You've quit your contraceptive and are ready to start a family, but could your pill or IUD have lingering effects on your fertility?
When Camillia, 34, decided that she and her partner were ready to try for a baby, she went to her doctor to have her IUD removed. "My doctor said I could get pregnant right away, but I thought that because of my age it would take longer," she says. Turns out, her doctor was right. Camillia was surprised when she became pregnant just ten days later.
It's not uncommon for women to believe that there will be a delay in fertility after being on birth control, and it's a concern that gynecologists constantly try to squash. So what's going on? Glenmarie Matthews, an OB-GYN in the family planning division at Montefiore Medical Center in New York City says that misunderstandings surrounding conception and birth control—sparked by both poor research and well-circulated myths—are to blame. "There were a lot of misconceptions around the pill when it was first introduced, and in the 1980s there was some research that suggested that oral contraceptives might delay fertility after discontinuation," she says. But since then, multiple studies have been published that show that the pill does not in fact affect fertility. Ditto goes for most other forms of birth control.
Another reason people think contraception can delay fertility is that we've been led to believe that getting pregnant is way easier than it actually is. So if a woman doesn't see the telltale two lines on a pregnancy test after a few months of trying to conceive, it's easy to point the finger at years of being on birth control. However, this delay is totally expected. "The normal fertility rate for a woman who isn't on birth control is approximately 30 percent per menstrual cycle," says Matthews. In other words, each month you only have a 30 percent chance of getting pregnant—nope, that's not super high. Your partner's fertility also plays a role (this pregnancy thing takes two, let's remember), and factors such as being overweight, smoking, taking certain medications, skimping on sleep and even being stressed out can hurt your chances of conceiving.
All this said, it is true that fertility can take a hit while you've been on birth control—but don't blame your contraceptives. The real culprit is the fact that you've blown out quite a few birthday candles since you first started using birth control, and the quantity and quality of your eggs just isn't what it used to be, says Audrey Lance, M.D., an assistant professor of obstetrics, gynecology and reproductive sciences at UPMC Magee-Women's Hospital. "Our fertility decreases pretty much every year after about age 25. So let's say that you spent 10 years on the pill and now you're 35 years old. It might take longer to get pregnant at age 35 but it's not because of the pill. It's because you're 35, not 25."
Still questioning how your specific form of birth control will impact your pregnancy plans? We break it down here:
Barrier Methods of Birth Control
Whether you use a condom or diaphragm to prevent pregnancy, barrier methods of birth control have zero impact on fertility. The moment you stop using them, your ability to conceive returns to normal. In fact, it could be argued that using barrier methods ups the chance of getting pregnant, since they decrease the risk of contracting sexually transmitted diseases that can cause infertility, such as chlamydia and gonorrhea.
Oral contraceptives use hormones to inhibit the body from ovulating (and—quick health class refresh—you need to ovulate in order to release an egg). "Once you stop taking the pill, these hormones are out of your body within 24 hours, and with your next cycle you can go back to ovulating and may become pregnant," says Lance. (Psst, this is why it's possible to get pregnant if you forget to take a pill.)
Of course, just because you're once again fertile doesn't mean that you'll become pregnant immediately. One study found that 72 to 94 percent of women will become pregnant after one year of being off of oral contraceptives, a rate that's similar to the percentage of women who become pregnant after one year of stopping other forms of contraception including non-med versions like using condoms and family planning.
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The Patch and Ring
Just like the pill, the patch and the ring (NuvaRing) use hormones to prevent ovulation, and fertility will return to normal levels within a day or two of removing the patch or taking out the ring, says Lance.
Depo-Provera, which is administered via a shot into the arm or buttocks, is similar to oral contraceptives in that it uses hormones to prevent ovulation. The big differences are that it contains a higher dose of the hormone progestin and women receive the shot every three months, which means that the medication hangs out in the system longer than it does with the pill, says Matthews. Because of this, it takes some time for the effects to wear off once women decide to stop getting the injections, which can impact the ability to become pregnant. According to Lance, the delay in fertility may last as long as six to nine months for some women.
"If a patient wants to use a birth control method for only a little while and then get pregnant, I don't recommend the shot because the return to fertility is unpredictable," says Lance. But if you are using Depo-Provera, remember that while fertility can be delayed, some women do get pregnant faster, so it's best to wait until you're ready to start a family before you discontinue use.
Implant-based forms of contraceptives, a.k.a. Nexplanon, are inserted under the skin in the upper arm and can prevent pregnancy for up to four years. The implant is very similar to Depo-Provera in that it releases the hormone progestin to prevent pregnancy, except in smaller doses, says Matthews. "It's also directly reversible after removal and most people ovulate within three months," she says.
There are two type of IUDs available, hormonal and copper. Hormonal IUDs work by thickening the cervical mucus so that sperm can't penetrate it. With the copper IUD, copper ions—which act as an effect spermicide—are released to prevent pregnancy. But just like with oral contraceptives, the pregnancy-preventing effects wear off quickly after removing the IUD and the cervical lining will soon return to its usual thickness. "With both hormonal and copper IUDs, women will go back to a normal state of fertility within a week or so of having them removed," says Lance.
If you're considering going off of any form of birth control, now's the optimal time to schedule an appointment with your gynecologist to discuss what you can do to maximize your chances of becoming pregnant. Your doctor will likely recommend starting prenatal vitamins and discuss whether there are any lifestyles changes you can make, such as losing weight or quitting smoking.
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Once you do stop taking your birth control, be ready for a missed period as soon as your next cycle. But don't stress if your baby making plans don't pan out as expected. "It's normal for healthy couples who have no infertility issues to take up to a year to become pregnant," says Lance. So relax—and have fun while you're at it.