Can Birth Control Cause Infertility?

3 Ways Birth Control May Impact Your Fertility After You Stop Taking It

Birth control pills in plastic tablet dispenser case
Birth control doesn't cause infertility, but it may impact some aspects of your future fertility.. Jonathan Nourok / Getty Images

Can birth control cause infertility? Many hormonal contraceptive choices have risks, but infertility is not one of them.

According to numerous studies, you are as likely to conceive if you used birth control in the past as a woman who has never used hormonal contraceptives.

One of the largest studies looked at women who had been using birth control for seven years.

They found that 21.1% conceived in their first fertile month.

 Of those who didn’t conceive right away, 79.4% were pregnant within a year.

This is similar to the general population’s odds for conception.

With all that said, there are some small studies that raise concerns.

However, as you will see below, these studies should be taken with a grain of salt.

Long Term Contraceptive Use and Endometrial Lining

A study published in Obstetrics and Gynecology reported that women who used combined (estrogen and progestin) birth control pills for 5 or more years were significantly more likely to have thinner endometrial linings.

The endometrium lines the uterus and is where an embryo would implant itself during pregnancy.

However, in this study, the 137 patients were already being seen in a fertility clinic. (The study was done on women preparing for a frozen embryo transfer.)

These women were already getting IVF treatment.

These results may not apply to women with otherwise healthy fertility.

Also, while the researchers concluded that long-term oral birth control pills may increase the risk of IVF cycle cancellation (due to the thin lining), pregnancy rates appeared to be similar between the groups.

In other words, as long as you were able to complete your IVF cycle, your odds of getting pregnant would be the same as someone who had never used the combined birth control pills.

Birth Control and Menstrual Cycle Variations

In another interesting but small study published in Gynecological Endocrinology, a group of 175 women who discontinued oral contraceptives was compared to a group of 284 women who had never taken birth control pills.

The women charted their body basal temperatures. This allowed researchers to observe cycle length, ovulation, and luteal phase length. The luteal phase is the time between ovulation and your expected period.  

The study found that 57.9% of the women who discontinued birth control pills ovulated and had healthy luteal phases in their first post-pill cycle.

However, many women in the post-pill cycle group had longer menstrual cycles than non-pill users. This lasted for up to 9 months. Also, more women in the post-pill group had shorter than normal luteal phases.

These cycle disturbances eventually corrected themselves by 9 months post-birth control use.

With that said, it’s important to note that this study did not look at clinical pregnancy rates and whether these cycle irregularities were enough to impact fertility.

Also, some women go on birth control to help regulate their irregular cycles. We don’t know how many of the women taking the birth control had irregular cycles before starting. Having irregular cycles may have increased their risk of longer-term effects.

Post-Pill Amenorrhea: When You Don’t Ovulate After Birth Control

You should have a cycle within one to three months of discontinuing most forms of reversible birth control.

(Get more details on when to expect your fertility to return here.)

One major exception to the one-to-three-month rule is if you had the birth control shot.

If you had a Depo-Provera (or DMPA) shot, you should get a cycle after 6 to 12 months of your last injection.

However, some women experience disruptions to their fertility for up to 18 months. Don't panic if you don't get your fertility back right away after Depo-Provera. (This is why your doctor was supposed to confirm that you had no family building plans in the near future, before prescribing the shot.)

If you don’t get a period within these time frames, talk to your doctor.

If you stopped birth control and haven't gotten a period yet, you may want to take a pregnancy test first. It’s possible you conceived!

Yes, you can get pregnant the very next month after stopping birth control. 

If you’re not pregnant, you may be experiencing post-pill amenorrhea.

This is when you don’t get a period for up to 6 months after discontinuing birth control pills.

Despite its name, this lack of ovulation is probably not due to birth control use.

Birth control creates a “fake” menstrual cycle. So even if a woman has a fertility problem that would cause anovulation, the hormones in the birth control pills would trigger a period. It would look like she has regular menstrual cycles.

But this only applies as long as she is taking them.

If you had irregular periods before starting birth control, you will likely have them again after you stop.

There’s a misconception that birth control pills “cure” irregular cycles. They don’t. They create an artificial cycle, but they don’t solve the original cause for the irregular cycles.

Be sure to see your doctor if you’re not ovulating after birth control pills or if your cycles are irregular or absent. Your doctor will likely run some fertility tests.

Your doctor may prescribe Clomid to “jump start” your fertility.

What If You Can’t Get Pregnant After Birth Control Pills?

You stopped birth control pills, your cycles have returned, but you’re not getting pregnant.

Now what?

While you may wonder if your birth control pills caused your problems, rest assured that this is highly unlikely.

There are many reasons why you may struggle to conceive.

Infertility affects 12% of couples, and both men and women can experience fertility problems.

In cases of female infertility, not ovulating is only one possible cause.

If you don’t conceive after six months (if you’re over 35), or you don’t conceive after a year, see your doctor.

Don’t wait! Delaying testing and treatment may reduce your odds for pregnancy success.

Sources:

Cronin M1, Schellschmidt I, Dinger J. “Rate of pregnancy after using drospirenone and other progestin-containing oral contraceptives.” Obstet Gynecol. 2009 Sep;114(3):616-22. doi: 10.1097/AOG.0b013e3181b46f54. http://www.ncbi.nlm.nih.gov/pubmed/19701043

Gnoth C1, Frank-Herrmann P, Schmoll A, Godehardt E, Freundl G. “Cycle characteristics after discontinuation of oral contraceptives.” Gynecol Endocrinol. 2002 Aug;16(4):307-17. http://www.ncbi.nlm.nih.gov/pubmed/12396560

Talukdar N1, Bentov Y, Chang PT, Esfandiari N, Nazemian Z, Casper RF. “Effect of long-term combined oral contraceptive pill use on endometrial thickness.” Obstet Gynecol. 2012 Aug;120(2 Pt 1):348-54. doi: 10.1097/AOG.0b013e31825ec2ee. http://www.ncbi.nlm.nih.gov/pubmed/22825095

Zieman, Mimi, MD. “Patient information: Hormonal methods of birth control (Beyond the Basics).” UpToDate.com. Accessed July 28, 2015. http://www.uptodate.com/contents/hormonal-methods-of-birth-control-beyond-the-basics

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