Girum, T., & Wasie, A. (2018). Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and reproductive medicine. https://doi.org/10.1186/s40834-018-0064-y
Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and reproductive medicine. 2018. doi:10.1186/s40834-018-0064-y
Girum, Tadele, and Abebaw Wasie. "Return of fertility after discontinuation of contraception: a systematic review and meta-analysis." Contraception and reproductive medicine, 2018.
Most women conceived within 12 months of stopping contraception
A 2018 systematic review of 22 prospective studies found that about 83 out of 100 women became pregnant within 12 months of stopping contraception. The 14,884 women had stopped to conceive. Hormonal methods and IUDs did not differ significantly.
Key Findings
Across 22 studies and 14,884 women who stopped contraception, the pooled 12-month pregnancy rate was 83.1% (95% CI = 78.2-88%).
Weighted mean 12-month pregnancy rates were 74.7% after implants, 77.74% after injectables (two studies), 87.04% after oral contraception and 84.75% after IUDs.
Hormonal and IUD users did not differ significantly in return of fertility. Progesterone type in the contraceptive and length of oral-contraceptive use also showed no significant influence.
Studies disagreed on age and parity. Some reported lower pregnancy rates with increasing age and others found no decrease, and parity findings pointed in both directions.
Study results varied widely (I-squared 95.3%), and a funnel plot showed evidence of publication bias. The fixed-effect estimate was 84.36% (95% CI = 83.3-85.4%).
Interpretation
The report is a systematic review and meta-analysis. It pools prospective cohort and observational studies with a random-effects model. Eligible studies enrolled women who ended a reversible method with the intention of becoming pregnant, and the outcome was pregnancy within 12 months. Oral contraception accounted for 11,636 of the 14,884 women. On extended hormonal contraceptive use and return of pregnancy, the authors write that the data may not support a reliable conclusion.
RRM Context
Restorative reproductive medicine treats the menstrual cycle as a vital sign. Hormonal contraception is a suppressive medication that commonly holds ovulation off during use. Cycle charting after stopping records when ovulation returns. A chart follows the cycle itself, and the review counts pregnancies over 12 months.
Our editorial summary of this paper, not the article's abstract.
Abstract
Introduction
Along with increasing availability and utilization of contraception, It is also important to confirm that the effects of contraception use on resumption of fertility after discontinuation However currently evidences on resumption of fertility after contraception use are inconclusive and practically fertility after termination of contraception remains a big concern for women who are using contraception. This fear poses a negative impact on utilization and continuation of contraception. Therefore, Estimating the rate of pregnancy resumption after contraceptive use from the available reports and identifying the associating factors are important for designing a strategy to overcome the problem.
Methods
The review was conducted through a systematic literature search of articles published between 1985 and 2017. Five bibliographic databases and libraries: PubMed/Medline, Global Health Database, Embase, the Cochrane Library, and African Index Medicus were used. After cleaning and sorting, analysis was performed using STATA version 11. The pooled rate of conception was estimated with a random-effects model. Heterogeneity was assessed by the I2 and publication bias through funnel plot.
Results
Twenty two studies that enrolled a total of 14,884 women who discontinued contraception were retained for final analysis. The pooled rate of pregnancy was 83.1% (95% CI = 78.2-88%) within the first 12 months of contraceptive discontinuation. It was not significantly different for hormonal methods and IUD users. Similarly the type of progesterone in specific contraception option and duration of oral-contraceptive use do not significantly influence the return of fertility following cessation of contraception. However the effect of parity in the resumption of pregnancy following cessation of contraception was inconclusive.
CONCLUSION AND
Recommendations
Contraceptive use regardless of its duration and type does not have a negative effect on the ability of women to conceive following termination of use and it doesn't significantly delay fertility. Therefore, appropriate counseling is important to assure the women to use the methods as to their interest.
