Can Birth Control Cause Infertility?

Birth control pills in plastic tablet dispenser case
Birth control doesn't cause infertility, but it may impact some aspects of your future fertility. Jonathan Nourok / Getty Images

Can birth control harm your fertility? Many hormonal contraceptive choices have risks, but infertility is not one of them. According to numerous studies, you are as likely to conceive if you used birth control in the past as a woman who has never used hormonal contraceptives.

In fact, one of the largest studies looked at women who had been using birth control for seven years. They found that 21.1% conceived in their first fertile month. Of those who didn’t conceive right away, 79.4% were pregnant within a year. This is similar to the general population’s odds for conception

However, you should know that the study specifically refers to the woman's first fertile month after stopping contraception. There can be some slight wait time between when you stop birth control and your fertility returns. With the exception of the birth control shot, this waiting period is usually short.

There are also some some small studies that raise concerns about the long-term risks to birth control. However, these studies should be taken with a grain of salt.

Long Term Contraceptive Use and Endometrial Lining

A study published in Obstetrics and Gynecology reported that women who used combined (estrogen and progestin) birth control pills for five or more years were significantly more likely to have thinner endometrial linings. The endometrium lines the uterus and is where an embryo would implant itself during pregnancy.

However, in this study, the 137 patients were already being seen in a fertility clinic because the study was done on women preparing for a frozen embryo transfer. These women were already getting IVF treatment, which means that the results may not apply to women with otherwise normal fertility.

While the researchers concluded that long-term oral birth control pills may increase the risk of IVF cycle cancellation (due to the thin lining), pregnancy rates appeared to be similar between the groups.

In other words, as long as you are able to complete the IVF cycle, the odds of getting pregnant would be the same as someone who had never used the combined birth control pills.

Birth Control and Menstrual Cycle Variations

In another small study published in Gynecological Endocrinology, a group of 175 women who discontinued oral contraceptives was compared to a group of 284 women who had never taken birth control pills.

The women charted their body basal temperatures, which allowed researchers to observe cycle length, ovulation, and luteal phase length. The luteal phase is the time between ovulation and your expected period. 

The study found that 57.9% of the women who discontinued birth control pills ovulated and had healthy luteal phases in their first post-pill cycle.

However, many women in the post-pill cycle group had longer menstrual cycles than non-pill users. This lasted for up to 9 months. Also, more women in the post-pill group had shorter than normal luteal phases. These cycle disturbances eventually corrected themselves by 9 months post-birth control use.

It's important to note that this study did not look at clinical pregnancy rates and whether these cycle irregularities were enough to impact fertility.

Some women go on birth control to help regulate irregular cycles. We don’t know how many of the women taking the birth control had irregular cycles before starting. Having irregular cycles may have increased their risk of longer-term effects.

Post-Pill Amenorrhea: Not Ovulating After Birth Control

You should have a cycle within one to three months of discontinuing most forms of reversible birth control. If you stopped birth control and haven't gotten a period yet, you may want to take a pregnancy test first. It’s possible that you conceived! You can get pregnant the very next month after stopping birth control.

If you’re not pregnant, you might be experiencing post-pill amenorrhea. This is when you don’t get a period for up to 6 months after discontinuing birth control pills. Despite its name, this lack of ovulation is probably not due to birth control use.

Birth control creates a “fake” menstrual cycle. Even if a woman has a fertility problem that would cause anovulation, the hormones in the birth control pills would trigger a period. It would look like she has regular menstrual cycles.

However, this only applies as long as she is taking them. If you had irregular periods before starting birth control, you will likely have them again after you stop. There’s a misconception that birth control pills “cure” irregular cycles. They don’t. They create an artificial cycle, but they don’t solve the original cause for the irregular cycles.

Tell your provider if you’re not ovulating after birth control pills or if your cycles are irregular or absent. They might want to run some fertility tests.

Your doctor may prescribe Clomid to “jump start” your fertility.

Fertility and the Birth Control Shot

Your cycles should return within about three months of stopping birth control, if not sooner. One major exception to the one-to-three-month rule is if you had the birth control shot.

If you had a Depo-Provera (or DMPA) shot, you should get a cycle after 6 to 12 months of your last injection.

However, some women experience disruptions to their fertility for up to 18 months. Don't panic if you don't get your fertility back right away after Depo-Provera. It can take up to 22 months—or almost two years—for your cycles to return after the birth control shot. That's not the average, but it's possible. This is why your provider is supposed to confirm that you had no family building plans in the near future, before prescribing the shot.

If you don’t get a period within 22 months, let your provider know.

What If You Can’t Get Pregnant After Birth Control Pills?

You stopped birth control pills, your cycles have returned, but you’re not getting pregnant. Now what? While you may wonder if your birth control pills caused your problems, rest assured that this is highly unlikely.

There are many reasons why you may struggle to conceive. Infertility affects 12 percent of couples, and both men and women can experience fertility problems. In cases of female infertility, not ovulating is only one possible cause.

If you don’t conceive after six months (if you’re over 35), or you don’t conceive after a year, don't wait to talk to your provider. Delaying testing and treatment may reduce your odds for pregnancy success.

Preventing Pregnancy Without Hormonal Birth Control

Even though the majority of research shows hormonal birth control doesn't cause infertility, some women still want to avoid it. Does this mean they have no way to prevent pregnancy? Of course not!

You may want to consider barrier method options. This includes contraception like condoms or a diaphragm. Barrier methods of birth control do require you to use them. They can't be effective if you forget or don't place them properly.

However, for those that are consistent and careful, they can provide an effective way to avoid pregnancy, while not interfering with your hormones. 

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