Does Oral Hormonal Birth Control Affect Fertility?
Oral hormonal birth control does not have a negative long-term effect on fertility, with most women returning to their normal fertility within 1-3 months after discontinuation. 1, 2
Return to Fertility After Discontinuation
Timeline for Fertility Return
- Most women (57%) conceive within 3 months after stopping oral contraceptives 3
- 81-83% of women conceive within 12 months after discontinuation 3, 2
- By 13 months, approximately 86% of women have conceived 3
Comparison to Other Contraceptive Methods
- 12-month conception rates for former oral contraceptive users (72-94%) are similar to those observed in women discontinuing:
- Intrauterine devices (71-92%)
- Progestin-only contraceptives (70-95%)
- Condoms (91%)
- Natural family planning (92%) 1
Factors That Do Not Affect Return to Fertility
Research shows that the following factors do not significantly impact the return of fertility after discontinuation:
- Type of hormonal method (combined vs. progestin-only) 2
- Type of progesterone in the contraceptive formulation 2
- Duration of oral contraceptive use 2, 4
- Extended-cycle or continuous-use regimens vs. traditional cyclic regimens 1, 3
- Age at first use of oral contraceptives 4
Temporary Delay in Fertility
There may be a temporary delay in conception in the first few months after discontinuation:
- This delay is typically limited to the early months following cessation 1
- After allowing for 2 years of suppressed fertility following discontinuation, no increased risk of ovulatory infertility was found (relative risk 1.2,95% CI 0.7-1.9) 4
- 88% of women with initial delays in conception eventually reported pregnancy, suggesting that absolute fertility was not impaired 4
Clinical Implications
Counseling Points for Patients
- Reassure patients that oral contraceptives do not cause long-term fertility problems
- Inform patients that there might be a temporary delay in conception for some women
- If fertility assessment is needed, discontinuation of oral contraceptives for at least 1-3 months is recommended to allow return of normal hypothalamic-pituitary-ovarian function 5
Special Considerations
- Women with pre-existing conditions like polycystic ovary syndrome (PCOS) may experience different patterns of return to fertility, as oral contraceptives are often used to manage PCOS symptoms 6
- Women who are concerned about fertility should be counseled that the absolute rate of conception after discontinuation of oral contraceptives is high and comparable to other contraceptive methods 1, 2
Common Misconceptions
Myth: Long-term use of oral contraceptives causes infertility Fact: Duration of use does not significantly affect fertility return 2, 4
Myth: Extended-cycle or continuous-use regimens delay fertility more than traditional regimens Fact: Return to fertility is comparable between these regimens 1, 3
Myth: Oral contraceptives permanently alter hormone levels Fact: Hormone levels typically return to baseline within weeks of discontinuation