Being on hormonal contraception (HC) for many years will make you infertile.
FALSE: We have a significant amount of evidence at this point to refute this idea. A 2018 meta-analysis that examined 22 studies on over 14,000 women found that contraceptive use, regardless of duration and type, had no negative impact on future fertility (1). In fact, some forms of HC can help offset the negative effects of certain conditions that impact fertility, such as endometriosis or PCOS. (2)
You can’t get pregnant until months after discontinuing HC.
FALSE: While it takes some women a few months to regulate and resume ovulation, it is possible to get pregnant immediately following discontinuation of birth control. Studies have shown that HC did not significantly increase time to conception once discontinued (1). It is recommended to continue birth control until you desire pregnancy.
Hormonal birth control can impact fertility testing.
TRUE: Fertility testing often includes hormone blood tests and an ultrasound. When you are on HC, you may not be going through your normal hormonal cycle, which can make some of these tests unreliable. AMH and AFC can be done when you are on HC. However, studies have found that AMH and AFC may be artificially low in patients on long-term HC. (3,4) This ovarian suppression is reversible with discontinuation of the HC, and increases in AMH and AFC are seen within 2-6 months. (3,4)
You cannot do an egg freezing cycle while on birth control.
TRUE & FALSE: The answer is, it depends on the type. Most forms of hormonal birth control need to be discontinued prior to the beginning of an egg freeze cycle. Patients who have been on long-term HC may benefit from a 3-6 month discontinuation in order to improve oocyte yield. (4,5) Patients with an IUD (hormonal or non-hormonal) may choose to keep their IUD in during the cycle, however if there is evidence of ovarian suppression on the hormonal IUD, outcomes may improve with removal.
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1. Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018 Jul 23;3:9. doi: 10.1186/s40834-018-0064-y. PMID: 30062044; PMCID: PMC6055351.
2. Grandi G, Barra F, Ferrero S, Sileo FG, Bertucci E, Napolitano A, Facchinetti F. Hormonal contraception in women with endometriosis: a systematic review. Eur J Contracept Reprod Health Care. 2019 Feb;24(1):61-70. doi: 10.1080/13625187.2018.1550576. Epub 2019 Jan 21. PMID: 30664383.
3. Letourneau JM, Cakmak H, Quinn M, Sinha N, I Cedars M, Rosen MP. Long-term hormonal contraceptive use is associated with a reversible suppression of antral follicle count and a break from hormonal contraception may improve oocyte yield. J Assist Reprod Genet. 2017 Sep;34(9):1137-1144. doi: 10.1007/s10815-017-0981-8. Epub 2017 Jul 1. PMID: 28669055; PMCID: PMC5581794.
4. Landersoe SK, Birch Petersen K, Sørensen AL, Larsen EC, Martinussen T, Lunding SA, Kroman MS, Nielsen HS, Nyboe Andersen A. Ovarian reserve markers after discontinuing long-term use of combined oral contraceptives. Reprod Biomed Online. 2020 Jan;40(1):176-186. doi: 10.1016/j.rbmo.2019.10.004. Epub 2019 Oct 15. PMID: 31831368.
5. Fox CW, Stanhiser J, Quaas AM. Evidence of profound ovarian suppression on combined hormonal contraception resulting in dramatically different ovarian reserve testing and oocyte retrieval outcomes: case report and review of the literature. F S Rep. 2020 Sep 2;1(2):94-98. doi: 10.1016/j.xfre.2020.05.007. PMID: 34223224; PMCID: PMC8244261.
6. literature. F S Rep. 2020 Sep 2;1(2):94-98. doi: 10.1016/j.xfre.2020.05.007. PMID: 34223224; PMCID: PMC8244261.