IUD Use Does NOT Cause Infertility After Removal
Chronic IUD use—whether hormonal (levonorgestrel) or copper—does not cause difficulty conceiving after removal, and fertility returns immediately without any waiting period required. 1
Evidence from Guidelines
The American Academy of Pediatrics clearly states that studies support rapid return to fertility after IUD removal for both copper and levonorgestrel-releasing devices, regardless of whether women are nulliparous adolescents or parous women of all ages. 1 This is the highest quality guideline evidence available and directly addresses the concern.
Key guideline facts:
- No waiting period is necessary before attempting conception after IUD removal, as fertility returns immediately 1
- Past associations between IUD use and infertility in nulliparous women were due to sexually transmitted infections (STIs), not the IUD itself 1
- Women should be counseled that fertility returns immediately upon IUD removal with no "recovery period" needed 1
Supporting Research Evidence
Multiple prospective studies confirm these guideline recommendations:
- A Norwegian study of 205 women found that 93.6% of women who removed their copper IUD to become pregnant successfully conceived, with time to conception unaffected by duration of IUD use, parity, or age at removal 2
- A prospective study of 600 women using copper IUDs found that all 97 women planning pregnancy had conceived within 39 months after removal, with only 1.8% experiencing ectopic pregnancy (similar to baseline population rates) 3
- A Yugoslav study of 540 women found no relationship between duration of IUD use or type of IUD and time to conception; only increasing age and history of pelvic inflammatory disease decreased monthly probability of conception 4
- A comparative study showed that copper IUD users actually had more rapid return to fertility compared to inert IUD users, with 3 times higher net cumulative probability of pregnancy in the first 3 months after removal 5
Important Caveats
The only factors that genuinely affect post-IUD fertility are:
- History of pelvic inflammatory disease (PID), which decreases monthly probability of conception regardless of IUD use 4
- Increasing maternal age, which naturally decreases fertility independent of contraceptive method 4
- Underlying STIs, which were historically misattributed to IUD use itself 1
Clinical Bottom Line
When counseling patients concerned about future fertility:
- Reassure them that both copper and levonorgestrel IUDs do not impair subsequent fertility 1, 3, 2
- Emphasize that fertility returns immediately upon removal with no delay needed before attempting conception 1
- Explain that any historical concerns about IUD-related infertility were due to untreated STIs, not the device itself 1
- Identify actual risk factors (age, history of PID) rather than attributing concerns to IUD use 4
The evidence is consistent and clear across both guidelines and research: IUDs are safe, effective contraception that do not compromise future fertility.