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How Birth Control Could Affect Your Fertility

Here’s the problem: There’s an awful lot of misinformation out there. Scan the Internet or even ask a random sampling of medical professionals, and you’re bound to get contradictory responses about how contraceptives such as the Pill, the IUD (intrauterine device), and Depo-Provera affect your fertility. To set the record straight, we asked experts for the latest, most up-to-date information. The good news: “With a few notable exceptions, immediately after you stop using birth control, your fertility will go right back to what it was destined to be,” says Paul Blumenthal, M.D., professor of obstetrics and gynecology at Johns Hopkins University Medical School in Baltimore and an adviser to the Planned Parenthood Federation of America.

Notice that Dr. Blumenthal did not say that your fertility will go back to whatever it was before you started using the method, and he doesn’t say that it will go back to being perfect. While in most cases you will go back to being as fertile as you would have been had you not been using birth control, that level of fertility still depends on many things that have nothing to do with your contraceptives. For example, you are no longer the same age that you were when you began using birth control. If you were 25 when you began taking the Pill or using a diaphragm, and you are 35 now, your chances of getting pregnant in the first year of trying will have gone down. There are also numerous health and lifestyle issues that affect fertility. Here’s a rundown of different contraceptives, and what you need to know about their effects on fertility.

Barrier Methods

If you relied on condoms or a diaphragm for birth control, your return to fertility is as simple as leaving them in your night-table drawer. “Barrier methods only work while they are on the body or in the body,” Dr. Blumenthal points out. As a bonus, condoms can actually help your fertility by protecting you against sexually transmitted diseases (STDs) such as chlamydia and gonorrhea, which can lead to infertility. (If you relied on natural family planning, in which you pay close attention to your cycle and only have intercourse on “safe” days of the month, you’ll have the added benefit of already being aware of your ovulation cycle once you want to get pregnant.)

Even with these basic methods of birth control, however, doctors still advise you to check in with your ob-gyn before you begin baby-making in earnest. “Around six months before they want to get pregnant, women should check in with their doctor to get necessary blood tests, update their immunizations, start taking vitamin supplements, and discuss changes like quitting smoking and losing weight, if necessary,” says Hilda Hutcherson, M.D., an assistant professor of ob-gyn at Columbia University Medical Center/New York-Presbyterian Hospital in Manhattan.

The Pill

Talk to five different women about oral contraceptives, and you’ll get five different opinions about what sort of effect they have on fertility. Some women swear their years on the Pill made their cycles regular and ultimately helped them conceive. Others are convinced that all those synthetic hormones must have wreaked havoc with their ovaries. Jane Kikuchi’s story is one doctors hear all the time: “I was worried it would take a while to get pregnant after being on the Pill for 12 years,” says the 37-year-old clothing designer in New York. “But literally days after having my period for the first time without the Pill, I got pregnant. I was shocked—it took me a few months to mentally adjust to the idea of being pregnant.”

Still other women worry so much about how lingering effects of the Pill might harm their fetus that they use a condom for months before attempting to get pregnant. “Patients have the misconception that when they go off the Pill that it somehow has to wash out of their system before they get pregnant,” says Anne R. Davis, M.D., assistant professor of ob-gyn at Columbia University Medical Center/New York-Presbyterian Hospital. “But there have been lots of babies who were conceived when their mothers were on the Pill, and numerous studies have shown there is absolutely no increased risk of birth defects for those babies.”

As for the notion that it takes several months for ovulation to “kick in” after stopping the Pill—it’s simply not true. According to Dr. Blumenthal, ovulation should begin within weeks. And the most recent studies show that within a year after going off the Pill, 80 percent of women who want to get pregnant will get pregnant—a number identical to that of the general population. “There may be some women in whom the hormonal signals between the pituitary and the ovary, which is what makes you ovulate, will be more profoundly depressed than in others,” says Dr. Blumenthal, “but on average the return to fertility is rapid, and by one year they are at the same level as everyone else.” Most cases of post-Pill amenorrhea (when you don’t get your period for months after stopping the Pill) can be attributed to underlying factors such as age, weight, or other physiological issues.

The good news about the Pill and pregnancy is that oral contraceptives can actually give you a boost in preserving your fertility by lowering your chances of getting uterine and ovarian cancer. It can also suppress the symptoms of endometriosis, in which the uterine lining grows outside the uterus, causing fertility problems. But can the Pill actually help you get pregnant? Not exactly. Even though some women who had erratic cycles swear that a few years on the Pill helped regulate them, doctors caution that the cycle regulation is artificial, and once women are off the Pill their fertility returns to whatever level it would have been. Some women’s cycles regulate themselves over time anyway, regardless of whether or not they take the Pill.

Once you do decide to go off the Pill, finish up your monthly batch, and then prepare yourself to be pregnant. Many doctors advise using a barrier method until you have had one or two periods, but that is only to help you keep track of your cycle so you can predict your due date. Even if you go off the Pill and get pregnant before you’ve had a period, a sonogram can help pinpoint how far along you are in your pregnancy.

Other Hormonal Contraceptives

Depo-Provera, a contraceptive injected into a woman’s arm or buttocks once every three months to prevent ovulation, is not intended for women who want to be pregnant any time soon. And doctors should always inquire about a woman’s timetable for family planning before prescribing the drug. That’s because Depo-Provera, while a highly effective method of birth control, is also the one hormonal contraceptive that can have lingering effects on fertility. “Even though Depo-Provera stops working reliably as birth control after three months, it persists in your body for many months longer because it’s deposited in the muscle. Once it’s in there, it takes time for it to work its way out,” Dr. Davis explains. Research has shown that the median time for return to fertility is 10 months after the last shot, though pregnancy can occur as soon as three months after. A year and a half after the last shot, the rate of pregnancy for former Depo users is the same as the general population’s.

In addition to the Pill and Depo, there are a few other hormonal methods of contraception. So far, because they’re still so new, there isn’t a lot of long-term data on the Patch, which delivers a low dose of hormones through the skin, or the Ring, which releases hormones through a small, flexible ring inserted into the vagina for three weeks at a time. But evidence suggests that fertility returns as soon as they are removed from the body. There may still be some women relying on their Norplant contraceptive implants. But since the implants were meant to be effective for only 5 years, and they have not been readily available since 2000 (there was a recall of some batches in 2000, and then the device was removed from the market in 2002), “anyone who has them is probably running on fumes by now,” says Dr. Blumenthal. Once the implants are removed, there is no residual effect on fertility.

The IUD

Intrauterine devices have been making a big comeback in the last few years after a long period in which they were on everyone’s blacklist. Back in the 1980s, there were a lot of reports charging that certain IUDs caused pelvic inflammatory disease (PID), which could lead to infertility. “What we have now learned is that the issue is not the device itself, but the exposure to STDs, often through multiple sexual partners,” Dr. Blumenthal explains. Analysis of extensive data from the World Health Organization has shown that when IUDs are given to appropriate patients (mainly women in mutually monogamous relationships), the risk of PID is extremely low, with only a slightly increased risk during the first few weeks after insertion.

When the IUD is removed, the return to fertility is fairly rapid, somewhere between the rate of the Pill and Depo-Provera, according to Dr. Blumenthal, who adds: “When you remove the IUD, since the ovary is not really affected in the first place, within a cycle or so the uterus recovers, the effect of the IUD is gone, and fertility returns to whatever level it was destined to be.” According to data from the Association of Reproductive Health Professionals, conception rates following IUD removal are not significantly different from the rest of the population’s.

Dr. Blumenthal points out a potential fertility benefit of one specific type of IUD, called Mirena. “There is some reason to believe that Mirena, a levonorgestrel intrauterine system that lasts for five years, may offer some protection against some STDs—though not HIV—because the little bit of hormone that’s in the IUD thickens the cervical mucus and prevents bacteria from ascending into the uterus.”

Sterilization

More than 1 million American men and women choose to be sterilized each year, and somewhere between 1 and 5 percent of them will eventually change their minds and ask for a reversal of the procedure. “I tell my patients, don’t even think about tubal ligation unless you are 100 percent sure you never want to get pregnant. In fact, I won’t even perform one on women under 30,” says Dr. Hutcherson. While patients are cautioned that sterilization is meant to be permanent, people do get divorced and remarried, or simply change their minds, and for those women, it is often possible to become pregnant again.

For women who have had their tubes tied, their chances of getting pregnant after a reversal range from around 40 percent to around 70 percent, depending on their age, the length of time between the sterilization and the reversal, the method of the original surgery, and the length of tube left to be joined. But doctors warn that even with a successful reversal, fertility levels will never go back to what they once were. “Once the tubes have been damaged, when you put them back together there’s always going to be some scarring that’s left behind,” Dr. Davis explains. She also points out that there is a greater risk for ectopic pregnancy after a reversal.

Men who have had vasectomies have a somewhat more successful rate of reversal than their female counterparts. Between 85 and 97 percent of men will eventually have sperm in their ejaculate, and approximately half of couples will achieve pregnancy. The most significant factor is the length of time between the vasectomy and the reversal. The average time to achieve pregnancy is 12 months.

With either male or female sterilization, pregnancy can be achieved without a reversal through in vitro fertilization (IVF). Sperm can be retrieved directly from the testes and/or eggs directly from the ovaries, without either having to travel through blocked passageways. But because of the significant cost of IVF, the American Urological Association recommends a vasectomy reversal before attempting IVF.

Whichever birth control method you’ve relied on, the important thing to remember is that once you go off of it, you must be prepared for pregnancy. “We see so many women who go off birth control and didn’t think they could get pregnant quickly, and then boom, they’re pregnant by dinnertime,” says Dr. Blumenthal. Wouldn’t it be nice if it were always so easy?  

A version of this article originally appeared in the Fall 2005 issue of Conceive Magazine.

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