EC Gynaecology

Background: Hormonal contraceptives are considered reversible. Yet, some women report delayed conception after discontinuation. Temporary endocrine readjustment, the pharmacokinetics of the method, reproductive aging, and previously masked disorders might be confused with contraceptive-induced infertility, which is a clinical concern.

Objective: Evidence is synthesized to describe the restoration of fertility after long-term hormonal contraception, emphasizing differences among methods, possible biological mechanisms, susceptible subgroups, and counseling implications.

Methods: In order to synthesize systematic reviews, prospective cohort studies, physiological studies, and pharmacogenomic studies related to return of ovulation, time to pregnancy, ovarian reserve markers, endometrial receptivity, and hormonal clearance, we used a narrative review framework.

Results: The majority of women become pregnant within one year of stopping reversible contraception, and there is currently no evidence to suggest that oral contraceptives, implants, or intrauterine contraception cause permanent infertility. Of all the contraceptives given, depot medroxyprogesterone acetate has the most consistent delay because the suppressive effect persists after the last injection. Using combined oral contraceptives can temporarily change the cycle biomarkers and suppress the anti-Müllerian hormone and antral follicle count, however these changes recover on stopping them. There is little evidence remaining endometrial, cervical, neuroendocrine or genetic effects. Conception is mostly delayed due to multiple factors. It may be a reflection of age, polycystic ovary syndrome, endometriosis, thyroid or metabolic disease, tubal disease, male-factor infertility, and lifestyle factors.

Conclusion: Most users can easily reverse long-term hormone contraception. The clinically relevant question is not whether contraception generally causes infertility, but why in some cases recovery takes longer, and then how the type of method, baseline reproductive health, and individual susceptibility interact. Studies that will prospectively link contraceptive exposure with hormonal recovery, ovulation, endometrial function and time to pregnancy are warranted.

Keywords: Hormonal Contraception; Return to Fertility; Time to Pregnancy; Ovarian Reserve; Depot Medroxyprogesterone Acetate; Endometrial Receptivity; Pharmacogenomics

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