27th July 2012 | by Dr. Stephen Hudson
What contraceptives can impact fertility? Will I be infertile if I’ve been on Depo-Provera for over 5 years?
Written by our medical expert Stephen Hudson, M.D.
Previous contraceptive use may impact future fertility – though thankfully this is usually in a positive rather than negative way. Previous use of Depo Provera may delay resumption of normal fertility though will not negatively effect long term chances of a successful pregnancy. These issues will be discussed in more detail below.
The common contraceptives include the following:
- Barrier methods such as condoms and the diaphragm.
- The birth control pill, patch and vaginal ring.
- Depo Provera and Norplant.
- The IUD (intra uterine contraceptive device – IUCD).
In this group condoms are the mostly widely used. Condoms are protective against sexually transmitted infections (STIs), so condoms can help protect the fallopian tubes from infection and potential damage.
Diaphragms are similar.
The birth control pill (BCP), Patch and vaginal ring (Hormonal contraception)
The BCP, contraceptive patch and vaginal ring are all “hormonal” in their action, and all work in a similar way. They contain both estrogen and progesterone. They all suppress ovulation (by suppressing the pituitary gland) and secondly they thin the lining of the uterus (endometrium) making it inhospitable to implantation by an embryo. Contrary to popular opinion, there is seldom any delay to fertility after stopping the BCP. In fact before fertility treatments such as IVF we commonly use the BCP to temporarily suppress the ovaries and allow for better recruitment of new healthy eggs.
Likewise there does not seem to be any relationship between the time the BCP has been used and future fertility. However – after taking the BCP there may be other factors that impair future fertility – the most important being age. This means that if a woman was to take the BCP for 5 years before trying to conceive, there will be a significant age difference. You will see the age related effects on fertility in the graph below.
I would like to add that hormonal contraception may also have a protective effect on fertility by thickening the mucus at the cervix and thinning the lining of the uterus (endometrium), both effects which may protect against STIs. All hormonal forms of contraception also have the added benefit of suppressing endometriosis – which is a condition commonly associated with infertility.
Depo Provera (DP) and Norplant (NP)
Both DP and NP are also hormonal forms of contraception (progesterone only – no estrogen). DP is given as an injection every 3 months, and NP comes as small rods which are injected under the skin and provide contraception for up to 5 years. DP has been more popular. They both suppress ovulation and thin the lining of the uterus (endometrium).
The majority of women who use DP stop having periods (called amenorrhoea) which many women appreciate. After stopping DP there can however be a delay until ovulation and monthly cycles resume. The average time it takes after the last DP injection until ovulation and menses resume is 9 months. By 18 months, as many women are pregnant after using DP as are women who discontinued other forms of contraception. The time that someone has used DP (eg 1 year or 5 years) makes no difference.
However because there can be this delay in return to fertility my preference is that women who are over 33 – 34 years of age, and who may be planning a pregnancy, use other forms of contraception.
Neither DP nor NP should have any long term negative effects on future chances of having a baby.
There are 2 types of IUDs – ones which release a hormone called progesterone and ones which don’t. There was a specific IUD design in the 1970s which was found to increase the chance of uterine and tubal infection, so IUDs went out of favor for many years. However the design flaw has been corrected and they are once again available, safe and effective.
The progesterone releasing IUCD (the MIRENA) is an excellent contraceptive and is also used extensively to treat heavy painful periods and endometriosis.
With the non hormone releasing IUDs there may be an increased risk of pelvic infection with exposure to the STIs, although this does not occur with the Mirena.
After using an IUCD there should be almost immediate return to normal expected fertility – unless some complication such as infection has occurred in the meantime.
As you have read, most forms of available contraception do not have a negative effect on future fertility – and in fact carry beneficial protective effects. Another beneficial use of the BCP and DP is that they are both protective against future chances of ovarian cancer.
One rare exception following long term use of hormonal contraception is a condition called “hypothalamic amenorrhoea.” This is very uncommon and has to be treated with fertility drugs to help a woman start ovulating again.