Myths About Birth Control Affecting Fertility

Does birth control cause infertility? No. Does it reduce ovarian reserve? No. Those are myths, here are the facts.

Couples use a variety of approaches as contraceptive methods (“birth control”) to prevent pregnancy, including oral or injectable medications, implantable devices, medical procedures or by altering sexual behavior. Birth control is a topic that has generated a good deal of myths, misinformation and misunderstanding among both women and men. A common misconception is that birth control causes a woman to gain weight, or that it serves as a valid method for prevention of sexually transmitted diseases.

These myths extend into the realm of fertility medicine, as patients often assume that birth control can cause female infertility. They may be hesitant to start recommended birth control by their primary care physician or obstetrician/gynecologist (OB/GYN) for fear that it may impede their timeline to starting a family. Understandably, how previous use of contraception might harm future fertility is a concern for many patients.

Misunderstanding about contraception and fertility come about for a number of reasons. Couples may not have had adequate sex education, and many find it difficult to talk about sex and contraception with their medical providers. Therefore, they cling to many outdated contraceptive concepts. Furthermore, the increasing use of social media and other internet resources make it easy for disinformation to spread.

I’ll address the more common types of birth control fertility myths based on current literature and what we hear about it from our fertility patients in the office setting. Barrier types of contraception like the female diaphragm and female/male condoms usually do not immensely contribute to these myths. However, hormonal birth control that uses various forms of estrogen and/or progesterone do. These are pills, patches, implants, injections, vaginal rings and intrauterine devices (IUDs).

Myth: taking contraceptive pills can cause infertility

Overall, the fact that hormonal contraceptive use delays or negatively impacts fertility is the big myth, and this is false. Many women are under the assumption that since hormones affect their menstrual cycle this can directly lead to future infertility. In reality, a woman can stop taking oral birth control pills and can resume normal ovulation (release of an egg) the next month. Research has shown that oral contraceptives cause no diminished chance of getting pregnant or harming fertility at all.

Some types of these pills can even help women regulate their cycles. This confusion may stem from the fact that estrogen or progesterone in some types of pills can prevent ovulation not only during use, but after discontinuation. However, this effect is only temporary and reverses completely when the woman stops taking the pill. Therefore, women should not be concerned that oral contraceptives are detrimental to their future fertility desires.

Myth: Birth control pills can advance ovarian aging and decrease ovarian reserve

There’s no evidence indicating contraceptive pills decrease ovarian reserve or speed up ovarian aging. The positive benefits of birth control pills are that they prevent ovulation or make the uterus unreceptive to pregnancy, can regulate menstrual cycles, and can help decrease painful periods, all while exhibiting zero impact on egg quality. Some women also think the pills have the potential to cause early menopause. Ovarian aging and decreased reserve is primarily a function of the female age, with increasing age contributing to a lower reserve and egg quality, and contraception does not alter this timeline.

Myth: Hormonal contraceptives can cause miscarriages or spontaneous abortions

Some women are concerned with the prospect of hormonal birth control causing miscarriages/spontaneous abortions. There is faulty logic behind this myth.  Estrogen/progesterone hormonal birth control prevents ovulation, and without ovulation no embryo is formed and therefore, nothing to implant for a pregnancy.

There is no truth to a connection between use of hormonal birth control and miscarriages or spontaneous abortions.

Myth: Starting the pill at a young age can cause infertility

Some young girls are prescribed birth control for reasons other than contraception, such as regulation of sporadic periods and to help decrease pain associated with menses. Initiation of birth control in adolescence does not cause future infertility or decrease the reproductive potential of the female. Remember, it is a temporary method to improve quality of life, and research shows that the young female has the same capacity for fertility in the future compared to other women who have never take birth control pills.

Myth: Taking birth control can extend a woman’s fertility

This is not true and is likely based on the idea that if the pills repress fertility, it effectively saves it up. Nothing can pause or reverse the effects of aging on a woman’s fertility, as it is related almost entirely to increasing female age. Just as oral birth control does not decrease ovarian reserve, no evidence exists for extending a woman’s fertility lifespan.

Myth: Plan B pill & other emergency birth control cause infertility

The effects of emergency contraception like the Plan B pill and Ella One are short term medications, acting on that singular menstrual cycle, and do not affect a woman’s immediate or future fertility. This is a common misconception, as up to 40% of respondents to a poll thought that these emergency contraceptives did cause female infertility. These pills temporarily bind to progesterone receptors to prevent pregnancy and carry no lasting effects past a short window of days. Women need to understand that they are not effective as regular birth control pills, so women should not count on these as contraceptive in place of regular methods.

Myth: Hormonal birth control pills can harm a woman’s health

In young healthy women without medical conditions, the positive benefits of birth control pills far outweigh the potential negative effects. Patients are happy to learn that women who use birth control pills have lower rates of ovarian cancer (30% – 50% lower than women who never use birth control pills). The risk for uterine cancer, endometrial cancer and colorectal cancer is also decreased in a similar fashion in women with long-term hormonal birth control pill use. In women with irregular cycles, it is also protective against uterine cancer. As you can see, these major decreases in cancer risk serve as positive health benefits.

Misconceptions about IUDs harming health

We find that some women are wary of using IUDs because they have heard that this can cause infections and that the IUD will damage their uterus and cause complications, even infertility. These complications were in a different type of IUD used in a prior generation and no such concerns now exist in today’s IUDs. In actuality, IUDs are very effective at decreasing pelvic pain, as well as reducing the risk of endometriosis and other abnormal/irregular bleeding symptoms. They are also recommended as the first-line contraceptive method by the American College of Obstetricians and Gynecologists. For this reason, we now commonly prescribe IUDs for patients in a variety of medical approaches, and they remain one of the most safe and effective contraceptive methods.

Closing note on birth control, fertility and PCOS

There is one thing women taking any form of birth control who then desire to get pregnant should be aware of regarding fertility. When they stop taking birth control, and their period does not return, it is vital to follow up with their OB/GYN and consider a complete fertility evaluation. Remember, other aspects of their health may be contributing to their lack of periods, and these elements can affect fertility as well as overall health.

A common reason for lack of periods is a condition known as polycystic ovary syndrome (PCOS). Use of contraception regulates cycles and often masks the most common symptom of this condition. In these patients, after stopping their contraceptive, they might experience irregular periods and anovulation (no ovulation). Therefore, patients can be unaware that PCOS may be contributing to their future issues with fertility. It is vital that women undergo a complete evaluation for this condition so that their fertility potential is maximized.