6 Ways You Can Still Get Pregnant After Taking Emergency Contraception
Everyone makes mistakes. Some are minor, like thinking an oatmeal raisin cookie is actually its superior cousin, chocolate chip. But others are potentially life-changing, like having unprotected sex even though getting pregnant isn’t currently on your to-do list. That’s where emergency contraception comes in. In a world where women are able to control their reproductive futures, EC is a backup plan for your best-laid plans. And instead of being one-size-fits-all, it exists in a few different forms, making it even easier to choose the one that’s right for you. But taking it properly is necessary for it to protect you to the fullest extent. Here’s what you should know before you resort to contingency plans.
First, some information about emergency contraception.
One common type of emergency contraception is OTC morning-after pills like Plan B and Next Choice, which use levonorgesterel, a synthetic version of the hormone progesterone, to delay ovulation, according to Planned Parenthood. The prescription morning-after pill is called Ella, and it uses a drug called ulipristal acetate to do the same thing.
ParaGard, the copper IUD, is well-known for being a great birth control option in general, but it can also serve as emergency contraception when inserted within five days after unprotected sex. ParaGard creates a toxic environment for sperm, and it prevents pregnancy more than 99.9 percent of the time.
Lastly, you can take multiple doses of regular birth control pills as emergency contraception, although you have to be precise about it, so one of the above options will always be your best bet.
Now that you understand your options, here, ob/gyns explain the factors that can make emergency contraception fail.
1. You don’t take it soon enough.
Morning-after pills like Plan B and Next Choice are effective if you take them within five days of unprotected sex. The major caveat here is that they work best when taken within 72 hours, then the efficacy starts dropping. Within three days after unprotected sex, these kinds of morning-after pills are between 75 and 89 percent effective at preventing pregnancy, according to Planned Parenthood. “The sooner you take it, the better it’s going to work,” Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology at Yale Medical School, tells SELF. Although levonorgesterel-based options like Plan B and Next Choice prevent pregnancy up to five days after unprotected sex, think of those first 72 hours as prime time.
Ella, the prescription morning-after pill, is also effective for up to five days, but it’s equally as effective the entire time, Katharine O'Connell White, M.D., M.P.H., director of fellowship in family planning, Boston University/Boston Medical Center, tells SELF. Ella decreases your risk of getting pregnant by 85 percent if you take it within the appropriate window.
ParaGard also needs to be inserted within that five-day window in order to be effective.
2. You throw up after taking EC.
At first, emergency contraception relied on estrogen to do its job, Minkin explains. “The estrogen in these things—they used mondo doses—used to make people nauseated,” she says. Now, forms of EC like Plan B and Ella don’t rely on estrogen, so nausea is less likely, but it can still happen, especially due to nerves. But if you take multiple birth control pills as your EC, there’s a decent chance you could ralph. “That’s great in a pinch, but it often leads to nausea and vomiting, which are a risk factor for failure,” White says.
No matter what, if you throw up within an hour or so of taking EC, you’ll need another dose. Your body might not have had enough time to metabolize it, White explains. “It’s really unlikely that this would happen after around an hour, but if you ever vomit and can see a pill, that’s a concern,” White says, and you should probably take another.
3. Your BMI is over a certain number.
Although BMI is a tricky measure for things like health, it does come into play with EC. According to Planned Parenthood, if your BMI is over 25, morning-after pills like Plan B are less likely to be effective. “It has to do with the distribution of the drug,” White explains. Ella’s threshold is higher—it doesn’t start to have a decreased effectiveness until your BMI is over 35.
“Being obese or overweight doesn’t render emergency contraception ineffective, just less effective,” Minkin says. In this instance, the copper IUD can be an especially great option for EC. “ParaGard will work very nicely as emergency contraception in someone with a higher BMI, and the other advantage is it will give you long-term contraception anyway,” Minkin says.
4. You start hormonal birth control right after taking Ella.
After a slip-up requiring emergency contraception, it might seem like you should immediately hop back on the non-baby-making train by getting yourself a scrip for birth control, stat. But you shouldn’t start or continue any form of hormonal birth control within the first five days of taking Ella, White explains. “Another hormonal birth control method can decrease Ella’s efficacy,” she says. In return, Ella can mess with hormonal birth control's mechanisms, according to its website. To be safe, after using Ella, use condoms until your next period, and don't use hormonal birth control until five days have passed.
5. You had just ovulated (or were just about to) when you had sex.
If you happen to have unprotected sex during your fertile window—four days before you ovulate, the day you ovulate, and the day after—you’re just naturally more likely to get pregnant, White explains. Morning-after pills prevents pregnancy by delaying ovulation, so if ovulation has already occurred, your EC can’t stop you from getting pregnant.
The only exception to this rule is the ParaGard IUD. “It’s the best emergency contraception we have. Because it works by inhibiting sperm, the timing in your cycle doesn’t matter as much,” White says.
6. You have more unprotected sex after you take EC.
Sometimes people think that after a dose of EC, they a sexual get-out-of-jail-free card, White explains. “Ovulation is just delayed, not stopped, so further acts of unprotected sex put you in the line of fire,” she says.
Once more, with feeling: Everyone makes mistakes. If you need emergency contraception, there’s no reason to feel down on yourself. The issue is when it becomes a habit. “If you find yourself needing morning-after contraception on several occasions, it’s not dangerous, but we can do better,” Minkin says. “If you’re sick of taking birth control pills, we can get you an IUD, the Nexplanon implant, or something else—there are lots of options, and you don’t have to rely on morning-after contraception.”