Contraceptives
and Fertility

There is a common misconcepTion ThaT oral conTracepTives have a negaTive
impact on fertility and that a woman will have difficulty conceiving in future once she starts using them.

In fact, once oral contraceptives are stopped, fertility should return to what it should be at that given time. It will not, however, return to what it was before the contraceptive was started which may have been many years ago. So, or example, if contraceptives were started in a woman’s 20s and she was now in her late 30s, her chances of pregnancy would have fallen accordingly. Apart from current age, the level of fertility will be affected by various health and lifestyle factors.

There is also a misconception amongst many women that when the oral contraceptives are stopped, they have to be ‘washed out’ of their system before they get pregnant. Ovulation and pregnancy can in fact occur safely within weeks of stopping the contraceptives.

Recent studies show that within a year after going off oral contraceptives, 80 per cent of women who want to get pregnant will get pregnant — a number similar to that of the general population. There may be some women in whom the hormonal signals which trigger ovulation are more profoundly depressed than in others, but on average, the return to fertility is rapid. If periods do not return, a visit to the fertility doctor is required as this could be due to other underlying conditions.

In fact, 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 painful periods and fertility problems. The normal and regular cycles experienced by a woman while on the contraceptives is artificial, and once women are off them, their fertility returns to whatever level it would have been.

This may or may not be the case with other hormonal contraceptives, which include injections like Depo-Provera, hormonal rings and implants.

The hormonal ring releases hormones through a small, flexible ring and is inserted into the vagina for three weeks at a time. The implant releases hormones through a flexible rod inserted under the skin for three years. Evidence suggests that fertility returns as soon as these devices are removed from the body.

On the other hand, Depo-Provera, a contraceptive injected into a woman’s thigh or buttocks once every three months to prevent ovulation, is the one hormonal contraceptive that can have prolonged effects on fertility, persisting in the body for many months. It is therefore not recommended for women who want to be pregnant any time soon. Studies have shown that the median time for return to fertility is around nine months after the last shot, though pregnancy can occur as soon as three months after.

IUDs (intrauterine device placed in the uterus to prevent pregnancy) are generally very effective and safe. However, if women are exposed to sexually-transmitted infections, this can lead to severe pelvic inflammatory disease (PID), which can then damage the fallopian tubes and cause infertility. Data from the World Health Organization indicates that when IUDs are given to suitable patients (mainly women in stable 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, and as with the majority of hormonal methods, fertility should return to whatever level it was destined to be.