What You Need to Know About Birth Control and Infertility
If you’ve been a long-time birth control user and are ready to start a family, you may wonder how it's affected your fertility. This wonder may even become a worry if you’ve been trying to conceive and it hasn’t happened yet.
Thankfully, birth control causing infertility as a side effect is a long-standing myth, no matter how many years you’ve been on it. But certain birth control methods can delay fertility by taking more time than expected for your natural menstrual cycle to start again, thereby postponing ovulation.
Read on to look at the most widely used birth control methods and how they impact fertility.
Birth Control Pills
Believe it or not, taking birth control pills (along with other forms of birth control) may preserve your fertility and health. Women who have used birth control pills have a 30% to 50% lower risk of ovarian cancer than those who have never used oral contraceptives. Birth control pills may also relieve the painful symptoms of endometriosis, a condition where tissue that normally grows inside the uterus forms on the outside instead.
Birth control pills are often used during fertility treatments to prevent the ovaries from producing an egg. This allows the ovaries to rest and coordinate the timeline for ovulation for fertility cycles.
However, research published in Human Reproduction found a short-term delay in the return of fertility when using birth control pills. On average, this could be approximately three months or range from two to six months. The return of fertility may be longer if you’ve taken birth control pills for longer than two years.
If fertility doesn't return after six months, this is clinically referred to as post-pill amenorrhea, which simply means you haven’t resumed normal menstruation or ovulation yet. There are several ways to treat this with fertility services, but first, it’s important to rule out underlying conditions that may delay ovulation.
The progesterone-only mini-pill is a safe substitute for women interested in birth control pills without unpleasant side effects. It works similar to combination birth control pills without containing estrogen. This may eliminate headaches and stomach pain that some experience when taking combination birth control pills.
The mini-pill suppresses ovulation but may not do it consistently, particularly if you don’t take it at the same time daily. However, for those looking to stop the mini-pill and start a family, this may lead to a quicker conception. Some may find their cycle returns immediately, while others may experience a few months' delays, similar to combination birth control.
Birth Control Patch
The birth control patch releases hormones into the bloodstream to prevent ovulation. It also thickens cervical mucus and thins the uterus lining to limit implantation. The patch has many of the same benefits as the pill for reproductive health because it contains the same hormones – estrogen and progesterone – and delivers them differently.
While the patch is extremely effective, there may be a short delay of one to two weeks in trying to conceive. Like birth control pills, it may take longer, as some research found it took up to four cycles for fertility to return. When this happens, it’s important to get evaluated to ensure there aren’t any health conditions requiring treatment before conceiving.
Birth Control Ring
The birth control ring may provide more flexibility for those who don’t want to take a daily pill or change their patch weekly. But now you’re ready to take it out, so what should you expect? A cohort study published in BMJ looked at almost 18,000 women who had tried to conceive for up to six menstrual cycles after taking various birth control methods. When it came to the birth control ring, a delay in fertility was similar to the delay one would have with birth control pills. On average, it took study participants roughly three cycles to conceive.
Vaginal rings, in particular, may help fertility return quicker than other methods due to the localized hormone release.
Birth Control Implants
A birth control implant differs from an intrauterine device (also called an IUD, more on that below) and provides a method of birth control you may not have heard about. In one study, only 40% of the participants had heard of birth control implants, clinically referred to as etonogestrel implants. For this birth control method, a thin, small rod that contains progestin is inserted into the arm to help prevent pregnancy. It does this in a similar mechanism that the mini-pill would, by controlling the ovaries from releasing eggs (suppressing ovulation) and thickening cervical mucus to prevent sperm from reaching an egg.
Birth control implants can stay in the arm for up to four years but can be removed whenever you’re ready. On average, birth control implants seem to have one of the shorter delays in returning fertility as research states it may take only two cycles for some to conceive.
Birth Control Injectables
Combined injectable contraceptives are a hormonal birth control method injected directly into the arm. One of the most well-known birth control shots is the Depo-Provera. Injectables like this are administered every three months and contain progestin to halt ovulation. While there are no long-term effects from using an injectable, those who do may have a longer delay in fertility than those who chose other birth control methods.
On average, women who stopped using an injectable took five to eight cycles (approximately four to eight months) before menstrual cycles and ovulation resumed. Researchers don’t state a direct medical cause for this. Still, previous studies support that injectables don’t cause infertility, nor are there any adverse pregnancy or birth outcomes.
IUDs are small, T-shape devices inserted directly into the uterus. They deliver progestin to the uterus and only need to be changed every three to six years by a healthcare professional. Aside from where they are inserted, they operate just like a birth control implant and have similar timelines in the return of fertility. In roughly two cycles, most women see their normal fertility patterns return, despite how long they’ve had an IUD. Yet a research team from the University of Oxford noted that when looking at three birth control methods: women using an IUD, birth control pills, and barrier methods, only 39% of women using an IUD conceived within a year compared to 54% of women using barrier methods.
The researchers found that short-term IUD use (less than three years) had a faster fertility return than those who stopped using birth control pills. It’s important to note that the longer a woman used an IUD, particularly those who used it for six years or more, had a linear relationship to fertility delay. So, your fertility recovery may be linked to your length of IUD usage and other factors such as age and overall health history.
Barrier methods include condoms, a diaphragm, a cervical cap, or a birth control sponge. Instead of using hormones, they physically block sperm from entering the uterus and reaching an egg. That same study out of The University of Oxford found that barrier methods resulted in a shorter fertility delay – 54% of women who used them conceived in a year. This is most likely because barrier methods don’t use hormones, which means your body doesn’t need to adjust to its normal cycle, and the ovaries haven’t been temporarily paused when it comes to ovulating.
Understanding Your Fertility
Fertility is a complicated issue that can become even more confusing if you’ve recently gone off birth control and are waiting for your cycle to return to normal (or show up at all!). Remember that your decision to take birth control – no matter which type you chose – did not have a long-term effect on your fertility. While there may be a longer delay than others regarding certain birth control methods like an injectable, you can still get pregnant.
If you’re uncertain why your cycle isn’t stabilizing or are getting anxious waiting, scheduling a consultation with a world-renown fertility clinic can give you peace of mind and the answers you may seek. A specialist can review your health history to rule out an underlying fertility issue and take the next steps to help regulate your cycles or start fertility treatments to help you conceive.