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Fertility After Oral Contraceptives

Fertility After Oral Contraceptives

Birth control pills are a popular choice of contraception for women wishing to delay pregnancy. As such, many women who are now trying to conceive have recently discontinued oral contraceptives. After discontinuing the pill, concerns often arise about the effects of previous oral contraceptive use on one's current ability to conceive.

Some of the questions that are frequently asked about oral contraceptives include:

  • How long will it take my cycle to regulate after discontinuing the pill?

  • Will previous pill use impact my future fertility?

  • How long will it take me to get pregnant after discontinuing the pill?

  • Can I start charting right after discontinuing the pill?

Surprisingly, there are few recent scientific studies responding to these questions. One relevant comprehensive recent study, however, is that by Dr. C. Gnoth and his colleagues at the University of Dusseldorf in Germany. In an article titled "Cycle characteristics after discontinuation of oral contraceptives," published in the journal Gynecological Endocrinology in 2002, Gnoth and his colleagues compared the cycle characteristics of women who had recently stopped taking the pill with those who had never used oral contraceptives. The cycle characteristics were determined using basal body temperature (BBT) charts.

Relevant Findings

  • 57.9% of all first cycles after discontinuing oral contraceptives were ovulatory (identified with BBT shift) with sufficient luteal phases (greater than 10 days).

  • 10.24% of all first cycles after discontinuing oral contraceptives were not ovulatory (compared with 3.44% of control group). Significant differences also appeared in the second and third cycles after discontinuing oral contraceptives.

  • Cycles were longer in the post-pill group up to cycle number 12.

  • Cycle disturbances (defined as a luteal phase length of less than 10 days or a cycle length greater than 35 days) were more frequent in the post-pill group until the seventh cycle.

  • Cycle disturbances after discontinuing oral contraceptives were reversible but regulation took up to nine months or longer.

Other Factors: Age and Previous Births

Other factors that may play a role in the time it takes for fertility to return after discontinuing oral contraceptives are age and parity (number of previous births). In a 1986 study published in The British Journal of Family Planning, Vessey, Smith and Yeates measured the influence of age and parity on the time it takes for fertility to return after discontinuing oral contraceptives. They compared women aged 25-29 with women aged 30-35 and those who had previously given birth versus those who had never given birth.

Some of their relevant findings included the following:

  • For women who had already had children, impairment of fertility after discontinuing the pill was very slight and of very short duration for women in both age groups.

  • Women aged 25-29 who had never had children had some impairment of fertility after discontinuing oral contraceptives but the effect was relatively short-lived.

  • Women aged 30-35 who had never had children had the longest delay in conceiving after discontinuing oral contraceptives but there was no evidence that the pill caused permanent sterility.

Charting After The Pill

The findings from these studies should be fairly reassuring to women hoping to conceive who have recently discontinued birth control pills- even if the first or second cycle after stopping the pill does not seem completely "normal." Indeed, one study (Farrow et al, 2002) is particularly reassuring, associating prolonged use of oral contraceptives with a decreased risk of delayed conception.

Charting your cycles right away after discontinuing the pill can help you to see when your own fertility returns and can help you see your own post-pill cycle characteristics. Talk to your healthcare provider if you find that it is taking longer than you expect to conceive after discontinuing the pill or if your chart is showing other cause for concern after a few cycles.

Sources:

Farrow, A., M. G. Hull, et al. (2002). "Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception." Hum Reprod 17(10): 2754-61.

Gnoth, C., P. Frank-Herrmann, et al. (2002). "Cycle characteristics after discontinuation of oral contraceptives." Gynecol Endocrinol 16(4): 307-17.

Vessey, M., Smith, MA., Yeates, D. (1986). "Return of Fertility after discontinuation of oral contraceptives: influence of age and parity." The British Journal of Family Planning 11: 120-124.

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