Unveiling the Connection: Birth Control's Impact on Fertility

Types of Birth Control

 

Hormonal Birth Control

Hormone methods of birth control help prevent ovulation (egg release from the ovary) from occurring. 

 

Hormone options include:

• Oral contraceptives (pill form)

• Patches

• Injections

• Vaginal Ring

 

Barrier Birth Control

Barrier methods may or may not include hormones and prevent fertilization (sperm inseminating egg) from occurring. 

 

Barrier options include:

• Intrauterine Device (IUD)

• Diaphragms

• Condoms

• Cervical Cap

• Sponge

 

Alternative Birth Control

Natural family planning, which involves tracking ovulation based on a woman’s menstrual cycle, is hormone free and does not impact fertility. 

 

Tubal ligation is a medical procedure in which women get their fallopian tubes blocked and is a permanent option for birth control.

 

Impact on Fertility

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Pills, Patches, Vaginal Ring

Hormonal birth control combines estrogen and progestin, or progestin only.  This method prevents ovulation from occurring and also thickens cervical mucous, which makes it difficult for sperm to survive and can prevent fertilization as well.

 

The pill form is taken daily, patches are changed weekly, and the vaginal ring is changed monthly.

 

Impact on Fertility: When women stop this form of birth control, ovulation returns relatively quickly, and women can get pregnant as soon as 1-3 months.  However, some women may experience temporary post-pill amenorrhea or discover pre-existing issues masked by the pill.

 

Injections

Injectable birth control contains the hormone progestin, which also prevents ovulation.  Injections are given every 13 weeks (four times a year).

 

Impact on Fertility: Since this form of birth control is administered in longer intervals (every three months), it remains in the system longer. As a result, it can take longer to get pregnant after the last injection is given.  It may take up to 9-18 months after the last shot is given to get pregnant.

 

IUD

An intrauterine device (IUD) is a small T-shaped device inserted into the uterus. There are two types: hormonal IUDs (which release progestin) and copper IUDs (which are hormone-free and rely on copper’s spermicidal properties).

 

Impact on Fertility:  Fertility typically returns within one cycle of removal, regardless of whether the IUD is hormonal or copper. Studies show that neither the duration of use nor the type of IUD has a lasting impact on a woman’s ability to conceive. However, some women may experience temporary cycle irregularities after hormonal IUD removal, while the copper IUD generally allows for a more immediate return to natural cycles.

 

Implant

Birth control implant is a progestin form of birth control.  It involves inserting a device into a woman’s arm by a physician.  Since it is a progestin-only form of birth control, it is a good option for women who cannot be on estrogen for medical reasons.

 

Impact on Fertility: Once removed, a woman can get pregnant relatively quickly, in as little as one month.

 

Cervical Cap, Diaphragm, and Sponge

According to Harvard Health, the cervical cap, diaphragm, and sponge are the least reliable sources of birth control and are not recommended for women who have already given birth.  This is a barrier form of birth control that involves inserting a device made of silicone or plastic into the vagina before a woman has sex. No hormones are involved, but spermicide, a gel used to kill sperm, must be used with the cervical cap and diaphragm.

 

Impact on Fertility: Since these methods are meant to be used each time a woman has sex and does not contain hormones, it does not impact fertility or the ability to get pregnant once not in use.

 

Tubal Ligation

 

Tubal ligation, often called “getting tubes tied,” is a permanent form of birth control involving a surgical procedure on a woman’s fallopian tubes. 

 

Impact on Fertility: Once performed, a woman cannot get pregnant on her own.  The procedure would have to be reversed to have a biological child, which does not always guarantee a pregnancy. If a woman does not want to perform the reversal, she can see a fertility specialist and consider undergoing IVF.

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Long-Term Effects of Hormonal Birth Control​

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While hormonal birth control is widely prescribed and often helpful for symptom relief, it’s important to acknowledge the full picture—especially when considering long-term use. In The Fifth Vital Sign, Lisa Hendrickson-Jack challenges the notion that hormonal contraceptives simply "regulate" periods. Instead, she explains that these methods suppress the natural hormonal cycle entirely, creating a withdrawal bleed rather than a true menstrual period. This distinction matters, especially when using your cycle as a reflection of your overall health.

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Some of the long-term effects highlighted in The Fifth Vital Sign include:

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1. Suppression of Ovulation
Ovulation is not just about getting pregnant—it’s a sign of health. Regular ovulation supports bone health, cardiovascular function, mood stability, and metabolic balance. Long-term suppression can mean missing out on these protective benefits for years, especially for women who start birth control in adolescence.

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2. Masking Underlying Conditions
Hormonal birth control may ease symptoms of PCOS, endometriosis, or irregular cycles, but it does not address the root cause. Instead, it can mask those issues, delaying diagnosis and treatment until a woman stops taking it—often when she's ready to conceive.

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3. Nutrient Depletion
Research shows that hormonal contraceptives can deplete key nutrients like folate, B6, B12, magnesium, selenium, and zinc. Over time, this can contribute to fatigue, mood changes, and reproductive challenges. Women may not be advised to replenish these nutrients while on the pill, even though the need is well documented.

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4. Impact on Cervical Mucus
Progestin-containing birth control will thicken cervical mucus to prevent sperm from reaching the egg.  However, this also suppresses fertile-quality mucus. After discontinuation, it may take time for optimal cervical mucus patterns to return, which can delay conception—even when ovulation resumes.

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5. Changes in Gut and Vaginal Microbiome
Hormonal birth control can influence the gut microbiome and vaginal flora, potentially increasing the risk for yeast infections, bacterial vaginosis, or gut dysbiosis. These imbalances may impact inflammation, immunity, and overall well-being.

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6. Mental Health Concerns
Some women report mood swings, anxiety, or depression while on hormonal contraceptives. While not all women experience this, Lisa emphasizes the importance of listening to your body and not dismissing emotional changes as unrelated or insignificant.

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7. Cancer Risk: A Complex Picture

One of the most widely discussed topics surrounding hormonal birth control is its relationship to cancer. The Fifth Vital Sign dives into this with nuance, encouraging women to look beyond simplified statements. While some forms of hormonal contraception have been shown to lower the risk of endometrial and ovarian cancer, studies also indicate a slightly increased risk of breast, cervical, and liver cancers—particularly with long-term use.

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Lisa Hendrickson-Jack emphasizes the importance of understanding individual risk factors. For example, starting hormonal birth control at a young age or using it for extended periods may heighten susceptibility for some types of cancer. Breast cancer risk appears to be slightly elevated while on hormonal birth control and tends to decline after discontinuation, but it may not fully return to baseline for 10+ years.

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It's important to note that risk varies depending on personal and family history, lifestyle, and overall health. The takeaway isn't fear, but informed decision-making. Women deserve full access to this information so they can weigh benefits and risks based on their unique bodies and health goals—not just standardized recommendations.

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Conclusion

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While most women will resume ovulation and be able to conceive after stopping birth control, it’s also important to acknowledge the nuances. Hormonal contraceptives can sometimes delay the return of a normal cycle or conceal underlying conditions such as PCOS or hypothalamic amenorrhea. They may also influence nutrient levels and cervical mucus quality. Understanding these effects can help women make more informed choices about how they manage their reproductive health.

 

Guided Fertility’s mission is to promote accurate information and a positive narrative surrounding birth control's impact on fertility, ensuring that women have the knowledge and confidence to make choices that align with their individual needs and goals.

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Sources

Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and Reproductive Medicine. 2018 Jul 23;3:9. doi: 10.1186/s40834-018-0064-y. Erratum in: Contraception and Reproductive Medicine. 2023 Apr 21;8(1):29. PMID: 30062044; PMCID: PMC6055351.

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​Harvard Health Publishing. (n.d.). Diaphragm, cervical cap, and sponge. Harvard Medical School. Retrieved March 27, 2025, from https://www.health.harvard.edu/birth-control/methods/type/diaphragm-cervical-cap-sponge

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Hendrickson-Jack, L. (2019). The Fifth Vital Sign: Master Your Cycles & Optimize Your Fertility. Fertility Friday Publishing. https://www.fertilityfriday.com/book/