• Breanna Failla

Birth Control Before Baby

I’m planning on getting pregnant and having a baby in the future. When should I stop my birth control?

First, let’s go over the basics. In order to become pregnant, you must be able to ovulate. Ovulation is the release of an egg from the ovaries. After the egg is released, it travels down the fallopian tube where it might be fertilized by a sperm cell. So, the ability to ovulate determines fertility. The way most methods of contraception work is by suppressing the process of ovulation and the way it is done can differ between types of birth controls. Depending on which method you decide to use, the return to fertility time (the time it will take to become pregnant) may differ. Let’s review the common methods of birth control and expected return to fertility.

Birth Control Methods Without Hormones

Non-hormonal methods of contraception such as male condoms, female condoms, diaphragms, or spermicide do not suppress the process of ovulation. Instead, these methods block sperm from getting to the egg. Since ovulation is not affected by these products, once you stop using them, it usually takes 1-3 cycles for a young female to become pregnant.,

Another example of a non-hormonal method is the copper IUD (Paragard®). After removal of the IUD, return to fertility can happen within the first month, but may take longer depending on the patient.

Birth Control Methods With Hormones

Hormonal contraceptives such as combined hormonal contraceptives (CHCs), progestin-only pills (POPs), transdermal patches, vaginal rings, and hormonal IUDs (example Mirena®) work by blocking ovulation. These methods have a short return to fertility, which averages about 1-3 menstrual cycles.

The progestin-only implant (Nexplanon®) works by releasing progestin over a 3-year period before having to be replaced. However, it can be removed at any time during that 3-year period. After removal, most women will resume ovulation in about 3-4 weeks.

The Depo-Provera® shot is injected every 3 months and works to suppress ovulation. On average, after they received the last desired shot, women were able to get pregnant within 10 months according to the manufacturer of Depo-Provera. Most (93%) in the study conducted by the manufacturer became pregnant after 18 months. So, unlike the other methods of contraception, Depo-Provera is important to stop well-ahead of any planned pregnancy. Depo-Provera is not recommended for patients that want to get pregnant soon after its discontinuation.

In Summary

If you are considering becoming pregnant in the future the main thing to remember when stopping any form of contraception is the return to fertility time. According to guidelines published by the American College of Obstetricians and Gynecologists, it is also important to remember that ALL women of child-bearing potential should take a folic acid supplement daily, even while on birth control. You can work with your doctor or pharmacist to establish these timelines and pick your preferred method.

References:

1. Barnhart, K. T., & Schreiber, C. A. (2009). Return to fertility following discontinuation of oral contraceptives. Fertility and Sterility,91(3), 659-663. doi:10.1016/j.fertnstert.2009.01.003

2. Bayer HealthCare Pharmaceuticals Inc (2000). MIRENA (levonorgestrel-releasing intrauterine system) [Package insert]. Whippany, NJ

3. Martin, K. A., & Barbieri, R. L. (2018, September 25). Overview of the use of combined estrogen-progestin oral contraceptives. Retrieved from www.uptodate.com

4. Pharmacia & Upjohn Company (2002). Depo-Provera Contraceptive Injection (medroxyprogesterone acetate injectable suspension) [Package insert]. Kalamazoo, MI

5. Stacey, D. (2018, October 7). When Does Fertility Return After Stopping Birth Control? Retrieved from https://www.verywellhealth.com/when-does-fertility-return-after-stopping-birth-control-4056322

6. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 187: Neural Tube Defects. Obstet Gynecol. 2017;130(6):e279-e290. doi: 10.1097/AOG.0000000000002412.[PubMed 29189693]


About the Author:

Yana Kalendareva, PharmD is a recent graduate of the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.


Article reviewed by Breanna Failla, PharmD Candidate and Brooke Griffin, PharmD, BCACP


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