No, Birth Control Does Not Cause Infertility When Started During Teenage Years
Hormonal contraception initiated during adolescence is completely reversible and has no negative effect on long-term fertility. 1 This is one of the most well-established facts about birth control pills, which are among the best-studied medications ever prescribed.
The Evidence is Clear and Reassuring
The American Academy of Pediatrics explicitly states that combined oral contraceptives (COCs) are "completely reversible and with no negative effect on long-term fertility" and are "a safe option throughout a woman's reproductive years." 1 This applies regardless of when contraception is started, including during the teenage years.
What the Research Shows
Multiple high-quality studies support this conclusion:
Combined oral contraceptives may actually be protective: A large case-control study found that OC use was associated with a lower frequency of primary infertility, particularly among younger women (age ≤20 years). 2 Both higher and lower estrogen dose formulations were associated with decreased risk of primary infertility.
No increased risk of ovulatory infertility: A nested case-control study within a cohort of 116,686 nurses found no statistically significant increased risk of ovulatory causes of delayed fertility among ever-users of oral contraceptives (relative risk 1.2,95% CI 0.7-1.9). Importantly, 88% of cases with delayed fertility eventually achieved pregnancy, confirming that absolute fertility was not impaired. 3
No effect from duration or age at first use: There is no trend of increasing infertility risk with increasing duration of use or younger age at first use. 3
Understanding Temporary Delays vs. Permanent Infertility
It's important to distinguish between temporary delays in return to fertility and permanent infertility:
Injectable Contraception (DMPA/Depo-Provera)
- DMPA is associated with a delayed return to fertility, typically 9-18 months after the last injection 11
- This delay is temporary while the endometrial lining returns to its pre-DMPA state and ovulation resumes
- This does not represent permanent infertility—fertility does return 1
- For adolescents, this delay "does not usually pose a major deterrent to using this method" 1
All Other Hormonal Methods
- Pills, patches, rings, implants, and IUDs: fertility returns rapidly after discontinuation
- Studies demonstrate "a rapid return to fertility after IUD removal" 4
Additional Benefits for Future Fertility
Oral contraceptives actually provide protective effects on future fertility:
- 50% decrease in risk of pelvic inflammatory disease (PID) 5, which is a leading cause of tubal infertility
- Protection against endometrial and ovarian cancers when used for more than 3 years 1
- These benefits represent "an excellent rationale for prescribing the Pill for young women who are sexually active" 5
Common Pitfalls to Avoid
Don't confuse correlation with causation: Some studies show associations between contraceptive use and certain outcomes, but this doesn't mean contraception causes these problems. For example, one study 6 found correlations between OC use and negative outcomes, but this likely reflects selection bias—sexually active teens who use contraception are already at higher risk for STIs and pregnancy simply because they're sexually active, not because of the contraception itself.
Don't delay contraception based on fertility concerns: The risks of unintended teenage pregnancy far outweigh any theoretical concerns about future fertility. The mortality risk from childbirth for teenagers is 11.1 deaths per 100,000 live births, while the risk of death from oral contraceptive use for teenagers is "virtually nil." 7
Bottom Line for Clinical Practice
When counseling adolescents and their families:
- Reassure them definitively: Hormonal contraception does not cause permanent infertility, regardless of age at initiation
- Emphasize the protective benefits: OCs reduce PID risk, which actually protects future fertility
- Address DMPA specifically: If discussing injectable contraception, explain that the 9-18 month delay in return to fertility is temporary, not permanent
- Focus on the real risks: The serious health risks come from unintended pregnancy, not from contraception use
The evidence from major medical organizations 1118 and multiple research studies 2357 consistently supports that hormonal contraception—including when started during teenage years—does not cause infertility.