From the Guidelines
The patient should have the Nexplanon implant removed as soon as possible to allow for conception, considering her desire to get pregnant. After removal, fertility typically returns quickly, often within days to weeks, as the implant's effectiveness is primarily due to its ability to prevent ovulation, which resumes shortly after removal 1. Given the patient's history of an ectopic pregnancy 6 months ago, it would be advisable to wait until she has had at least one normal menstrual cycle after Nexplanon removal before attempting conception. This allows time to establish a baseline for ovulation tracking and ensures the body has adjusted after contraceptive removal.
- Key considerations for the patient include:
- Starting prenatal vitamins containing folic acid (400-800 mcg daily) before conception to reduce the risk of neural tube defects
- Early prenatal care due to her increased risk (10-15%) of experiencing another ectopic pregnancy
- Scheduling an early ultrasound (around 6-7 weeks) once pregnancy is confirmed to verify the pregnancy's location in the uterus
- Discussing specific risk factors that contributed to her previous ectopic pregnancy with her healthcare provider to address any modifiable factors before conception. The American College of Obstetricians and Gynecologists (ACOG) and the CDC support the use of contraceptive implants like Nexplanon, but in this case, removal is necessary for the patient to conceive 1.
From the Research
Fertility After Nexplanon Removal
- Persons will experience a rapid return to fertility once the Nexplanon implant is removed 2.
- The Nexplanon implant exerts its contraceptive effects primarily by suppressing ovulation, and its removal allows for a return to normal ovulation and fertility 2.
Ectopic Pregnancy and Fertility
- A history of ectopic pregnancy is a risk factor for future ectopic pregnancies 3.
- However, having had an ectopic pregnancy does not necessarily affect fertility, and many women are able to become pregnant again after an ectopic pregnancy 3.
Nexplanon Removal and Pregnancy
- Nexplanon removal is a simple office-based procedure, and women can try to become pregnant immediately after removal 2.
- However, in some cases, Nexplanon removal can be difficult, especially if the implant has migrated or is deeply placed 4, 5.
- Women who have had difficulty with Nexplanon removal or have experienced complications may need to consult with a healthcare provider before trying to become pregnant 4, 5.
Precautions and Considerations
- Women who have had an ectopic pregnancy should be aware of the risks of future ectopic pregnancies and should seek medical attention immediately if they experience any symptoms of pregnancy or ectopic pregnancy 3.
- Healthcare providers should be trained in Nexplanon insertion and removal to minimize the risk of complications and difficulties 2, 5.