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Took Next choice ipill after sex. Are there any issues using Next Choice One Dose so close to possible ovulation?

Mar 2013
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Practicing since : 1998
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Hello Doctor -
Question about Next Choice One Dose and ovulation.
My girlfriend and I had sex yesterday (06/22) and the condom slipped off. The condom did not break and the opening of it remained at the opening to her vagina. We were able to pull it out immediately and it appeared intact and did contain what seemed to be a large amount of semen. We were still very concerned some semen may have entered or even leaked out the side of the condom. We purchased the Next Choice One Step and she took it about 3.5 to 4 hours after the event.
Our concerns are about the efficacy of the Next Choice ECP when taken very close to possible ovulation. Earlier this month we had a pregnancy scare when she was 5 days late for her period. At that time, she was supposed to get her period on 06/01. She was under a good deal of stress and ended up receiving it on 06/05. It lasted until 06/08. We have since begun using condoms for contraception; she is not taking any medications and is nearly 30 years old. According to a period app she uses on her phone, she is predicted to be ovulating today.
Our concerns:
1. Are there any issues using Next Choice One Dose, which has levonorgestrel, so close to possible ovulation? Does it lose efficacy when so close to ovulation?
2. Since her period was 5 days late the last time, is it reasonable to assume ovulation was delayed for this cycle? Will her period most likely be late again this month given it was late last month?
3. Since it appeared as though most of the semen was left in the condom and she used Next Choice soon after the event, is it reasonable to assume there is a very low chance of pregnancy?
Posted Wed, 10 Jul 2013 in Women's Health
Answered by Dr. Aarti Abraham 1 hour later

Thanks for your query.

1. According to WHO ( World Health Organization ), the levonorgestrel containing emergency contraceptive pill has efficacy ranging from 52 % - 94 %. Generally, if taken within 72 hours of unprotected intercourse, the success rate is more than 90 %. There are very few studies in women who take it close to ovulation. It is obviously not effective AFTER ovulation, when fertilization has most probably occurred. However, just before ovulation, the success rate is still fairly good, around 70 %.

Here is a link which you can go through for more scientific evidence :

2. If the delayed period last time was an isolated event, and not the norm, it is safe to assume that her periods would be regular otherwise. Also, scientifically speaking, even in irregular cycles, the time period between start of menses and ovulation is unpredictable, but that between ovulation and the next period is more fixed. Hence, if she has her period two weeks from now, it is all the more confirmatory that she was near ovulation. As her period was 5 days late last time, it is not necessary that ovulation too would be that much delayed, since, as I said, the gap between start of period and ovulation is variable.

3. As most of the semen was contained within the condom, and further Emergency contraception was taken very soon, yes, it is reasonable to assume that the chances of pregnancy are quite low, even though she is near ovulation.

Regardless of that, please take a pregnancy test if she is overdue by more than 5 days next time.
Just a word of caution - emergency contraceptive pills are known to cause irregular bleeding / spotting anytime after consuming them. They also can prepone or postpone your normal period by a week or more. So it is further unpredictable as to when she would menstruate next.

Wish you all the best.

Feel free to discuss further.
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