7 January 2020

Can Birth Control Cause Fertility Problems?

Doctor
Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London

 

Effective birth control is one of the transformative medical advances that has allowed generations of women to take control of their own destinies. It’s easy to forget that since the pill was introduced in the UK in 1961, we have been at liberty to enjoy a level of personal freedom that our grandmothers never knew. Absolutely, birth control pills can cause infertility: that is what they are designed for! But of course that type of elective, temporary protection from involuntary pregnancy is not what we think of as infertility.

Just as women want reliable contraception at certain times, we also need reassurance that, when the time comes to try for pregnancy, there won’t be a backlash from previous contraception. So can birth control cause infertility? The good news is that it doesn’t, but different types of birth control can cause a small fertility delay.

Types of birth control and infertility

We all know that if you stop using a barrier method like condoms or a diaphragm, you can get pregnant the moment you stop using them. Most people’s doubts and concerns focus on the longer term effects of hormonal contraceptives, whether these are a pill, an implant or an injection. Some methods do carry a risk of having to wait a few months for fertility to return to square one. This is probably what gives rise to the myth that birth control pills can cause infertility. How do the main birth control methods compare?

  • The combination pill. This is one that contains both progesterone and oestrogen. It works by preventing ovulation as well as thickening the mucus at the neck of the womb and thinning the lining avoiding the ovulation and making the implantation less likely. According to the NHS, it is 99% effective when taken correctly, which is what makes it rightly very popular. When you stop taking it, your cycles should be back to normality . Nonetheless for some women it can take longer to recover their normal cyclers. The NHS recommends that you allow yourself three months for a normal menstrual cycle to re-establish.
  • The ‘mini pill’. This contraceptive has a similar effect, thinning the uterus lining and also preventing ovulation. As soon as you stop taking it, the lining of the womb starts to thicken again and cycles re-establish. Similarly, most women recover their regular cycles after dropping the pill but in some situations the this period could be longer.
  • Hormonal or copper IUD. IUDs have a mechanical effect, making the implantation more difficult. The IUD that contains hormone, is a combined treatment were the progesterone will thickenthe cervical mucus and make the womb lining thinner. In both cases, cyclic menses should restablish within a month of their removal although with the hormonal IUD, as for the pill, it could take up to three months for the menstrual cycle to return to normal.
  • The vaginal ring and contraceptive patch. Both of these hormonal contraceptive methods are relatively recent and so there is less research evidence on their long-term impact, but they work in a way very much like the pill, and all the evidence to date suggests that they are equally safe, and that periods return after stopping their use within the normal three months.
  • The contraceptive injection. The ‘shot’ is best known in the UK under one of its trade names, Depo-Provera. The injection is repeated every three months and is especially helpful for women who don’t want to be bothered with remembering to take a pill every day. However, this is the one that gives rise to all of the fears about birth control causing infertility. With this drug, it can take up to a year for your cycles to re-establish, and so it is less used among women that would like to become pregnant in the near future.

What if you don’t get pregnant after stopping birth control?

A study of 2,000 women who wanted to become pregnant after taking the birth control pill for seven years was carried out by the European Active Surveillance Study on Oral Contraceptives. Researchers found:

  • 21% were pregnant within one cycle after stopping birth control,
  • 79% were pregnant within one year,
  • Rates of pregnancy were lower among women over the age of 35.

These results reflect the chances of pregnancy in the general population, and researchers concluded that birth control has no effect on fertility. So why does the belief persist that birth control pills can cause infertility?

The explanation may be in another common misconception about birth control pills; that they make your menstrual cycle regular. They appear to, but only because the controlled levels of hormone create a ‘false’ regularity and bleeding. If your periods were erratic before taking the pill then once you stop, your normal, i.e. irregular, pattern will return. So it is always possible that the birth control pill was in a sense disguising an underlying problem, which could only come to light when you stop taking it.

When should I seek advice if I fail to conceive?

Don’t panic if you’re not pregnant in the first few months after coming off birth control. To begin with, 12 months is the normal timeframe given to couples when trying to conceive.  Secondly, it’s possible that you’re one of the people whose normal rhythm takes a while to re-establish itself. Therefore, give your body time to recover and if after that you are still not pregnant after a year, or six months if you are over 35, it’s time to seek fertility advice. Likewise, don’t forget that for heterosexual couples, male infertility is just as likely to be the cause as any problem with the female partner. Hence why it is important to receive a reproductive assessment is order to find out potential causes of infertility.

It’s best to find out in good time, so you have the chance to take action. After all, the pill gave you the chance to take control of your own future, so the availability of fertility treatment, if necessary, could represent a similar kind of liberation.

Finding out about IVI

You can take a look at our introductory video to find out more about IVI and the range of treatments and services we offer so you have a feeling for what to expect from your first visit. Even better, why not come to one of our Patient Open Evenings in our flagship London clinic? Book a place by calling 0800 52 00 161, or get in touch through our online contact form and we will call you back.

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