Pregravid contraceptive use and fecundability: prospective cohort study [孕前避孕与生育能力的关系：前瞻性队列研究]

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BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3966 (Published 11 November 2020)
Cite this as: BMJ 2020;371:m3966

Authors
Jennifer J Yland, Kathryn A Bresnick, Elizabeth E Hatch, Amelia K Wesselink, Ellen M Mikkelsen, Kenneth J Rothman, Henrik T Sørensen, Krista F Huybrechts, Lauren A Wise

Abstract
Objective To evaluate the association between pregravid use of a variety of contraceptive methods and subsequent fecundability.

Design Prospective cohort study.

Setting Denmark and North America, 2007-19.

Participants 17 954 women who had tried to conceive for up to six menstrual cycles at study entry. At baseline, participants reported their contraceptive histories, and personal, medical, and lifestyle characteristics.

Main outcome measures Pregnancy, determined by bimonthly follow-up questionnaires for up to 12 months.

Results Approximately 38% (n=6735) of participants had recently used oral contraceptives, 13% (n=2398) had used long acting reversible contraceptive methods, and 31% (n=5497) had used barrier methods. Women who had recently stopped using oral contraceptives, the contraceptive ring, and some long acting reversible contraceptive methods experienced short term delays in return of fertility compared with users of barrier methods. Use of injectable contraceptives was associated with decreased fecundability compared with use of barrier methods (fecundability ratio 0.65; 95% confidence interval 0.47 to 0.89). Users of injectable contraceptives had the longest delay in return of normal fertility (five to eight menstrual cycles), followed by users of patch contraceptives (four cycles), users of oral and ring contraceptives (three cycles), and users of hormonal and copper intrauterine devices and implant contraceptives (two cycles). Lifetime length of use of hormonal contraceptive methods was not associated with fecundability.

Conclusions Use of some hormonal contraceptive methods was associated with delays in return of fertility, with injectable contraceptives showing the longest delay. The findings indicated little or no lasting effect of long term use of these methods on fecundability.