What are the chances of pregnancy using both methods of contraception?
August 28, 2013 1:56 PM   Subscribe

I am now in a committed relationship with a woman, and both of us are virgins. We have discussed at length our desires, concerns, dislikes, and fears about sex, and we are both horrified of an accidental pregnancy.

Before this relationship, I thought long and hard about having children, and although I am only 22 years old, I believe that because of my own health issues (diagnosed on the autism spectrum) and dislike of children that having a vasectomy done would be the best choice for me. I believe that I would be a terrible father and that this will not change in the future, regardless of what age I am. Better to not have children than turn out to be as bad of a father as mine was to me.

Now because of her own health issues she has also considered a tubal litigation (female equivalent of a vasectomy?) because she doesn’t want to pass her health issues onto a child. She is 26 years old with a severe case of Crohn’s Disease.

An issue we are concerned about is that I might not be able to make an appointment to have a vasectomy done for a couple more months because of employment and appointment times, and we both would like to have sex before then. However the chance of an accidental pregnancy scares us both and we’re worried about having sex until there is a 100% certainty it cannot and will not happen.

What are the chances of an accidental pregnancy if I use a condom and she uses a birth control pill? Will that be safe enough that we can be certain of no pregnancy until either I or both of us have our sterilization operations done?
posted by 8LeggedFriend to Human Relations (39 answers total) 1 user marked this as a favorite

I would recommend that both of you go to Planned Parenthood to discuss all of your options. There is no 100% anything in this world but her going on the pill and you using a condom is pretty close to it.

The pill doesn't work instantly and it may take as long as 30 days to one cycle for her to be regulated on it.

The more you know the better you can plan.
posted by Ruthless Bunny at 2:00 PM on August 28, 2013 [11 favorites]

Birth control combined with a condom makes for an extremely small chance of pregnancy.

Have fun and good luck.
posted by Lutoslawski at 2:01 PM on August 28, 2013

The only birth control that is 100 percent effective is no sex. If this is really a huge worry, experiment with sexual activities that can not lead to pregnancy.

If you combined birth control pills, condoms, timing her cycle AND pulled out, I'd say chances of pregnancy would be as slim as a vasectomy, though someone else can do the math. (vasectomies and tubals not being 100 percent safe, but pretty damn close.)
posted by Dynex at 2:01 PM on August 28, 2013

The pill doesn't work instantly and it may take as long as 30 days to one cycle for her to be regulated on it.

This. Also, my doc was extra-conservative and said to use backup methods for 3 months before going with the pill alone.
posted by telophase at 2:01 PM on August 28, 2013

This article from Heather Corinna of Scarleteen covers this issue very well:
Condoms are 98% effective in perfect use and 85% effective in typical use. We show estimated rates for using combined methods of contraception here. On that page, you’ll see the combined rate for perfect use of both methods is 99.99% effective the estimated combined rate of both methods used more typically is 98.8%. If we do that same averaging we did with the pill, for those who use condoms really well, that gives us a 91.5% effectiveness. For those who use both methods very well, then we’re looking at just over 99%, a little more than a 4 percent difference between using the pill alone, and just about the same effectiveness as the pill by itself in the kind of perfect use found in a controlled study.

Again, in more practical terms, that means that for 100 people using both the pill and condoms really well over one year, that probably less than one will become pregnant as opposed to five with the pill alone or close to nine with condoms alone.
posted by Jairus at 2:02 PM on August 28, 2013 [4 favorites]

First off, I'd say that either 22 or 26 are too young to be making permanent, and possibly irreversible decisions about your reproductive future.

Also, you are NOT your father. Being raised by bad parents will not necessarily make you one. Some of the best parents I know were raised by terrible parents. Once can learn as much from negative examples as by positive ones.

That said, no form of birth control is 100% reliable, yadda yadda yadda, but combining condom use with birth control, my understanding is that you're well into the 99th+ percentile in likelihood of pregnancy prevention, which are better odds than in many other areas of adult life.

Hold off on making permanent reproductive decisions till your early 30s at least - a lot of life will happen to you between now and then, and your feelings about the subject may in fact change, practice informed, careful, safe sex until then, and have fun!

And nthing a visit to Planned Parenthood. This is one of many reasons why they exist and are such a valuable resource.
posted by stenseng at 2:02 PM on August 28, 2013 [3 favorites]

The chance of an accidental pregnancy for perfect use of those two methods would be something like 1 in 16666 for a year of use. The chance during typical use (which means both of you occasionally screw up) would be closer to 1 in 150 for a full year.
posted by Justinian at 2:03 PM on August 28, 2013

With the condom and the pill together, the chances of pregnancy seem awfully miniscule. But I'm not a doctor.

Planned Parenthood has an excellent overview of birth control and each method's effectiveness.
posted by Leontine at 2:03 PM on August 28, 2013 [1 favorite]

If you're correctly using a condom and the pill, your chance of getting pregnant are comparable to, say, your chances of being assaulted on the street by a six-foot-three-inch Icelandic man (who is married to an Irish woman who goes by Elizabeth) with a bright blue pickaxe who is singing the Dutch national anthem.

On a Thursday.
posted by Tomorrowful at 2:03 PM on August 28, 2013 [16 favorites]

100% is not a realistic expectation, unless she's willing to use abortion as a fail-safe (and even then, she could change her mind if it actually happens).

Perfect use of condoms and pills together gets you well above 99% certainty (exact perfect-use failure rates vary but are typically below 1% for the pill alone and below 2% for condoms alone). Typical-use failure rates are quite a bit higher (10-15% for each), but you're still pretty safe if you combine methods.

The two of you will have to decide what your acceptable risk is, because any birth control method, even a tubal ligation or vasectomy, has a greater than 0% failure rate. Combining pills and condoms (with correct use of both) gets you to the same ballpark failure risk as a vasectomy, which is to say, very low but not zero.
posted by randomnity at 2:06 PM on August 28, 2013 [3 favorites]

Do yourself a favour and spend some time looking at the data rather than just listening to opinions about how impossible it is. I know more than one toddler who was born to parents using condoms and the pill.
posted by Jairus at 2:08 PM on August 28, 2013

Do yourself a favour and spend some time looking at the data rather than just listening to opinions about how impossible it is. I know more than one toddler who was born to parents using condoms and the pill.

This is ridiculous fear mongering. Either you have conversations with literally thousands of people about the details of their birth control methods, or someone is lying to you.

As the data shows, the chances of getting pregnant while using condoms and BC properly is <1%, which is as close to perfect as possible.
posted by Lutoslawski at 2:19 PM on August 28, 2013 [10 favorites]

The data has been provided. It's 0.006% per year for perfect use and roughly 0.7% per year for typical use.
posted by Justinian at 2:20 PM on August 28, 2013 [8 favorites]

Even after a vasectomy, you need to use protection for several weeks to months. It takes time for the live sperm to get fully cleared out.

I have not looked at the statistics for birth control in a while, but my recollection is that birth control pills, if properly used, are the most effective non-sterilization method (up to 99.5% depending on brand/type). Condoms are the most effective non-chemical or barrier method. You can increase the effectiveness of condoms by also using spermicide.

You can also be extremely sexually intimate without vaginal intercourse. There are lots of ways for two people to satisy each other without risking pregnancy. It isn't strictly an either/or situation.
posted by Michele in California at 2:23 PM on August 28, 2013 [4 favorites]

Get to a Planned Parenthood or other doctor to discuss your options.

In addition, a vasectomy is not immediately effective. It can take up to three months to clear the sperm that was there before your tubes were cut. That means if you can't get it done for 2 months you won't be protected for a total of up to 5 months. You will also have to send in your semen sample to make sure that it was effective.

Planned Parenthood also reports that female sterilization also is not 100% (it's not as easy to test as a vasectomy is). Keep in mind that female sterilization (surgery) is more expensive than a vasectomy as well.

Current options may also include an IUD. This is why you should make an appointment and discuss full options and information.

I am totally fine with you being young and choosing not to have children. Keep in mind some doctors may not want to preform a vasectomy unti you're about 25, while others will. This is also something to discuss with your doctor along with your full long term plans for children, especially if there may be a chance that you will be in a different relationship later in life.
posted by Crystalinne at 2:24 PM on August 28, 2013 [4 favorites]

My partner and I used those two same things (condoms + pill) for 8 years with no problems. It gave us the peace of mind we needed.

Even with the "double coverage", there's still a chance. Discuss with PP as Ruthless Bunny suggests.
posted by xiaolongbao at 2:27 PM on August 28, 2013

It sounds like an IUD would certainly be an option to consider.
posted by mmdei at 2:35 PM on August 28, 2013

"Do yourself a favour and spend some time looking at the data rather than just listening to opinions about how impossible it is. I know more than one toddler who was born to parents using condoms and the pill."

This is ridiculous fear mongering. Either you have conversations with literally thousands of people about the details of their birth control methods, or someone is lying to you.

Or they were just 'lucky'. Consider that someone who got pregnant under those circumstances is probably likely to talk about such a remarkable event, and someone who hears about it is much more likely to remember it. That doesn't mean such events are common (just the opposite), but it explains why, of the thousands of people who looked at this question, one of them might know two or three people who had unintended children while using multiple forms of contraception.

As the data shows, the chances of getting pregnant while using condoms and BC properly is <1%, which is as close to perfect as possible.

Well, no, one could get even closer using, for example, a vasectomy plus an implant. Or one could add fertility awareness and withdrawal to condoms and oral contraceptives.

Also, you misunderstand the statistics. It's not "<1%", it's that (with typical use as Justinian indicated), .7% of couples will become pregnant per year using those methods combined. Over the course of, say, 30 reproductive years, the cumulative probability is notably higher: approximately 19%. 1-in-5 isn't that great for a couple that wants to avoid a pregnancy as strongly as the Asker does.

If you're correctly using a condom and the pill, your chance of getting pregnant are comparable to [absurdly unlikely circumstance].

Uninformed hyperbole is not helpful.
posted by jedicus at 2:46 PM on August 28, 2013 [6 favorites]

I'm not going to dive into the statistics inside baseball, but in general:

Life involves risk. Your tolerance for risk depends on you as a person. Being afraid of the very small risk involved in having sex while using two forms of birth control strikes me as a tolerance for risk that is very, very low. It's your life, and I can tell from reading your question that we are probably very different people, but maybe it could be helpful to think about this as just another calculated risk that you take as part of being a human.

No judgement, either way.
posted by ablazingsaddle at 2:54 PM on August 28, 2013 [6 favorites]

Nthing that you should talk to Planned Parenthood together. And be forewarned that, right or wrong, you are likely to encounter a fair amount of resistance if you decide to pursue getting a vasectomy at age 22.
posted by usonian at 2:58 PM on August 28, 2013 [2 favorites]

Uninformed hyperbole is not helpful.

Okay, then let me rephrase it this way, less-hyperbolically:

The chances of pregnancy under these conditions are small to begin with and subject tremendously to proper use, which the OP and his girlfriend are exceptionally motivated to get right. The chances are not far off from the chances of various deadly/awful random events which most people do not actively worry about on a regular basis, such as serious car accidents. Therefore, inasmuch as human beings generally do not refrain from going outdoors and having a life due to the hypothetical fear of various unfortunate events, the OP and his girlfriend should feel as comfortable having sex with proper condom use and proper pill use combined as they would engaging in any other normal human activity without active frequent worry about randomly being killed by an out-of-control driver even though that's absolutely a real thing that happens to real people regularly.
posted by Tomorrowful at 3:06 PM on August 28, 2013 [2 favorites]

Over the course of, say, 30 reproductive years, the cumulative probability is notably higher: approximately 19%. 1-in-5 isn't that great for a couple that wants to avoid a pregnancy as strongly as the Asker does.

That's irrelevant AND fear-mongering. Even if failure rates were cumulative like that (and they aren't), the OP and his significant other do not plan to have sex for their entire reproductive lives using these methods, only a matter of months.

OP, short of abstinence, no birth control is 100%. Many people decide that using reliable contraception, as you plan to, and accepting that small chance is more than worth it. How well it will work for you is largely dependent on how responsible you are with that contraception. If you make sure to always use a condom, and use it correctly, and your girlfriend takes her birth control every day at the same time like clockwork, the chance of pregnancy during six months of sexual activity is virtually nil.

That said, you have to be careful, consistent, and trust each other to do the same for this to work. Around 49% of pregnancies in the U.S. each year are unplanned (I know, that blows my mind, too!). The majority of those pregnancies are among teenagers, many of whom do not use any birth control at all, but pregnancy scares do happen even with contraception. I cringe when I hear of people who have had not just one but several scares or multiple abortions--that has to be incredibly difficult for the relationships to get past. You and your girlfriend should discuss what you would do if she did become pregnant, even as you do your darnedest to make sure it does not happen.

I can say that as a responsible birth control pill user, though, I never had any pregnancy scares, and I used the pill for over ten years before going off of it to start a family.

One more thing. Twenty-two is very young to consider making any permanent change in your life. Ten years ago, you probably never thought you'd ever want to have sex. Five years ago, you rationally decided to stay a virgin until you met someone you could commit to. Now, you have a girlfriend and are eagerly considering a sexual relationship. People change. Don't be too quick to rob yourself of options. You may find yourself reevaluating your choices down the line.

Now good luck, be safe, and have fun!
posted by misha at 3:16 PM on August 28, 2013 [3 favorites]

Even if failure rates were cumulative like that (and they aren't)

Er... they are. If you have a 0.7% failure rate per year than the rate of failure over 30 years is indeed almost 20%. The rest of your comment is spot on though.
posted by Justinian at 3:21 PM on August 28, 2013

If your partner is on the pill (and has allowed it to take effect, and so forth) AND you're using the condom effectively, the odds of making feet for baby shoes is very narrow indeed. Everybody knows.

Here's my addition: if you're using a condom and something goes wrong with that condom -- which is not that unlikely to happen -- it doesn't seem very subtle when you pull out, but one may not realize the error until after the fact. [Yeah, yeah, if one doesn't notice during the act OR after the fact one may never know at all, I know.] I'm thinking that, following discovery of the error, your partner could take a Plan B One Step morning-after pill or a pharmaceutical of that nature and maintain extremely slender odds.

The important detail that I cannot address: is it safe for a woman who is on the pill to take the morning-after pill?
posted by mr. digits at 3:30 PM on August 28, 2013

Mod note: Folks maybe keep answers on the narrow topic of this question? Thank you.
posted by jessamyn (staff) at 3:39 PM on August 28, 2013

Lots of other temporary options besides the pill/condoms. IUD (either hormonal or copper), Implanon, patch, ring. Anybody know what happened with RISUG (it's a form of reversible male sterilization)? That could also be worth looking in to.
posted by nat at 3:52 PM on August 28, 2013

Even if failure rates were cumulative like that (and they aren't), the OP and his significant other do not plan to have sex for their entire reproductive lives using these methods, only a matter of months.

As mentioned, they are cumulative in that way, mathematically (it's a binomial distribution, not just multiplying by 30). I know they don't plan to use these methods for their entire reproductive lives. I included the cumulative probability for two reasons. First, to underscore that, if the Asker and his SO do not want a child under any circumstances, then yes, they probably want to use a more secure form of contraception (i.e. their intuition is correct). Second, contrary to the suggestions made by some commenters, to demonstrate that condom + pill is neither as good as it gets nor close to perfect.
posted by jedicus at 4:17 PM on August 28, 2013

Mod note: From this point forward, please stop this derail.
posted by jessamyn (staff) at 4:27 PM on August 28, 2013

I really think, given your rather extensive set of concerns and the extremity of the solutions you're talking about, you must go talk to Planned Parenthood, or some other reproductive counseling/education type provider if you're not in the US. Having said that, your chances are quite good for "a few months" with both a condom and the pill used properly/almost-perfectly.

But do please go in and endure the tacky lessons in how to properly use a condom, and (both of you) practice with the darned things. You're virgins (i.e., inexperienced) and you really really really don't want to mess this up, per your testimony above. I think I was in college about six minutes before receiving the first horror story about people who found out they didn't actually know what they were doing with a condom on the same day they found out the girl was pregnant. My sister had two roommates in a row in that situation, actually (in this enlightened era, it seems they let you stay in the dorms only until you have the baby, and then they make you move out because infants aren't allowed.)

Also, as an FYI, her medications for Crohn's could theoretically mess with the birth control; lots of medications do and it looks like lots of people with Crohn's are given steroids (my BC plus the steroids for my asthma... did not play well together; my understanding is that the BC itself was still fully effective, but oh my gosh it was a dreadful experience.)
posted by SMPA at 5:11 PM on August 28, 2013 [2 favorites]

Anecdata: my husband and I just used condoms for maybe eight years without incident.

I'd encourage your gf to consider an IUD. It's less permanent than tubal ligation but you don't have to take a pill everyday. It might be hard to find a doc willing to do a tubal ligation on a young woman but you may have an easier time getting an IUD.

Also, FWIW, there is a non-zero chance that your gf could still get pregnant after a vasectomy. Unlikely but possible.
posted by kat518 at 5:39 PM on August 28, 2013

As mentioned, Plan B emergency contraceptive is a good thing to know about and keep in mind should you have concerns about stuff like condom breakage. Nthing that you both go together to talk to someone at a Planned Parenthood. Having all the proper and correct info always helps me feel more confident in my choices. You two sound pretty mature, responsible, self-aware, and in possession of good communication skills - have fun!
posted by eviemath at 6:14 PM on August 28, 2013

I noticed several commenters pointed out that vasectomy is not a 100% effective birth control method. I just wanted to add that the same is true for tubal ligation. Although it is quite rare, I did see a patient with a pregnancy after tubal ligation just a few weeks ago. I hope that you both find a solution that is comfortable for you!

And by the by, while you are at Planned Parenthood, you might want to ask for a script for Plan B to keep on hand in case of emergencies while you are using whatever other non-surgical methods you choose.
posted by treehorn+bunny at 6:25 PM on August 28, 2013 [1 favorite]

From my own experience — and at the time I looked into this I was 10 years older than your girlfriend is now — your girlfriend may have a difficult time finding a doctor willing to perform a tubal ligation on her. There's a high level of paternalism among medical professionals when it comes to young people making possibly-irreversible decisions to end their fertility (although the same medical professionals don't seem to get weirded out when similarly-aged young people make the irreversible decision to become parents).

I'd nth the suggestion that your girlfriend consider an IUD (the most effective form of female birth control other than surgical sterilization or total abstinence). I've had one for five or six years now and love it. When this one reaches its expiration date, I plan to have it pulled and immediately replaced with another, I'm so satisfied with it.

It will probably be easier to find a doctor willing to place an IUD than one willing to do a tubal ligation on a 26-year-old. The American College of Obstetricians and Gynecologists issued guidelines in 2012 saying that IUDs are safe for teens and "should be offered as first-line contraceptive options for sexually active adolescents". Of course, it takes a while for practice recommendations like this to filter out, and (as I mentioned) there's still a lot of paternalism lingering around young people making permanent or even semi-permanent decisions to close off reproductive possibilities, but at least there are the guidelines to point to while discussing it with the doctor or NP.

Also, you didn't mention whether your girlfriend has ever had problems with depression or other mood disorders, but if she has, my advice is to be very VERY cautious of birth control pills. In my case, they pushed my usual major depression over the line into an extensive period of suicidal thoughts. This is an under-researched area, but here's one good article about it.
posted by Lexica at 6:27 PM on August 28, 2013 [2 favorites]

Under the circumstances, I think I second Michele in saying that if you're this freaked out about pregnancy, you can just avoid PIV sex and stick to all sexual activities that don't get sperm near her vagina.

You both will have a horrible time trying to talk anyone into getting permanently snipped at your ages, unfortunately. I would not count on either of you being able to get that done while you're still in your 20's unless you get lucky.
posted by jenfullmoon at 8:20 PM on August 28, 2013

It is probably worthwhile for one of you to shop around for a doctor willing to do a permanent solution. At 22 it is super unlikely that you will find a doctor willing to do a vasectomy though, so that's something that will take at least months to years to do and you may as well get started now.

Not all women do well on hormonal birth control, either due to sensitivity to the hormones and side effects, or because they forget to take the pills with clockwork regularity or have medication like antibiotics that interfere. You could consider trying a diaphragm - fitted properly, and used with spermicide and condoms (check that the spermicide and lube you use are okay to use with condoms), that's a good option. IUDs could be a really great choice, combined with condoms but not all women can have an IUD.

One of our family's doctors gave a three month injection (depo I think) as a trial before putting in the 3-year hormonal implanon implants to make sure that the side effects were well-tolerated because of some health issues that might have reacted badly. I thought that was a sensible approach.

Definitely ask about the morning-after pill with whatever approach you settle on because there will be slip-ups.
posted by viggorlijah at 8:40 PM on August 28, 2013

Depending on where you live, neither of you may legally be allowed these procedures because you are young and childless. A friend of mine was not allowed tubal ligation until after her second child.

Your partner obviously has more options and needs them as many may not be viable due to her reactions. You two may also want to test your fertility, as I've heard of many fastidious people who it turned out had such a low chance of conception it was a waste on many fronts.
Yes, there is a chance of birth control failure, but eliminating clear pathways for sperm to meet egg can deal with that.

Since you are both virgins, there is a lot to figure out, whether it's allergies, reactions or what you both enjoy, so figuring out things that don't lead to pregnancy would be advisable. It's not something that can be preplanned, you have to learn from experience and communication.
posted by provoliminal at 11:28 PM on August 28, 2013

If there is no chance of any sperm getting near your girlfriend's ova then you are 100 percent sure of there being no pregnancy. If you use the condoms correctly by keeping all your ejaculate away from her and keep your unsheathed penis away from her vagina at all times then you should be fine.
posted by h00py at 5:09 AM on August 29, 2013

The reason I made the point about the cumulative efficacy rate, OP, is that studies show that users become more, rather than less, adept at using condoms and so the failure rates actually go down in typical use over time.

Which is important for you to know, because when contraception fails, it can almost always be attributed to user error. I'll give you a recent example: condoms are the contraception of choice today for most sexually-active teenagers (no prescription, parental notification or doctor's appointment required). A while back, some anti-choice types mounted a crusade against Planned Parenthood accusing them of giving out faulty condoms. The failure rate for those condoms was high, but it wasn't because the condoms failed--they weren't full of holes or anything--it was that the kids who were using them were not using them correctly.

And you are inexperienced, and so is your partner, so understanding how to properly use your chosen method of birth control is really important.

I also feel pretty hesitant in advocating an IUD for your girlfriend, though. If you look at some AskMe threads about them, you'll see that for many women the insertion process is both invasive and particularly painful. Now, maybe your girlfriend is nothing like me, but when I was a young woman pre-sex I remember worrying my "first time" would be really painful. Having an IUD inserted painfully beforehand would only have contributed to that apprehension.

Obviously, OP, there are a lot of factors to consider here, some of them really personal. That's why most of us answering your question are also suggesting you two do some research on your own, like finding out if your doctors are okay with the tubal ligation and vasectomy now and visiting Planned Parenthood, so you can determine if the risk is acceptable to you.
posted by misha at 2:17 PM on August 29, 2013 [1 favorite]

IUD, yes. Basically the same effectiveness as sterilization, and virtually impossible to mess up once it's inserted.

Got my first one prior to ever having had intercourse. Invasive, yes, painful, yes, but I thought, "I'm sure childbirth is worse than this" and have survived to have plenty of worry-free sex.

In the meantime, as many people have said, orgasms don't require intercourse. Go forth and have fun together.
posted by orangejenny at 7:45 PM on August 29, 2013

« Older Good basic digital CCTV camera?   |   Why do all VPN's give me the BSOD? Newer »
This thread is closed to new comments.