IUD Removal and Return to Fertility
IUDs do not affect fertility after removal—fertility returns rapidly and immediately, with no delay period needed. 1
Evidence for Immediate Return to Fertility
The American Academy of Pediatrics guidelines explicitly state that studies support a rapid return to fertility after IUD removal, whether copper or levonorgestrel-releasing devices. 1 This applies to both nulliparous adolescents and parous women of all ages.
Key Fertility Data After IUD Removal:
No waiting period is required before attempting conception after IUD removal 1
Conception rates are excellent:
Mean time to conception is 4.4-5.9 months, which is comparable to women discontinuing other contraceptive methods or no contraception at all 5, 2
Historical Concerns Have Been Disproven
Past associations between IUD use and infertility in nulliparous women were attributable to sexually transmitted infections (STIs), not the IUD itself. 1 Case-control studies definitively demonstrated this distinction, clearing IUDs of causing tubal infertility.
Important Clinical Points:
Duration of IUD use does not negatively affect return to fertility—even extended use beyond the approved duration shows no impairment 5, 3
Type of IUD (copper vs. levonorgestrel) does not affect fertility outcomes 6, 3
Age at removal is the only factor that influences conception rates, as expected with normal age-related fertility decline 3
Nulliparous women may conceive slightly earlier than parous women after IUD removal 4
Pregnancy Outcomes After IUD Removal
Pregnancy outcomes following IUD removal are generally excellent, with normal rates of:
- Live births: 66.9-83.6% 5, 4
- Spontaneous abortion: 4.4-10.1% (within normal population ranges) 5, 6, 4
- Ectopic pregnancy: 1.8% (not elevated above baseline) 6
Clinical Bottom Line
Counsel patients that fertility returns immediately upon IUD removal with no "recovery period" needed. 1 Women can attempt conception in the first cycle after removal. The only factor affecting time to conception is the woman's baseline fertility status, primarily influenced by age, not by prior IUD use.