From gaining weight to going through mood swings to losing your libido, there are lots of claims floating around about the contraceptive pill. Some are true (yep, you might find yourself a little more emotional in the months after you start taking oral contraceptive pills) while others are total myths.
But what about your fertility? Is it fact or fiction that the pill can cause you to become infertile?
The short answer is, hormonal contraceptives, like the pill, absolutely don't lead to long-term infertility. But the long answer is a bit more in-depth.
Here’s what you should know about the link between the pill and fertility, and if not oral contraceptives, what actually makes someone infertile.
What is infertility?
You might already be familiar with the concept of infertility. If not, it basically refers to an inability to get pregnant.
According to the World Health Organisation though, its official definition is “a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse” [1].
Infertility can affect both males and females, and it’s not exactly uncommon. In fact, about 1 in 6 Aussie couples of reproductive age have some degree of fertility issues.
For 2 in 5 couples, infertility is caused by a sperm problem, another 2 in 5 because of a complication with the female reproductive system, and for the rest it can be due to a mix of circumstances or no known cause [2].
Yep, that’s right — the pill definitely isn’t a factor in infertility. We’ll dive into more detail shortly.
How does the pill work?
Before we get into the nitty-gritty of the pill, it’s helpful to know exactly what’s going on with your reproductive system each month.
Every month or so, as part of your menstrual cycle, your body gears up for a potential pregnancy. It does this by releasing a mature egg from 1 of your ovaries — a process known as ovulation that happens roughly 2 weeks before your period.[3]
Next, the egg travels down 1 of your fallopian tubes where it hangs out waiting for sperm. During unprotected sex, sperm travel from your vagina up through your cervix (the opening to your uterus) to meet the egg sitting in your fallopian tubes.
After that, the egg heads towards your uterus. If it’s met any sperm en route, it’ll arrive in your uterus fertilised. If not, the egg gets reabsorbed by your body [4].
The pill is a type of birth control that contains a couple of hormones — oestrogen and progestogen — that work to stop your body from ovulating. If you’re on the pill, your ovaries won’t release an egg each month. The pill also makes it really hard for sperm to get into your reproductive system by making the fluid around your cervix thicker [5].
Does being on the pill affect fertility?
The whole point of contraception — whether it's an oral contraceptive or another type of hormonal birth control, or a barrier method like condoms — is to prevent pregnancy. So in effect, your fertility is impacted while you’re taking the pill — at least for a period of time.
If you take it correctly — that is, every day — the pill is more than 99% effective at stopping pregnancy [6]. Even if you make the occasional mistake, the odds of getting pregnant are still 93% [5].
This means that while you’re on the pill, it’s almost impossible (or at least very, very difficult) to conceive. So, you can think of the pill as a way of pausing your fertility, not getting rid of it entirely.
Can the pill cause long-term infertility?
We know now that the pill helps halt your body’s ability to conceive. But something you might be concerned about is whether this affects future fertility — either by significantly delaying your ability to get pregnant or making it difficult to get pregnant at all.
The good news is that it doesn’t on either front. The reason you need to take the pill every day is that the hormones within it only remain in your body temporarily. After stopping birth control, it usually only takes about 2 months for your body to return to its normal fertility level [7].
A 2018 review also found that the length of time you use contraception, nor whether you're using non-hormonal or hormonal contraception, doesn’t alter how long it takes for fertility to return [8].
In that same review, results from 22 studies concluded that 83.1% of women who previously used birth control were able to get pregnant within a year of stopping. This isn’t overly inconsistent with overall conception rates, which are between 85-90% within 12 months of trying (different studies have had varying results) [9].
If you’re struggling to get pregnant after being on the pill for a really long time, it’s more likely a result of other infertility causes and not the pill itself.
What causes infertility?
So, if not the pill, what leads to infertility in women? Here are some of the most common causes of fertility problems [1][2].
Age
Age is one of the biggest reasons behind infertility. Over time, it becomes more and more difficult to get pregnant because both your egg supply and egg quality drop.
When you’re in your 20s, you’re at your most fertile. A study found that the chance of conceiving within a year is 85% in your 20s, 75% at age 30, 66% at age 35 and 44% at age 40 [10].
After 35, you also have a higher chance of experiencing miscarriage, stillbirth and genetic abnormalities, along with having a multiple pregnancy (twins or more) [11].
Issues with the reproductive system
Your reproductive system is made up of your vagina, cervix, uterus (AKA the womb), ovaries and fallopian tubes. Issues that affect these can lead to infertility, including [12][13]:
- Polyps, tumours, fibroids or scarring in the uterus
- Cervical abnormalities, or issues with cervical mucus
- Inflammation of the fallopian tubes, which can result in damage or a blockage
- Endometriosis, which can damage the ovaries or fallopian tubes
Hormonal problems
Ovulation happens as a result of hormonal changes, meaning there are some hormonal problems that can interfere with your body’s ability to ovulate.
Polycystic ovary syndrome (PCOS) is one of the most common, where the body’s reproductive hormones are out of balance [14].
Other hormonal issues that can alter fertility include hyperprolactinemia (where too much prolactin, the hormone that helps your body produce breast milk, affects ovulation), and having an overactive or underactive thyroid [12].
Another ovulation problem that can cause infertility is Primary Ovary Insufficiency (POI), whereby the ovaries don’t work as they should before a woman turns 40 [15]. With POI, periods are irregular and there’s still a chance of falling pregnant.
Note that this isn’t the same thing as early menopause, which is where periods stop entirely and a woman is totally unable to get pregnant.
If you’re keen to explore your hormones and fertility, you should consider getting a fertility test. at everything from your egg reserve and ovulation cycles, measuring different hormone levels and how they can impact your ability to conceive.
The test is designed to give you a clearer picture of your fertility, arming you with the knowledge you need to make the right decisions for your body.
Sexually transmitted infections (STIs)
A few STIs — namely chlamydia and gonorrhea — can eventually lead to infertility. This is because they’re some of the main causes of pelvic inflammatory disease (PID), and chlamydia in particular is linked to fallopian tube infection.
Both PID and infection can inflict some pretty nasty — and permanent — damage to the reproductive system if left unchecked [16].
Health reasons
There are several other health problems linked to infertility [12], including being over or underweight (both of these can impact ovulation), going through cancer (including undergoing chemo or radiation), and some autoimmune disorders including Hashimoto’s, lupus and rheumatoid arthritis — all of which may cause inflammation in the uterus or placenta [17].
Lifestyle factors
Several lifestyle factors increase the risk of being infertile, including smoking, heavy drinking, drug use, stress, poor nutrition and overexercising.
How long after stopping the pill can I get pregnant?
There’s no single answer to this one. In theory, you could get pregnant right after coming off oral contraceptives but there’s a very low chance of that happening.
This is because your natural menstrual cycle needs to resume after you stop taking it, thus bringing your body back to its usual fertility level. In most cases, this process takes about 2 months, but it could be shorter or longer [7].
If you're worried about conceiving too early after coming off the pill and the effect it’ll have on your baby, you can rest easy. There’s actually no conclusive evidence that previously taking the pill harms your unborn bub [18]. And even if, on the off chance, you do get pregnant while you’re on the pill, there’s an incredibly low risk of anything bad happening to your baby [19].
Feeling a little more confident about getting on the pill? Kin’s contraceptive pill subscription makes taking the pill simple, with speedy and dependable delivery so you never run out, unlimited GP consults, and a regular digest of handy resources on everything fertility and reproductive health.
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