Fertility after the pill

I recently referenced a NY Times article summarizing a study showing a link to stress and fertility problems.   As an Internist and Primary Care Physician, I am often asked fertility questions by my patients that are trying to conceive.  “I’ve been on the pill for years and now I want to get pregnant.  Will it be hard for me to conceive?” is an incredibly common question.  The answer depends on many factors.   The main determinants of fertility are age and the regularity of ovulation before and after oral contraception use.

Does duration of pill use affect fertility?

The amount of time a woman used oral contraceptives prior to attempting conception has little to do with time to recovery of their prior cycle.  Most physicians recommend waiting for a cycle off the pill before attempting conception, however, it is possible to get pregnant right away.  Therefore, if you do not wish to get pregnant right away, an alternative, non-hormonal, method of contraception is recommended.

Oral contraceptives use hormones to suppress ovulation.  If a woman does not ovulate, she can not get pregnant.  Once oral contraceptives are stopped, the hormones from the pill are out of the system in 3-4 days.  After that, the body’s own hormonal rhythm takes over.  So, if a woman had a regular ovulatory cycle before starting the pill, it is reasonable that she will resume that cycle shortly after stopping.  If the pill was being used to regulate an irregular cycle, then the ovulatory issues that existed prior to the pill will need to be addressed after the pill.

Fertility after the pill is mostly determined by fertility prior to the pill.  Duration of oral contraception use is not a major factor.  It takes the average couple about 8 months to conceive, so fertility testing prior to 1 year of attempting conception is not recommended unless there is an underlying issue that may be contributing to infertility.

How does this affect my practice?

A good history about why a person was using the pill, determining any risk factors for fertility issues is most important in answering the question of “will I have fertility issues after the pill?”  Once a sense of how regular a woman was before starting the pill, we can begin to predict what issues, if any, may need to be addressed.  A conversation with your doctor can lead to a plan, alleviate stress and allow you to enjoy the journey to a new part of your life.

The path to wellness begins with a proper diagnosis