Can Birth Control Make You Infertile? The Research Into Birth Control And Infertility
The simple answer to this question is generally no. The only form of birth control that is proven to make you infertile is a sterilization procedure, either in the form of a vasectomy or tubal ligation. There are some types of birth control that can affect your chances of infertility. Let's look at some of the research behind birth control and infertility.
Can hormonal birth control make you infertile?
Typically when people talk about hormonal birth control they're referring to one of the following:
- Oral contraceptives, dozens of different contraceptive pill formulations.
- Intrauterine devices (IUDs) both hormonal marketed as Mirena and non-hormonal.
- Contraceptive patch, marketed as Ortho Evra and Xulane.
- Vaginal ring, marketed as NuvaRing.
- Contraceptive implants, marketed as Nexplanon and Implanon.
- Contraceptive injections, marketed as Depo-Provera, Depo-subQprovera, MPA (medroxyprogesterone acetate suspension) for injection.
While the amount of research varies depending on the type of contraception, all studies point to very little to no increased chance of infertility by using hormonal birth control with the exception of contraceptive injections.
As one of the first and most widely-used methods, researchers have plenty of data to work from when looking into this form of birth control and infertility.
A Boston University School of Public Health study [Human Reproduction, May 2013; 28 (5): 1398-1405] examined pregnancy rates of 3,700 women who took oral contraceptives. They found that some women had a slight delay in fertility (two to six months) after stopping use. After this delay, fertility rates were similar to women who had not been on oral contraceptives.
In fact, researchers found that those who had taken oral contraceptives for more than two years had slightly higher fertility rates.
The World Health Organization notes that modern copper (non-hormonal) IUDs are one of the "safest and most effective of all the reversible contraceptive methods currently available."
However, there is an increased relative risk of pelvic inflammatory disease (PID) compared to other birth control methods or no birth control at all.
Pelvic inflammatory disease typically occurs when a sexually transmitted infection spreads into the reproductive organs. This can lead to tubal damage, ectopic pregnancy, and infertility in severe cases. The CDC notes that the risk of PID is primarily confined to the first three weeks after insertion of an IUD. Those who are at high risk for STIs are also at higher risk for this IUD complication.
A smaller-scale 2016 study from The European Journal of Contraception & Reproductive Health Care [2015; 20 (3): 223-230] found no difference in pregnancy rates between IUD and non-IUD users. They did, however, find that women of African-American descent who used IUDs did have higher rates of infertility. The researchers noted that this may be related to other factors affecting African-American infertility rates, which may be nearly twice as high as infertility rates in Caucasian women.
For hormonal IUDs with levonorgestrel, a study in the International Journal of Women's Health [2009; 1: 45-58] found that "pregnancy rates after removal are 89 per 100 for women less than 30 years of age –are similar to women who had not been using any form of birth control."
Contraceptive rings, implants, and patches
These forms of birth control are less widely-used and, unfortunately, have less research as well. However, the few studies into these forms of birth control and infertility continue to point to minimal additional risk.
A Contraception study [1995 Apr; 51(4): 237-242] followed 627 women who used an implant and found two-year pregnancy rates of 88%, comparable to those who hadn't used contraception.
A Modern Fertility article notes that 27 out of 29 women in a study on the safety of vaginal rings returned to a normal ovulation cycle after removal. No large-scale research studies are available beyond this, but since vaginal rings are a more localized birth control method, the potential for fertility issues is unlikely.
Rarely a condition known as post-pill amenorrhea-galactorrhea may occur in which breast secretion occurs and menses do not restart. This is due to an elevated prolactin level caused by some pills with high estrogen content that usually resolves without treatment. If it persists, it could be due to a microadenoma in the pituitary and needs to be evaluated by a fertility doctor.
Amenorrhea (absence of menses) may continue for an extended time after Depo-Provera, and Depo-subQprovera injections.
In a large study of Depoprovera users who discontinued injections the average time to return to ovulation was five to eight months. The average time to conception was ten months, with a range of three to 31 months, and was unrelated to duration of use (Depo-Provera®, Physician Package Insert (May 2006).
Rare cases of permanent anovulation have occurred following the use of DPC. Among 15 patients who received multiple doses of Depo-subQprovera the earliest return to ovulation was six months, the medium time to ovulation was ten months, and 20% had not ovulated after one year.
However, ovulation has been reported to occur as early as 14 weeks after a single injection. Among 28 women who discontinued Depo-subQprovera to become pregnant, only one became pregnant within one year (Depo-subQprovera 104 Physician Package Insert, October 2007).
How long does birth control stay in your system?
You can become pregnant after one to two menstruation cycles for most birth control methods. The only outlier is contraceptive injections, which may delay your fertility for up to ten months or more. If you now have or previously had amenorrhea after using contraceptive injections or other hormonal methods, one of our fertility doctors can help you.
What happens when you stop taking birth control?
While birth control likely won't make you infertile, there may be other factors to consider. Any issues you had before taking birth control (or those that developed during) could affect your fertility. Common conditions include polycystic ovary syndrome (PCOS) and endometriosis.
Further, if you stop taking birth control when you're older, your fertility will have naturally declined as you aged.
If you're trying to get pregnant and want answers, it may be time to talk to a fertility specialist. For those in Louisiana and neighboring states, contact The Fertility Institute today to talk to one of our fertility nurses about fertility testing and other options and to schedule an appointment with one of our fertility doctors.