Bcp fertility what is it

Here at The Gynae Centre in London we frequently see patients that have been using hormonal contraceptives for years but are ready to start a family.

They often have concerns about their use of birth control and infertility. However, contrary to the popular myth, Dr Alex Eskander, Consultant Gynaecologist at The Gynae Centre, explains that birth control does not have any lasting effect on fertility levels.

Much research has been carried out into the effect of hormonal contraceptives and whether birth control can harm your fertility. The overwhelming conclusion is that it has no adverse effect on your fertility, but there are a few things that you should bear in mind. The combined pill has many benefits but does also come with risks ; it has been linked to increased risk of depression, blood clots, thrombosis and breast cancer.

Below we have simplified the 28 day menstrual cycle. For women who have longer cycles, this may vary slightly.

This triggers the ovaries to start ripening an egg and producing oestrogen. The oestrogen then signals for your body to start producing Luteinizing Hormone LH. Day Progesterone causes lining of your uterus to thicken in preparation for an egg to implant. Day You experience ovulation about half way through your cycle day At this time the mucus at the entrance to the womb entrance thins to allow sperm through. Women who have used hormonal birth control are just as likely to conceive as women who have never used hormonal contraceptives.

A three-year study of 3, participants found that long-term use of oral contraceptives did not affect their ability to have children in the future. In fact, people who had used combined estrogen and progestin birth control pills for more than two years were found to be more fertile than the study participants who had used them for less time. As with oral medications, studies have also shown that there is no impact on future fertility with other forms of hormonal contraceptive, either.

Whether you choose a vaginal ring, patch, intrauterine device IUD , implant, injection, or birth control pills, your ability to get pregnant later in life should not be affected by these methods. If hormonal contraceptives don't affect fertility, why is there such a persistent myth that they do?

There could be a few reasons. Your menstrual cycles should return within about three months of stopping most forms of hormonal birth control, if not sooner. Even so, depending on the contraceptive used and the individual person, it could take some time for fertility to return. Because of this delay, it may seem like birth control has adversely affected fertility.

The three-year study with thousands of participants found that there may be a short-term fertility delay of two to six months after a person comes off of oral contraceptives. Rings, patches, IUDs, and implants could also have a transient delay of one to three months before fertility returns once you stop using them.

There may be a longer fertility delay with the birth control shot Depo-Provera. It can take up to 22 months—or almost two years—for your menstrual cycles to return after the injection.

A lengthy wait is not the average, but it is important to speak with a healthcare provider about your contraceptive options if you are planning to get pregnant. In regards to oral contraceptives, a long delay of menses that lasts at least six months is referred to as post-pill amenorrhea. Despite its name, this lack of ovulation or anovulation is probably not due to birth control use, but rather an underlying health condition.

They might want to run some fertility tests. Birth control overrides your own body's natural hormonal cycle and creates a "fake" menstrual cycle often including a "withdrawal bleed" that people may refer to as a period.

This medical hormone cycle can mask underlying issues. Even if a person has a health condition that causes anovulation, the birth control cycle can still make it look like they are having regular menstrual cycles.

In other words, if you had irregular periods before starting birth control, you will likely have them again after you stop. Upon discontinuing birth control, you may discover there are other reproductive issues preventing you from getting pregnant. Some health conditions that could result in anovulation or irregular ovulation include:. The longer you wait to address any underlying health conditions, the longer it could take to conceive.

If you experience a lack of menstruation, heavy bleeding, or irregular cycles, speak with a healthcare professional. Another reason people believe long-term birth control use affects fertility has to do with the endometrium and its lining, which is where an embryo would implant during pregnancy.

While there is a study that reported on the relationship between endometrial lining and birth control usage, there is no definitive research that suggests fertility issues. A study published in Obstetrics and Gynecology reported that women who used birth control pills for five or more years were significantly more likely to have thinner endometrial linings. A thin lining could make it difficult for an embryo to implant and result in a pregnancy.

It is important to note, however, that the study patients were already being seen in a fertility clinic and preparing for a frozen embryo transfer. Delay of fertility after termination of contraception remains a big concern for women who are using contraception. Particularly women who ever experienced post pill amenorrhea or fail to become pregnant within expected date of fertility after termination of contraception have speculated contraceptive options cause delayed return of fertility.

Controlling unwanted fertility with highly effective reversible contraception allowed couples to have the number of children they want at the time they want to have. On the other hand fertility delay or impairment as a result of prior contraception use may lead to dissatisfaction and lower contraception use irrespective of actual desire [ 3 — 7 ].

Delayed return of fertility or infertility among previous contraceptive users is commonly linked to their contraceptive use. Therefore, this premise that leads to misconception among family planning users need to be synthesized and tested using the available evidences across the globe. These concerns were also raised by scholars from early reports that Oral Contraceptive use may cause secondary amenorrhea, which is associated with anovulation and reduced reproductive fecundity. However these concerns were disproved from more recent studies partly from development of low dose hormonal contraception, prevention of PID and implementation of scientific technique [ 13 — 16 ].

There are a number of studies and few specific reviews conducted to assess the effect of different forms of contraceptives on subsequent pregnancies. The findings were inconclusive, in some studies contraception shown to have only an initial temporary delay in conception for the first few months after discontinuation [ 13 — 16 ]. While in recent studies no association was observed between contraceptive use and secondary amenorrhea [ 17 — 19 ] except with higher doses of oestrogen [ 20 ].

On the other hand many studies have reported that, the type of intrauterine device as well as duration of use has not been found to be related to fertility return [ 21 ]. Therefore, we aimed to conduct a comprehensive systematic review and meta-analysis through reviewing globally published observational studies on the effect of fertility return after discontinuation of different contraception among married and in union.

Return of fertility is measured in terms of pooled rate of fertility return within 1 year in order to bring conclusive evidence.

So that policy makers and other stakeholder could have synthesized evidence to rely on in decision making on prospect of the problem. Systematic literature search of articles was made. Articles published between and containing information on rate of pregnancy following cessation of reversible contraception were retained for systematic review and meta-analysis.

In addition the reference lists of primary and pertinent review articles were also uploaded into an EndNote XI library EndNote, Carlsbad, CA, USA to identify cited studies not captured by the electronic search and after all checked for duplications. One-year pregnancy rate was used to exclude women who developed secondary infertility. Unable to conceive despite of unprotected sexual intercourse with optimum frequency for 1 year and above is called infertility, but the scope of this review is delayed return of fertility after cessation of contraceptive use.

Therefore, 1 year rate of pregnancy is more informative to assess delayed resumption to fertility than other time scales. The outcome of interest was the rate of pregnancy among modern reversible ex-contraception users.

However studies reporting rate of delivery as the only outcome, Studies published before , studies assessing fertility after abortion or post abortion contraception were excluded.

Also Studies conducted in the same location during the same time period were considered as potential duplicates and therefore excluded from the analysis. Three experts reviewed each article and decided based on the inclusion and exclusion criteria. Titles and abstracts derived through primary electronic search were thoroughly assessed for possibility of reporting pregnancy rates within 1 year period and filtered for potential eligibility.

If needed, and whenever possible, the authors were contacted for clarifications. From each eligible research, the following information was extracted based on the preformed database Excel, Microsoft, format: about author, study participants, studies study design, sample size, study setting , Type of contraception, length of use, year of publication, year of study start and end, eligibility criteria, rate of pregnancy, etc.

All data were extracted independently and in duplicate using a standardized extraction form. Returned abstracts were reviewed and full texts retrieved if they contained relevant information. At the same time, each selected research was assessed for methodological quality and possibility of bias.

The outcome variable rate of pregnancy was defined as the proportion of women who were pregnant within 1 year of contraception discontinuation. Risk of bias in individual studies and across studies was assessed through evaluating reliability and validity of data for each important outcome variables.

Methods used to assess the outcome variable in each study were also used to assess risk of bias. For all studies; the study design, study participants, the outcome, presence of loss to follow up were assessed based on the eligibility criteria and quality assessment check list.

Moreover all studies were prospective studies which employed the same participants and outcome was measured in the same standard. The risk of publication bias and heterogeneity was assessed through the standard statistical approaches. An outcome of interest was rate of pregnancy after discontinuation of contraception before or at 12th month. These were calculated with a random effects model according to the DerSimonian and Laird method [ 23 ]. When heterogeneity between studies was found to be significant, pooled estimates were based on random-effect models and the Hedges method of pooling.

Results were displayed visually in forest plots. From studies initially identified, 22 [ 24 — 44 ] were retained for final analysis based on the inclusion and exclusion criteria and quality assessment.

From the initial search, literatures were identified as abstract, bibliography and full text research from the selected electronic data bases. After reviewing the abstracts, 62 possible researches were transferred to preformed format of endnote, searched for full text research and cleaned for duplications and 32 abstracts of articles were identified for full text review.

The studies enrolled a total of 14, women who discontinued contraception for the sake of pregnancy. Of them discontinued implants, discontinued injectable contraception, women discontinued IUD and 11, discontinued oral contraception. The primary outcome of the studies was rate of pregnancy after discontinuation of contraception at 12 month. Some studies also assessed the possible reasons for delay in resumption of pregnancy. With duplicates, 5 studied implants [ 24 — 29 ], 2 injectables [ 30 , 31 ], 5 oral contraception [ 32 — 36 ] and the rest 12 assessed return of fertility after discontinuation of IUD [ 37 — 43 ].

All included studies were prospective cohort and prospective observational designs conducted in different parts of the world and published between and with English language. The mean exposure time duration of use of implant users extend from Survey characteristics are described in Table 1. The 12 month pregnancy rate following discontinuation of different forms of implant with the intension to have pregnancy was measured in 8 studies with duplicates.

Based on this estimates, Moreover a study reporting exceptionally lower rate of pregnancy With the same hormonal composition ex-injectable contraception users have a pregnancy rate of One year pregnancy rate following cessation of different types of Intrauterine device IUD was The studies also noted that there is no significant difference between different types of IUD in terms or fertility resumption.

Also in this case pregnancy was resumed with in a brief period of time following cessation of use or removal of the device. There is a wide overlap in the reported 1-year pregnancy rates after discontinuation of different forms of contraception.

The rate of pregnancy was unexpectedly higher among ex-oral contraception users, followed by IUD users. However this difference was not statistically significant. Also the funnel plot showed evidence of bias with some of the studies missing at the bottom rather than around the main effect. The presence of heterogeneity and publication bias resulted in adjustment of the point estimate of the rate of pregnancy following cessation of different types of contraception under a random effect model from In a fixed effect model the pooled estimate of pregnancy rate was In all cases pooled estimate from random effect model was used for report and discussion Fig.

Forest plot showing the rate of one year pregnancy following discontinuation of contraception, weighted according to random-effects model. The effect of some demographic characteristics, like age at contraceptive discontinuation and parity on resumption of pregnancy were inconclusive from these findings.

Some studies reported a decrease in resumption of pregnancy rates with increasing age [ 25 , 26 , 33 , 37 , 38 , 41 , 43 ] and others showing no such decrease with increased age [ 30 , 34 , 40 , 42 ]. In addition, the effect of parity on pregnancy rates was inconsistent, with some studies suggesting that age-adjusted pregnancy rates were significantly higher in multiparous women [ 33 ], while in another study it was lower among nulliparous women [ 41 ], unaffected by parity [ 26 ] and significantly lower among multiparous women in Delbarge et al.

The possible effect of hormonal contraception and prolonged use of oral contraception on impaired fertility was not supported in these findings [ 25 — 31 ]. Higher level of fertility was observed among non-hormonal contraception users in many studies [ 37 — 43 ] however the difference was not statistically significant.

According to this review Return of fertility at the first year was not significantly different for hormonal methods and IUD users. Similarly type of progesterone in contraception and duration of oral-contraceptive use do not significantly influence return of fertility following cessation of contraception. However effect of parity in resumption of pregnancy following cessation of contraception was inconclusive.

The rate of fertility return in this review was comparable to other reports of reviews and articles which assessed specific types of contraception [ 45 — 48 ].

However the finding was slightly lower than reports of women who discontinued barrier methods or using no contraceptive method of