Return to fertility following the discontinuation of progestin-only contraceptives: a narrative review of the evidence

Abstract

Around 8% of sexually active, fertile women wishing to delay or prevent pregnancy have an unmet need for modern family planning. While progestin-only contraceptive methods are highly effective, fear of infertility following use is a barrier to adoption. We conducted this narrative review with a systematic approach to summarise evidence on ‘return to fertility’, with the outcomes of return to ovulation, median or mean time to pregnancy, and pregnancy rates (ability to become pregnant within a year of method discontinuation) following progestin-only contraceptive discontinuation. We searched four databases (PubMed, CINAHL, Web of Science and The Cochrane Library) for any conference abstracts, original research articles or systematic reviews or meta-analyses published in English through 31 August 2023. We located 9 systematic reviews, 47 original research articles and 4 conference abstracts for oral contraception, injectables, hormonal intrauterine devices (IUDs) and implants. Oral contraception and hormonal IUD users return to ovulation and fertility sooner than injectable and implant users. However, by 1 year after discontinuation, pregnancy rates across methods are similar. While future fertility is a concern of potential modern contraceptive method users and healthcare providers, evidence suggests that individuals using progestin-only contraceptive methods may experience only slight delays in return to fertility following discontinuation and comparable. These results point to the need for continued and new efforts to provide communities with accurate information about contraceptives to dispel myths discouraging their use, and additional research using standard measurements.