estrogen; return to fertility in 6–12 months May cause weight gain and mood changes; can also cause amenorrhea Patch Estrogen and progestin are absorbed through the skin; applied once a week for 3 weeks; no patch during week 4 < 1%–9% Easy to use; return to fertility in a few cycles; can be used continuously for ovulation suppression and menstrual regulation Can cause localized skin rash; may detach Vaginal ring Estrogen and progestin are absorbed through the vagina; placed in vagina for 3 weeks of every month < 1%–9% Easy to use; fertility returns in a few months Local symptoms, such as increased vaginal discharge Combined oral contraceptives Contain both estrogen and progestin taken once a day for 3 weeks of every month or 3 months (extended cycle) < 1%–9% Reduces menstrual cramps and menorrhagia; easy to use; return to fertility in a few months Intermittent bleeding and spotting are the most common adverse effects; increased risk of thrombosis; should be taken at the same time every day Extended-cycle combined oral contraceptives Can be taken continuously for 3 weeks < 1%–9% Reduces menstrual cramps and menorrhagia Intermittent bleeding and spotting are the most common adverse effects Progestin-only pills Contain progestin only, taken daily < 1%–9% Can be used by women who cannot use estrogen Vaginal bleeding and spotting are common; fertility may take a few months to return after contraception discontinued; should be taken consistently every day at the same time every day ↵a Within first year; lower number is with ideal consistent use, whereas higher number is with typical use.
Based on information in references 21 and 23.
Type of contraception How it works Failure ratea Advantages Disadvantages Male condom Physical barrier to sperm 2%–18% Best protection against sexually transmitted disease Can break; must be used consistently to be effective Female condom Physical barrier to sperm 5%–21% Can be placed before intercourse; protects against sexually transmitted disease More expensive than male condoms; must be used consistently to be effective Diaphragm Physical barrier to sperm 6%–12% Can be inserted 6-8 hours before a sexual encounter and can be reused; slight reduction in risk of some sexually transmitted diseases (not human immunodeficiency virus) May increase the risk of urinary tract infections; effective only when used with a spermicide; must be used consistently to be effective ↵a Within first year; lower number is with ideal consistent use, whereas higher number is with typical use.
Based on information in references 21 and 23
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- Article
- ABSTRACT
- TRANSPLANTS IN WOMEN ARE INCREASING
- FERTILITY IN WOMEN WITH END-STAGE RENAL DISEASE
- TERATOGENICITY OF IMMUNOSUPPRESSANTS
- CRITERIA FOR A SUCCESSFUL PREGNANCY
- CONTRACEPTIVE COUNSELING AFTER TRANSPLANT
- VERY EFFECTIVE CONTRACEPTIVES (UNINTENDED PREGNANCY RATE 0%–0.9%)
- EFFECTIVE CONTRACEPTIVE METHODS (UNINTENDED PREGNANCY RATE 1%-9%)
- MODERATELY EFFECTIVE METHODS (PREGNANCY RATE 10%-25%)
- LESS-EFFECTIVE METHODS
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