Can birth control cause infertility?

Medical Director

Dr Mireia Galian

IVI London

Effective birth control is one of the transformative medical advances that has empowered generations of women by preventing pregnancy. It’s easy to forget that since the pill was first introduced in the UK in 1961, we’ve been able to enjoy a level of personal freedom that our grandmothers never knew. Absolutely, birth control can cause infertility: that is what they’re designed to do! 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, if we want to try for a baby, there won’t be side effects of birth control that could impact our fertility. So can birth control cause infertility? The good news is that it doesn’t, but it can take some time to return to previous levels of fertility after using certain types of hormonal birth control.

Types of birth control

We all know that if you stop using a barrier method like male or female condoms or a diaphragm, you can get pregnant from the moment you stop using them. Hormonal contraceptives are not so straightforward, and you may have concerns about the longer term effects. Whether it’s the contraceptive pill, the birth control implant, an intrauterine device or the contraceptive injection, these methods carry a risk of having to wait a few months for fertility to return. This is what gives rise to the myth that birth control can cause infertility.

How does hormonal contraception work?

Most hormonal birth control methods combine synthetic versions of female reproductive hormones to prevent pregnancy. Oestrogen and progesterone are two naturally-occurring female reproductive hormones. Their main function is to regulate the menstrual cycle, however they also contribute to a wide range of other bodily functions too. Oestrogen and progesterone help to prepare the body for pregnancy by thickening the womb lining and stimulating blood flow to the uterus. The majority of contraceptive drugs contain a dose of a progestin (a synthetic form of progesterone), or a combination of synthetic oestrogens and progestins. Taking these hormones disrupts the natural reproductive hormone production cycle.

When will my fertility return to normal?

The combined pill

The combined pill contains both artificial progesterone and artificial oestrogen. It prevents pregnancy by stopping ovulation, thickening cervix mucus and thinning the womb lining to inhibit fertilisation and implantation from taking place. According to the NHS, it is 99% effective when taken correctly. It is among the most popular forms of hormonal contraception. Microgynon, Rigevidon and Ovranette are the most common combination pill brands prescribed in the UK. 

When you stop taking the combined pill, your cycles should be back to normal fairly quickly. For some women, it can take longer. The NHS recommends that you allow at least three months for your normal menstrual cycle to re-establish. 

Progesterone-only pill, or ‘mini’ pill

The progesterone-only pill has a similar effect to the combined pill. It prevents pregnancy by thickening cervical mucus so sperm cannot reach the egg. Like the combined pill, it is 99% effective when taken correctly. Unlike the combined pill, the progesterone-pill must be taken at the same time everyday in order for it to be effective. The progesterone-only pill is sometimes called the mini pill, or ‘minipill’ because it does not contain oestrogen. 

As soon as you stop taking the progesterone-only pill, the mucus in the cervix will start to thin and your cycles will re-establish. Most women recover their regular cycles very quickly, and it’s possible to get pregnant within days or weeks of stopping the mini pill. In some situations, it can take longer for your normal cycle to return.

Hormonal or copper IUD, or the coil birth control method

An intrauterine device (IUD) is a small T-shaped object made with copper or plastic. It must be placed inside uterus through the cervix by a clinician. Copper is toxic to sperm, which means the copper IUD makes the uterine environment inhospitable. It can also stop a fertilised egg from implanting. Hormonal IUDs function in a similar way. Instead of releasing copper, hormonal IUDs release a small amount of progestin. This thickens the cervical mucus while thinning the womb lining to prevent pregnancy. Both the hormonal and copper IUD also have a mechanical effect known as the foreign body reaction. The presence of the device inside the uterus triggers a local inflammatory response, which makes it very difficult for an embryo to implant itself into the endometrium. Both the copper and hormonal IUD are the most effective long-term contraceptives, preventing against pregnancy for 5 to 10 years.

Your normal menstrual cycle should re-establish within one month of copper IUD removal, and within three months of hormonal IUD removal.

Vaginal or hormonal ring

The vaginal ring, known widely by the brand name NuvaRing, is a relatively new form of contraception. When used correctly, it is over 99% effective against pregnancy. It consists of a small flexible ring that is self-inserted into the vagina. You can do this at home. When inside the vagina, the vaginal ring releases synthetic versions of the hormones oestrogen and progesterone. Like the combined oral contraceptive pill, these hormones thicken the cervical mucus, thin the uterine lining and stop the ovaries from releasing eggs. A vaginal ring can protect against pregnancy for one month. This means you must take out and re-insert a new vaginal ring each month.

All the evidence to date suggests that vaginal rings have the same effect on fertility as other hormonal contraceptives. Your normal menstrual cycle should return within three months.

Contraceptive patch

Like the vaginal ring, the contraceptive patch is a newer form of contraception. In the UK, it is known widely by the brand name Evra. Contraceptive patches are a form of hormonal birth control. They are small, sticky plasters that release synthetic versions of the hormones oestrogen and progesterone into the bloodstream. One patch prevents against pregnancy for approximately one week. This means you must remove and re-apply a new patch weekly for a maximum of three weeks. On the fourth week, you must not wear a patch for a full 7 days. Some women experience a menstrual bleed during this time.

As soon as you stop using the patch, you can start trying to get pregnant. You may wish to wait until you’ve had a natural bleed, however it is possible to get pregnant upon removing your last patch.

Contraceptive injection

The contraceptive injection is best known in the UK under one of its trade names, Depo-Provera. It protects against pregnancy by releasing a dose of progestin into the bloodstream through a needle and syringe. It must be administered by a clinician and cannot be self-administered at home. One injection can prevent pregnancy for three months, after which it must be repeated. This form of progesterone-only birth control is more than 99% effective. Like other long term contraception, it may be beneficial if you find it difficult to remember to take a pill everyday.

The injection is a method of contraception that often gives rise to fears about birth control causing infertility. It can take up to 12 months for your fertility to return, and so it is not recommended for women who want to get pregnant in the near future.

Birth control implant

The contraceptive implant, sometimes known by its brand name Nexplanon, is a small plastic rod laced with progestin. It is inserted underneath the skin in your upper arm under local anaesthetic. The implant is a form of hormonal birth control that can prevent against pregnancy for up to three years. It is more than 99% effective. Like other progesterone-only forms of contraception, it protects against unwanted pregnancy by thickening the cervical mucus, thinning the endometrium and making it more difficult for a fertilised egg to implant. 

Once the implant is removed, your fertility should return to normal very quickly. It’s possible to get pregnant as soon as it is removed.

Non-hormonal birth control options

If you are considering getting pregnant in the near future, you may wish to try non hormonal birth control. Unlike hormonal contraception, non hormonal birth control tends to have very few or no long-term side effects. Because they do not contain hormones, your reproductive cycle is not disrupted by non hormonal forms of contraception. The most effective non hormonal methods include:

Diaphragm

The diaphragm, or ‘cap’ is a barrier method of female contraception. It is a dome-shaped device that is inserted into the vagina before sex. It prevents pregnancy by preventing the sperm from passing through the cervix. Spermicide must be applied to the inner section of the diaphragm before it is inserted. The NHS advises that the diaphragm is roughly 92 – 96% effective when used correctly with spermicide. The diaphragm can be inserted at any time but more spermicide must be applied every three hours before sex. In order to prevent pregnancy, the diaphragm must remain inside the vagina for six hours after sex.

It’s possible to get pregnant as soon as the diaphragm is removed. This makes it a recommended method of contraception if you want to try for a baby in the near future.

Male condoms

Male condoms, also known external condoms, are the second most widely used form of contraception. They prevent pregnancy by creating a barrier that stops the sperm from reaching the egg. When used correctly, male condoms are up to 98% effective. External condoms are widely available and can be accessed for free at most sexual health clinics and GP surgeries. Since they are a male contraceptive, they do not affect the female reproductive cycle and you can get pregnant as soon as you stop using them.

Female condoms

A female condom, also known as an internal condom, is another barrier method of contraception. It is a flexible latex sheath with a ring on both ends. It can also be made from synthetic latex. Female condoms are inserted into the vagina before sex, during which they stop sperm from reaching the cervix. Female condoms are 95% effective when used correctly. They protect against pregnancy in a similar way to male condoms and you can also get pregnant as soon as you stop using them.

Natural cycle birth control, or natural family-planning

Most women are only fertile during a short period of time each month. This is known as the ‘fertile window’ and it is part of the menstrual cycle. Tracking your menstrual cycle can be a very effective way to plan, and prevent a pregnancy. It is a birth control method with no side effects that doesn’t require artificial hormones. However, it does require consistent planning and you must commit time to it everyday. It involves tracking bodily signals that indicate specific stages of your menstrual cycle. This includes changes in body temperature and the texture of cervical mucus.

Natural cycle planning is becoming a popular method of non hormonal birth control, helped by fertility tracker mobile apps. However, the effectiveness of this birth control method depends entirely on each individual: if you are considering tracking your cycle to prevent unwanted pregnancies, it’s important you are properly trained by a specialist.

Copper IUD, or ‘copper coil’

As we mentioned earlier in this article, the copper IUD is a highly effective non-hormonal method of contraception. It can last for up to 10 years. It was first adopted in the 1970s and continues to be used today, although it is now less popular than its hormonal counterpart. The copper coil does not release hormones, so you still ovulate every month and your cycles continue as normal. However, it can cause your periods to become heavier, longer or more painful. If you do experience heavier bleeding, this is part of your body’s natural response to the device and is nothing to worry about. If the pain begins to interfere with your daily life, you should consult your GP.

What about male birth control?

Men have fewer contraception options than women. Today, the most common types of male birth control are external condoms or a vasectomy. A vasectomy is a surgical procedure in which the vasa deferentia, the tubes that transport sperm to a man’s semen, are cut and tied. It is sometimes known as male sterilisation because it is not easily reversed. In cases where reversal is possible, there is no way to guarantee that fertility will return as normal.

Male birth control pill

A safe and effective birth control pill for men is not yet a reality, although research is ongoing. There have been several significant advances in the development of male contraceptives in the last decade alone. These include injectable hormones and implant trials. Long-term safety and reversibility are among the requirements that must be met before such a product can come to market. While scientific progress is slow, there is clear appetite for male birth control among men and women, promising a high number of potential users if hormonal male birth control became available. Meanwhile the American Chemical Society report that a non-hormonal birth control pill for men could start human trials by the end of 2022. Whether hormonal or non hormonal, an effective male contraceptive could become a reality very soon.

Does birth control protect against a sexually transmitted infection (STI)?

No. Unless you are using a barrier method of contraception like a male condom or female condom, you are not protected against STIs. Non-barrier methods, like oral contraceptives, are very effective at preventing unwanted pregnancies but cannot protect you from STIs. The only way to be protected against pregnancy and sexually transmitted infections is by using a condom.

If you are in an exclusive relationship, it may be beneficial for you both to get an STI test so you can be sure that you are not putting yourself at any risk by not using a condom.

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

A recent study of 2,000 women who were trying to conceive after taking the birth control pill for at least seven years was carried out by the European Active Surveillance Study. Researchers found:

• 21% were pregnant within one menstrual cycle after stopping the contraceptive pill
• 79% were pregnant within one year of stopping the contraceptive pill
• 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 permanent effect on fertility. So why does the belief persist that birth control pills can cause infertility?

The explanation may be down to another common misconception about birth control pills: that they regulate your menstrual cycle. They may appear to, but it is important to remember that controlled levels of synthetic hormones create a ‘false’ regularity. If your periods were irregular before taking the pill, then this irregular pattern will return once you stop. It may be possible that the pill was disguising an underlying problem, which could only come to light when you stop using it. Many young women start taking the pill during their teenage years, as it is often prescribed to alleviate heavy or very painful periods and improve acne. For this reason, women come off the pill when they’re ready to start a family without knowing their natural cycle.

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. Give your body time to recover. If you’re not pregnant within a year, or six months if you are over 35, you should seek fertility advice. Don’t forget that fertility issues do not only affect women: male infertility is equally as common. It is important to have a fertility 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. While birth control 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 connect to one of our Virtual Open Evenings and learn more about our flagship London clinic? If you would prefer to speak to one of our fertility specialists, book an appointment by calling 0800 52 00 161, or get in touch through our online contact form and we will call you back.