Do I Need Birth Control If I Was Diagnosed With Infertility?

Use Birth Control After Infertility?! Yes, Here’s Why.

Various forms of contraception
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You won’t be trying to conceive forever. There will likely come a time when you don’t want to get pregnant. You may be done having children (after conceiving with fertility treatments, perhaps), or you may want to eliminate the stress of trying to conceive. Or, you may be medically advised not to conceive.

If you don't want to get pregnant, you will need to go on birth control or choose a method of contraception.

Infertility is not birth control. This can be a surprising and frustrating realization for couples that have spent months and years trying to get pregnant.

Do you really need contraception after infertility? For what reason might a fertility-challenged couple decide or need to use birth control? And could going on hormonal birth control further harm your fertility, making it even harder to conceive if you choose to try to have another child in the future?

Can I Really Get Pregnant Naturally If I’m Infertile?

Yes, even if you have been diagnosed with infertility, you may be able to get pregnant on your own. This partially depends on the cause of your infertility. It’s also important to know the difference between infertility and sterility.

Infertility is defined as the inability to conceive after one year of unprotected sexual intercourse. With infertility, your odds of conception are lower than the general population.

But it’s not necessarily impossible for you to conceive on your own.

Sterility, on the other hand, is when you are incapable of conceiving (or impregnating your partner) without medical assistance. For example, if both of a woman’s fallopian tubes are completely blocked, she is sterile. Or, if a male has zero sperm count (azoospermia), he is sterile.

Conceiving without the help of assisted reproductive technology would be impossible in these situations.

Most couples struggling to conceive are not sterile. Whether it’s low sperm count or poor ovulation, there often remains a possibility of natural conception, even if that chance is low. Researchers have looked into these odds.

What Are the Odds of Conceiving After Infertility?

In one study, couples that had IVF treatment in French fertility treatment centers were sent follow-up questionnaires seven to nine years later. The surveys were sent to both those who conceived with IVF and those who did not.

Out of 1,320 couples that conceived with IVF, 17 percent (or 218 couples) went on to conceive naturally within the next seven to nine years. Out of 814 couples that had not had success with IVF, 24 percent (or 193 couples) went on to conceive spontaneously.

Researchers found that those with unexplained infertility and those who were younger were more likely to get pregnant without medical help post-IVF.

Another study found a similar spontaneous conception rate—21.6 percent of couples went on to get pregnant without fertility treatments in the years after they received IVF.

Women diagnosed with primary ovarian insufficiency (also known as premature ovarian failure) often require IVF treatment with an egg donor to get pregnant.

However, you may be surprised to hear that 5 to 10 percent of these same women go on to conceive with their own eggs, sometimes with the help of fertility drugs but also sometimes spontaneously. No one is clear exactly why.

There are a few caveats to keep in mind:

  • First, many of these studies rely on couples returning mailed surveys. Those who are happy to have conceived may be more likely to respond. Therefore, happy-ending stories may be over-represented.
  • Secondly, these percentages don’t provide a per-month-odd ratio, which is likely very low. These are the percentages that managed to conceive over several years time.
  • The bottom line is this: you probably don’t want to forego fertility treatments based on these statistics. However, unless your doctor tells you otherwise, if you don’t want to get pregnant, you shouldn’t rely on your infertility as birth control. (Yes, even if you needed an egg donor previously to conceive.)

Reasons to Go on Birth Control After Infertility

Making the decision to go on birth control or use contraception after infertility can be challenging and controversial. After all the struggle of trying to get pregnant, why would you want to actively prevent pregnancy from happening?

There are several good reasons.

For those who have conceived (with or without the help of fertility treatments), reasons to actively prevent pregnancy include:

  • Spacing children: It’s a legitimate desire to not want two very young children at once.
  • Deciding to stop building their family: Whether you’re stopping after one or five children, you can decide when you're finished having kids.
  • Being unsure if you want more kids: Maybe you just don’t know if you want more. You may choose to prevent until you decide.
  • Medical advice against pregnancy/birth: Your doctor may advise you not to get pregnant, for a number of reasons.

For those who have not conceived after infertility, reasons to actively prevent pregnancy include:

  • Taking a temporary break from trying to conceive: It can be very difficult to emotionally recover from the stress of trying to conceive if the possibility of pregnancy still exists.
  • Deciding on a childfree life: To have peace and resolution, you may choose to use contraception after deciding on a childfree life after infertility.
  • Medical advice against pregnancy/birth: Your situation may change, and your doctor may advise you not to continue trying to conceive.

Using contraception after infertility can feel strange. It’s not uncommon for men and women to think that they should “just let things happen” after so much struggle. Some even feel guilty for actively preventing, thinking they are somehow “rejecting” the idea of a “miracle” baby.

There’s no reason to feel guilty for needing or wanting to prevent pregnancy temporarily or permanently. It is often the only way to move on or regain peace of mind. This is worth as much, if not more, than the possibility of a “surprise.”

Will Birth Control Harm My Fertility, If I Want to Try to Conceive Again?

Particularly for those who may want to try to get pregnant again, the concern that going on birth control may harm their future fertility can keep them from even considering contraception.

Here’s the good news: The majority of the research on birth control shows that hormonal birth control does not cause infertility.

Here’s the not-so-good news: A few small studies show a slight impact on some fertility factors. While these effects seem to be temporary, they may be more likely to occur in women who have fertility problems.

One study found that previous birth control use may cause a thinner endometrial lining, but this didn’t seem to impact pregnancy rates. Another study found that some women experience slightly irregular cycles for up to nine months after stopping the pill.

This doesn’t mean you shouldn’t consider hormonal birth control, but it is worth discussing with your doctor. There are some instances when your doctor may recommend hormonal birth control. For example, if you had surgery to remove endometrial lesions, hormonal birth control may slow down the build-up of new endometrial deposits.

One form of hormonal birth control that you should avoid if you have any intention of trying again within two years is the Depo-Provera (or depot medroxyprogesterone acetate, or DMPA) shot. While other forms of birth control typically impact your fertility for a few months after stopping, the shot can continue to work up to 18 months after your last injection.

If you’re worried about possible adverse effects of hormonal contraception, you can use a barrier method instead. Condoms or a diaphragm with spermicide may be better choices.

Sources:

Lande Y1, Seidman DS, Maman E, Baum M, Dor J, Hourvitz A. “Spontaneous conceptions following successful ART are not associated with premature referral.Hum Reprod. 2012 Aug;27(8):2380-3. doi: 10.1093/humrep/des202. Epub 2012 Jun 12.

Soave I1, Lo Monte G, Marci R. “Spontaneous pregnancy and unexplained infertility: a gift with many whys.N Am J Med Sci. 2012 Oct;4(10):512-3. doi: 10.4103/1947-2714.102010.

Troude P1, Bailly E, Guibert J, Bouyer J, de la Rochebrochard E; DAIFI Group. “Spontaneous pregnancies among couples previously treated by in vitro fertilization.Fertil Steril. 2012 Jul;98(1):63-8. doi: 10.1016/j.fertnstert.2012.03.058. Epub 2012 Apr 21.

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