“…1,10,12,20,21 These effects have been presumed to render the endometrium relatively inhospitable to implantation or to the maintenance of the preembryo or embryo prior to clinically recognized pregnancy by producing a predecidual or decidualized endometrial bed with diminished thickness and with widely spaced, exhausted, and atrophied glands; by altering the cellular structure of the endometrium, leading to the production of areas of edema alternating with areas of dense cellularity 18,20,21 ; and by altering the biochemical and protein composition of the endometrium. 47 Although these changes are consistently seen in women taking OCs, there is currently no direct evidence to link these changes to preembryo or embryo loss in women taking OCs. However, this hypothesized postfertilization effect seems to be so well accepted that in many medical articles and textbooks it has been explicitly listed as the third mechanism of OCs (after suppressing ovulation and prefertilization effects).…”