Does birth control cause infertility?

Birth Control Does Not Cause Permanent Infertility

Birth control methods do not cause permanent infertility, though some methods may temporarily delay return to fertility after discontinuation. The evidence consistently demonstrates that fertility returns to baseline levels comparable to women who never used contraception, though the timeline varies by method 1, 2, 3.

Return to Fertility by Method

Oral Contraceptives (Pills, Patch, Ring)

• 12-month conception rates after stopping oral contraceptives range from 72-94%, which is comparable to women discontinuing other methods 1.
• There may be a slight initial delay in conception during the first few months after stopping, but this effect becomes negligible by 30-42 months 2.
• No evidence exists that duration of use or age at first use affects long-term fertility 4.
• Among women diagnosed with temporary ovulatory infertility after stopping oral contraceptives, 88% eventually achieved pregnancy, confirming that absolute fertility was not impaired 4.

Injectable Contraceptives (Depo-Provera)

• Median delay to conception is approximately 9 months after the last injection (5.5 months plus the 15-week duration of the medication's effect) 5.
• The FDA label for Depo-Provera specifically addresses delayed return to fertility as an expected effect, not permanent infertility 6.
• Prolonged use does not increase the delay before conception, and nulliparous women have similar fertility return as parous women 5.
• 12-month conception rates are comparable to other methods once the medication effect wears off 1.

Intrauterine Devices (IUDs)

• Median delay to conception is 4.5 months after IUD removal 5.
• 12-month conception rates range from 71-92%, similar to oral contraceptives and other methods 1.
• While there is a theoretical very small risk of tubal damage from infection, epidemiological studies do not show increased infertility rates overall 3.

Barrier Methods and Natural Family Planning

• No significant effect on subsequent fertility 3.
• Barrier methods may actually be protective against factors that could impair fertility 3.

Key Clinical Points

Reassurance for Patients

• Approximately 85% of healthy couples not using contraception will conceive within one year of regular unprotected intercourse 7.
• Former contraceptive users achieve similar conception rates to this baseline, confirming that modern contraceptive methods do not cause permanent sterility 1, 2, 3.

Common Pitfall to Avoid

• Do not confuse temporary delay in return to fertility with permanent infertility. The initial delay seen with some methods (particularly Depo-Provera and oral contraceptives) is a reversible pharmacologic effect, not reproductive damage 5, 1, 2.

Method-Specific Counseling

• For Depo-Provera users planning pregnancy: counsel that they should expect approximately 9 months from their last injection before conception is likely, and consider discontinuing 12-15 months before desired conception 5.
• For oral contraceptive users: reassure that any delay is typically limited to the first few months, with fertility normalizing thereafter 1, 2.
• For IUD users: fertility returns rapidly, with most women conceiving within 4-5 months 5.