Does contraception affect future fertility?

Written by Dr Renee Verkuijl
14 Oct

A common question that I get asked by couples who are having trouble conceiving is whether their previous contraceptive use may be affecting their ability to fall pregnant now. As a fertility specialist, I know that issues with fertility can be one of the most difficult challenges couples will ever face. It is normal to feel stressed, sad, angry, or even cheated by your own body, because we feel that having a family should come naturally. The thought of not being able to have children can make many couples feel like there is something wrong with them. People can start asking questions like “Why is this happening to us?” and wondering whether there is anything or anyone to blame. Considering their previous contraceptive use is one of them.

If you’ve been taking ‘The Pill’

The most commonly used method of contraception in Australia is the oral contraceptive pill. A Danish study in 2013 involving 3,727 women showed that there was no evidence that long-term oral contraceptive pill use had any harmful effects on pregnancy rates1.

Both short-and long-term pill users were likely to experience a temporary delay in conception, but this does not affect a woman’s chances to fall pregnant.  This study has brought good news for users of ‘The Pill’ with respect to future fertility. Fertility is slightly reduced during the first couple of menstrual cycles after stopping the pill, but after that, monthly fertility rates quickly return to their usual level.

If you’ve been using other contraceptives

None of the other reversible contraceptive forms used in Australia have any permanent effects on fertility either. With the Intra Uterine Devices (IUD’s), Implanon and Depo-Provera long-term fertility is maintained. Most contraceptives are associated with a temporary reduction in fertility. However with the injection of Depo-Provera it takes an average of 9-10 months before ovulation returns and therefore it may take longer before you can fall pregnant. If you want to become pregnant in the next 12 to 18 months I advise you to use a different method of contraception.

The impact of STI’s on fertility

It is important to realise that even though contraceptive use does not permanently affect fertility, certain sexually transmitted infections can. All the previously mentioned contraceptive options do not protect you from these.

One of the most common STI’s in Australia is chlamydia. This infection can affect both women and men and if left untreated in women it can cause permanent scarring to their fallopian tubes, which can cause problems with fertility. About 70% of women and 50% of men with chlamydia do not have any symptoms and do not know that they have this condition.  The rate of positive chlamydia tests has tripled in Australia over the last decade2 so I encourage you to have frequent STI checks and use barrier contraceptives.

The impact of ‘bad habits’

There are definite lifestyle and dietary changes that can boost fertility and you can optimise your own chances by changing ‘bad habits’. For instance, we know that stopping smoking can improve your fertility and this is also beneficial for your baby during pregnancy and throughout your child’s life. Being overweight, or underweight, can also affect fertility so aim for a healthy weight to improve your chances of conception. A healthy diet and regular exercise can help you with this. It is important for some people to reduce their caffeine or alcohol intake. You should discuss this with your GP.

A woman’s age

While there may be a number of contributing factors to pregnancy delay, by far the biggest challenge women face is their age. As a woman ages her fertility declines - so we do not have unlimited time to have our own biological children.  This decline increases significantly once a woman reaches her mid-30’s.

If you are trying to fall pregnant, it is important to understand the factors that can affect your fertility, as well as those that cannot. But if you are starting to feel stressed or confused about the situation, I would recommend you speak to your GP, particularly if you are over 35. He or she can give personal advice to boost your chances of conceiving, and recommend some fertility tests if necessary too.
 

1. Hum Reprod 2013 May;28(5):1398-405. doi: 10.1093/humrep/det023. Epub 2013 Feb 20
2. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features10Jun+2012

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Related Articles

Conceiving in your 40s, what are the chances?

I was recently asked to comment in a Sun Herald article on 26th August (also published online here: Sydney Morning Herald) on Collette Dinnigan, who pregnant at the age of 46, has called on women not to leave it too long to try for a baby.

It is always news when a high profile personality such as Ms Dinnigan, has a child, particularly when the personality in question is a bit older.  The difficulty is that these occasions, while very happy for the people involved, give a misleading picture of the actual likelihood of conception in these circumstances.  Remember that high profile personalities such as Ms Dinnigan, are human beings who quite rightly value their privacy and so very rarely (quite understandably) talk to the press when things aren’t going so well.  It was therefore, a particularly courageous action of Ms Dinnigan, while celebrating her own happiness, to so publicly, point out the difficulties that may face other women, seeking the same fulfilment.

What then, are the issues for women in their forties who are planning to have a child?

The main difficulty is that conceiving is simply harder at that age and, even once a woman does conceive, the risk of miscarriage is higher.  Surprisingly, although we have very good data about the effects of age on IVF conception (more shortly), we don’t have very good statistics about the effects of age on conceiving naturally. The limited available data about natural conception comes from old population studies or studies of unique populations, such as the Hutterites of North America, who do not use contraception.  Interestingly these data, such as they are, seem to be entirely consistent with the more modern and abundant IVF data.  Generally, in one year of trying, 75% of women under 30 years and 66% of 35-year-old women but only 44% of 40-year-old women will achieve a live baby naturally.

The main explanation for this, is that women are born with a finite number of eggs, and from that moment onwards, the number of eggs is declining all the time, until women go through their menopause at around 50-51.  Nonetheless, women in their 40s do still ovulate each month.  What is it about their eggs that cause all these problems?

A common misunderstanding with some women is that the fact she looks and feels young, and leads a healthy lifestyle, means that her eggs will be healthier. I regularly see women who have taken enormous care with their fitness and their health.  The rest of their body is in great shape, completely fit and ready to carry that longed-for pregnancy.  Sadly, despite this, the eggs still can’t do it.  The effects of time are remorseless and, sadly, there is no wonder drug to fix it.

Scientists have shown that eggs from older women are more likely to have an abnormal makeup making pregnancy less likely, miscarriage more common and increasing the risk of Down Syndrome, a condition where a child is born with an extra chromosome number 21.

Nor is IVF a cure for this problem. For women, in their early 40s, IVF is still a good thing to try and gives significantly higher success rates than trying naturally.    However, IVF success rates fall sharply after the age of 40 and by the time a woman is 45 are close to zero.

So, what’s the good news?  Well despite all of the above, many women do conceive in their forties, either by IVF, or naturally, and have very happy healthy families.  It is obviously better to have your family earlier, if you can, but all hope is not lost, just because you’re past 40.  Conception and early miscarriage are the big problems but, if you do conceive and get past the first few weeks, by far the most likely outcome will be a healthy child.  While the risk of Down Syndrome is increased, most of the other problems that affect young children are not increased by being conceived a later maternal age.

Finally, many women worry that by having their children later, their long term health and emotional development may be affected.  On the contrary, we now know that the children of older mums grow up to be as healthy and bright as any other child.

Snapshot of Fertility in Australia

There have been a number of happy and high profile stories in the press recently about older celebrities giving birth to healthy children. Stories like this used to be extraordinary, but they certainly seem to be on the increase.

While this trend is supported by data that shows the fertility rate and numbers of births are increasing for women over 30 and especially for women in their early 40s, women and couples should understand the risks associated with having children later in life. 

Interestingly, research from the ABS (Australian Bureau of Statistics) shows that in 2011 a record 12,800 babies were born to women in Australia over the age of 40 – an increase from 7,100 babies born ten years previously.

While this number continues to increase, it’s important to understand that evolution is still yet to catch up with the social realities of this day and age. While a woman’s likelihood of becoming a mother can be delayed due to career aspirations, or taking the time to find ‘the one’, we are still wired to breed in young adulthood.

As we get older, the chances of successfully conceiving decrease.

Studies show that by the time you reach 36, your likelihood of conceiving naturally is half that of a 20 year old. By the time you’re at the age of 41, your chances of natural conception have reduced to just 4%.

Why is this?

While a woman is born with 2 million eggs, these are the only eggs she will ever have. By the time she hits puberty that number has already dropped to 400,000. And as age progresses, the egg quantity and quality continues to decline.

Men are at less of a disadvantage when it comes to age and infertility, but should still be aware that there is a relationship between the two. The fact is, male factors contribute to over 40% of all infertility cases. While some of these issues can be lifestyle related, abnormalities and low counts caused by other issues can play a role, including age.

While we can’t stop or reverse the ageing process, there are positive steps both genders can take to boost fertility and a successful pregnancy.

IVF Australia, Melbourne IVF and Queensland Fertility Group, have teamed up to create their latest infographic - “Fertility and Age in Australia” which explores some of these issues.


 Fertility in Australia infographic

There’s a sperm donor shortage in Australia – but only 20% of men know about it

The leading fertility clinics in the Virtus Health group, including IVF Australia, Melbourne IVF and Queensland Fertility Group, have joined forces to research sperm donation in Australia.

What did we find out about Sperm Donation?

Only 20% of men are aware that there is a shortage of sperm donors in this country.

While the majority of Australians are aware of the need for blood and organ donation, the requirement for sperm donors is largely unknown.

Who uses sperm donation?

Used by patients as either part of an In-Vitro Fertilisation (IVF) cycle, or via Intrauterine Insemination (IUI), donor sperm can help overcome male factor infertility (15%), or help same-sex couples (35%) and single women (50%) have a child.

What are the common motivations for donation?

The same research also discovered that the common reasons for wanting to donate sperm included:

  • Helping others to have a family (38%)
  • Knowing other people going through fertility treatment (24%)
  • Knowing my sperm count and quality could be assessed at donation (20%)
  • Everyone deserves to be a parent if they want to be (18%)

Sperm donors in Australia can be known to the recipient or recruited via the clinic. Many couples and individuals choose their sperm donor through a clinic, as knowing the demographic profile of the donor but not their identity is a preferred option. In these cases, children of sperm donors are able to access their biological father’s details when they are 18 years old.

The reason for this is that in the past, many donor conceived individuals have reported extreme distress about the absence or lack of information about their biological parents. Nowadays, the exchange of this information, once the child has turned 18 years of age, is considered to be an important part of the use of donated sperm.

While Australians cannot be paid for their sperm, most clinics reimburse donors for legitimate expenses. Sperm donors in Australia are typically aged 25-45, with or without their own families, and of any sexual orientation.

De-identified donor sperm can be used to create up to five or 10 families, depending on what state they’re in, please check with your local state for family limits. Unlike popular belief from movies such as Vince Vaughn’s ‘Delivery Man’. Donors need not worry – fathering 500+ children from their sperm donation is a scenario only Hollywood can create.

Would you or someone you know now consider sperm donation?

After seeing the results of this research, we want to raise awareness of the need for more sperm donors in Australia. If it is something that you would consider talk to your local clinic for more information.

Sperm Donation in Australia Infographic

Sperm Donation in Australia infographic

 

* Research conducted by Woolcott Research in March 2012. 

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