Fertility After Mirena IUD Removal
Fertility returns rapidly after Mirena (levonorgestrel-releasing IUD) removal, with no impairment to conception rates—women can attempt pregnancy immediately after removal.
Return to Fertility Timeline
Fertility recovery is essentially immediate following Mirena removal. 1 The levonorgestrel-releasing IUD causes only local endometrial effects, and removal results in quick return of both menstrual bleeding and fertility. 1
Evidence-Based Conception Rates
The data on IUD removal and fertility return is reassuring:
- Within 12 months after IUD removal: 77.4% of women who discontinued the 52-mg levonorgestrel IUD specifically for pregnancy achieved conception 2
- Cumulative pregnancy rates after any IUD removal: 61.5% at 3 months, 87.9% at 6 months, 92.3% at 12 months, and 96.7% at 18 months 3
- Mean time to conception: 4.4 months (range 1-18 months) after IUD removal 3
These rates demonstrate that IUD use does not impair fertility as a spacing method. 3
Clinical Management at Removal
Standard Removal Procedure
The CDC recommends locating the IUD strings during speculum examination and removing the device by pulling gently on the strings. 4
Key procedural points:
- Simple string traction is the standard technique for removal when strings are visible 4
- No waiting period is required before attempting conception after removal 1
- Counsel the patient to return promptly if she experiences heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever after removal 4
Duration of Prior Use Does Not Matter
Extended duration of IUD use does not negatively affect return to fertility or pregnancy outcomes. 5
- Women using the Mirena for up to 8 years showed excellent fertility return 2
- Even extended use beyond 3 years showed average conception intervals of only 4.15 months 5
- Length of IUD use does not affect pregnancy outcomes or offspring health 5
Pregnancy Outcomes After Removal
Pregnancy and offspring outcomes after Mirena removal are generally excellent. 5
- The vast majority of pregnancies progress to term with normal birth weights 5
- No evidence suggests increased risk of congenital abnormalities related to prior levonorgestrel IUD use 5
- Spontaneous abortion rates are not elevated compared to baseline populations 5
Important Counseling Points
Immediate Contraceptive Effect Cessation
Contraceptive protection ends immediately upon removal—if the patient is not ready to conceive, alternative contraception should be offered at the time of removal. 4
Menstrual Pattern Normalization
Regular menstrual bleeding typically returns quickly after removal. 1 Women who experienced amenorrhea with the Mirena (approximately 50% by 2 years of use) should expect return of menses, though the first cycle may be irregular. 6
No "Washout Period" Needed
Unlike some hormonal contraceptives, there is no medical reason to delay conception attempts after Mirena removal. 1 The local hormonal effects resolve rapidly, and systemic hormone levels were minimal during use.
Common Pitfalls to Avoid
- Do not counsel patients that they need to wait before trying to conceive—this is unnecessary and delays family planning 1
- Do not assume longer IUD use means delayed fertility return—duration of use does not impair subsequent fertility 2, 5
- Do not fail to offer immediate alternative contraception if the patient is removing the device for non-fertility reasons 4