Return of Ovulation After Nexplanon Removal
Ovulation returns rapidly after Nexplanon removal, typically within the first month, with most women resuming normal ovulatory cycles immediately.
Timing of Ovulation Return
Ovulation resumes promptly after Nexplanon removal, with fertility returning to baseline levels without delay 1, 2.
In a prospective study monitoring ovarian function after etonogestrel implant (Implanon/Nexplanon) removal, ovulation was documented to resume within the first 6-week monitoring period following removal 2.
Research demonstrates that 40% of women experience return of ovulation within one month of removal, and the vast majority (95.8%) conceive within 12 months if attempting pregnancy 3.
Contraceptive Mechanism and Reversal
Nexplanon works primarily by suppressing ovulation through continuous progestin release 1, 2.
During use, ovulation is consistently inhibited—in one study, the first ovulation with Implanon was not observed until after 30 months of use, demonstrating robust ovarian suppression 2.
Once the implant is removed, the contraceptive effect ceases immediately as etonogestrel levels drop rapidly, allowing the hypothalamic-pituitary-ovarian axis to resume normal function 1.
Fertility Outcomes After Removal
Fertility returns rapidly following implant removal, with pregnancy rates of 76-100% within one year after removal—rates that are no different from discontinuation of any other contraceptive method 4.
In a Chilean study of 87 women desiring pregnancy after Norplant removal (similar progestin implant), cumulative conception probability was 25% at one month, 49% at three months, 73% at six months, and 86% at twelve months 5.
There is no correlation between the length of implant use and the interval from removal to conception, meaning prolonged use does not delay fertility return 5.
Clinical Implications
Women should be counseled that they can become pregnant immediately after Nexplanon removal and should use alternative contraception right away if pregnancy is not desired 1.
If pregnancy is desired, attempts can begin immediately after removal without any waiting period 3, 4.
Age may affect time to conception after removal: women older than 30 years show a higher frequency of intervals longer than 6 months compared to younger women, though this reflects normal age-related fertility decline rather than implant effects 5.
Important Caveats
The rapid return of fertility is a key counseling point—there is no "washout period" needed as with some other hormonal methods like depot medroxyprogesterone acetate (DMPA), which can have delayed return of ovulation for 15-49 weeks after the last injection 6.
Pregnancy outcomes after Nexplanon removal are normal, with no increase in ectopic pregnancy risk, fetal malformations, or impaired infant health 4.