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Birth control and infertility?

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Miz asks:

I have been on birth control pills for three years now and I finally got off of them two weeks ago. Now I am scared that I may be sterile. It really scares me because I don't want to be infertile. Is there a way for me to find out if I will be able to become pregnant?

Sarah replies:

There has been no reliable data to indicate that the hormonal birth control available today causes infertility (contrary to what certain groups of individuals who wish to limit women's reproductive choices may say), no matter how long one is on it. So there is really no science to support the idea that birth control would make you sterile.

In fact, some women do become pregnant the cycle after stopping hormonal contraceptives. On average though, it'll takes around three months for your body to adjust to being off the contraceptives, so it would be even more likely after that point. (Please note though, this does NOT mean that you should assume you're protected from pregnancy during that early time after stopping birth control. It just means that chances of pregnancy will be increased once you're three months or so out. You should still consider yourself fertile as soon as you stop using the hormonal contraceptives.) Some doctors will suggest waiting at least three months before trying to become pregnant to allow your body to normalize. There is no data to indicate that there is any danger to a woman or a pregnancy if conception occurs prior to that three month period, but it may be easier and less stressful if you're having regular cycles again before you begin trying to conceive. Some women may find that it takes longer for their cycles to normalize (6 months to a year, in some cases, and rarely longer than that). This does not mean that the contraceptives are causing infertility, just that the body needs some time to adjust.

So if you're hearing things about "birth control causing infertility," it's often being said by people who are interested in scaring women out of using contraception.

There are also some people who may have told you that they had problems becoming pregnant that were caused by birth control. Of course, we do not want to discount anyone's experience, but there can certainly be some misunderstanding associated with these instances. Unless a woman has actively tried to become pregnant with a given partner prior to going on birth control, how are we to know that there was not an underlying fertility issue that was there before they ever began using the hormonal contraceptives? We don't know about that. So in many cases, there may have been another issue there beforehand.

Also, it's important to understand that while we do know a lot about reproduction, we don't know everything. In fact, we're light years from knowing exactly how everything works. Things have to be exactly right and coincide precisely for a pregnancy to occur. It's both as simple, and as complicated, as a sperm and an egg meeting. And sometimes other things (like aspects in our environment or diet or other medications) may change what's going on in the body in ways that we can't even measure. Fertility issues are also not always related to a woman, they can just as easily have to do with a male partner. Or, if you're trying to conceive without doing something like charting so that you make sure that attempts to conceive occur at the right time in your cycle, you may find that it takes longer because intercourse may not be timed with your ovulation. Any (or many) of these thing can coincide and cause it to take longer to become pregnant. Somewhere around 85% of women using no contraceptives during a given year will become pregnant, on average. It may only take a short time, it may take a longer time...it's impossible to guess exactly how long the process may be.

If you're concerned about your fertility, the best thing to do is talk with your health care provider. Every menstruating woman should be getting reproductive health care on a regular basis. Your care provider will be able to look at your overall health, reproductive health, and health/family history and help you know whether fertility may be an issue for you or what you can do to increase your chances of conception if you wish to become pregnant. If you have any underlying issues, they will be able to help you figure out how to treat those.

However, worrying about fertility just because you're been on hormonal birth control isn't really necessary. Consider the number of women in the world who have used hormonal contraceptives...that number is pretty darn high. If it caused sterility, lots of people would have noticed by now and it's something we would have heard a lot about.

You may want to check out the following for more information:

written 19 Jul 2008 . updated 20 Jul 2008

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