Getting Pregnant On Your Terms: Fertility Strategies After Contraceptive Use
Although the common myth is that you can get pregnant "immediately" after stopping birth control, the reality is not so cut and dry. Today, most people plan their pregnancies around real life circumstances. Job offers, moves or housing plans, age, fertility health, and other factors all go into planning to welcome a new person into your family.
Although this seems obvious, we must remember the burden is on the pregnant person to make these plans as it is their body who will be doing all the reproductive labor of gestating for several months. I often hear people tell me that they plan to "stay on birth control for X amount of months, and then when they are ready, they'll stop using the birth control and get pregnant the very next month." Sadly this is not always the case, and people are left confused and with the fear of infertility looming over them. This also dampens the whole baby making process, as intimacy and sex are affected by this disappointment around planning and timing.
So let's break down why conventional birth control is not the best option for getting pregnant on your timeline.
1. The rhetoric fed by doctors is that you can get pregnant right away after getting off of birth control. This is true for some people, and you will be able to see your thermal shift return in the following cycle by watching your basal body temperature. But research tells us that generally, there is a delay. The length of the delay varies widely. The problem is that people wait until the timing is right for them, get off of birth control, and then have an unexpected delay in fertility that causes them to worry. This is fair, considering they were told that "normal" is when there is an immediate return to fertility.
In one study, "the mean time to pregnancy was 3.5 cycles"
The authors declare that this is a "slight delay" and that "Thereafter, the cumulative rate of conception did not differ from that observed in fertile women who attempted to become pregnant without prior contraception"
But again, who are the authors to determine what is a slight delay to people trying to conceive, when doctors are telling them it is an immediate return? This is a question that goes unanswered.
Another study states "Numerous studies have demonstrated some delay in the time to conception in previous users of OCs who discontinued use in order to conceive, but this impairment appears to be temporary and typically limited to the early months following cessation of OC use."
It goes on to report 12 month conception rates in those using different contraceptives.
Cyclic Oral Contraceptives (that means the pill with the placebo pills included and you have a pill bleed each pack): 72%-94% get pregnant in the first year after discontinuing
IUDs: 71%-92% get pregnant in the first year after discontinuing
Progestin Only Contraceptives: 70%-85% get pregnant in the first year after discontinuing
Condoms: 91% get pregnant in the first year after discontinuing
Natural Family Planning: 92% get pregnant in the first year after discontinuing
From this we can see that on the low end, combined oral contraceptives, progestin only contraceptives, and IUD's seem to have lower rates of conception after the first year of trying than simply not wearing condoms anymore or using NFP to get pregnant. But it does vary quite a bit from study to study.
Another thing to note about this is what is the difference between "the body can get pregnant" and "the body can stay pregnant"? What is the difference between just being able to conceive versus having the best possible body and mind to bring a new life into the world?
Not only do we want to have pregnancies, we want those pregnancies to be healthy, with less health problems throughout and a smooth labor and delivery. None of that is really considered in these studies talking about the return to fertility. The quality of the fertility is left behind, meanwhile, there is a global downward trend with fertility that is very concerning.
The problem then becomes, what does the person do when they aren't getting pregnant? If they return to their doctor before the first 12 months of trying, the doctor will simply tell them to keep trying. What I call "non-advice advice." After that, it is up to the doctor to decide when to bring you down a road of assisted interventions like IUI & IVF. This takes even more precious time, in terms of fertility planning. It also costs an astronomical amount, which creates more stress and hampers intimacy, all problems when it comes to trying to conceive.
2. Conventional birth control still obscures the science of the menstrual cycle. Very rarely will you find gynecologists and even fertility specialists who are literate in the menstrual cycle and can teach patients how to identify the basic signs of ovulation. Because there is no attempt to counsel couples on how to get pregnant more easily, it creates many logistical problems with trying to conceive. So not only are your cycles disrupted and potentially irregular because you're recovering from a huge shift in hormones, but you're trying to conceive on days you aren't even fertile. This is physically exhausting bc now you're "trying" every single time you have sex & this is spiritually exhausting on your partnership
This could be remedied rather easily by teaching people to identify signs of fertility and to learn to confirm when they ovulate via basal body temperature, or even hormone monitoring. And because doctors don't have a financial incentive to teach body literacy, they don't. And the more that you struggle trying to conceive, the more potential money that pours into their industry in one way or another. Keep that in mind.
3. Lifestyle changes should begin months or years in advance to prepare for pregnancy. I think at least a year of health focus is best. Sometimes longer if you are working on healing from addiction to cigarettes or alcohol. Charting can tell you about certain weaknesses that conventional birth control cannot - for ex: slow/fast thyroid, progesterone levels, anovulatory months etc. These details matter because your overall health is very important to the health of your pregnancies and will even affect baby's health going many years into their lifetime. This makes the case for at least trying to understand body literacy and some of the gems that it can bring to you. If you have underlying conditions that may affect pregnancy you can see them in the chart whereas birth control is more likely to mask them.
The problem occurs when you get off of birth control and those underlying conditions become more obvious to you. Sometimes they come back worse than they were before, or you have other unexpected side effects. None of these issues are really counted when we talk about the return to fertility. There is a denial that birth control can contribute to underlying health issues which CAUSE infertility. Therefore, the status quo is to make the claim that birth control doesn't affect future fertility.
But this is far from settled science, and I think much of this has yet to be studied. For example, we still don't know much about the atrophying of cervical crypts during birth control use and how this can affect your cervical fluid after contraceptives. Problems with cervical fluid will undoubtedly make it harder to conceive. Same with post-pill hypothyroidism, because a healthy thyroid is necessary to make sex hormones and to conceive easily. These are all things to consider when you are choosing a contraceptive and when you choose to discontinue its use so you can get pregnant.
Getting Pregnant on Your Terms Post Pill: Strategies to Consider
Fertility Health - Review your charts as you come off the contraceptive. Monitor cervical fluid quality (read my blog on Improving Cervical Fluid), ovulation, and progesterone levels through the length of your luteal phase and the strength of the rise in temperatures.
Metabolic Health - Watch for lower than normal temperatures (95/96 degree range F pre-ovulatory), sluggishness, exhaustion, anxiety, temperature intolerance, brittle hair and nails, and an enlarged thyroid. More info can be found in this blog, Adrenals, Thyroid, and Stress Response.
Liver & Gut Health - Look out for signs of inflammation like skin problems (rashes, acne), fatigue, low vitamin D levels, achy muscles, swelling and redness, headaches and migraines, trouble concentrating, and loose stool or constipation. These are signs that your detox pathways need more support. You can learn more about herbs specific to the liver and the gut in my seminar Integrating Herbalist Practice with Fertility Awareness.
Mental Health - Getting pregnant, even when you're setting out intentionally, is a huge life altering event. Your mental health deserves to be prioritized. Similar to your body, you should treat your mind with the same reverence it deserves. There are significant mental health impacts to contraceptives (read more in my blog Mental Health Impacts of Contraceptives), and you may also need additional time to recover from this! Prioritizing mental wellness, including changing your environment or lifestyle to improve your quality of life, may be indicated at this time. Connect with your community and simplify what has become too complex or too difficult in life. Pregnancy is the beginning of a new kind of cycle that you will experience and it will benefit you to have your mind in a stable place.
These are some starting places to explore what works for you. You'll never be able to do absolutely everything, there's just so much fertility advice out there. So don't be afraid to be selective, take an accounting of yourself and focus on what you need the most.
How much time will you realistically need to work on these strategies to have the best chance of a healthy pregnancy?
Unfortunately there isn't much data on this, but from my experience looking at charts I think these four factors impact it the most
How young you were when you first started using contraceptives
How long (continuous or intermittent) you used contraceptives for
What kinds of contraceptives you used
If you had underlying health issues or family history of reproductive and/or metabolic conditions
Try these strategies for at least 3 months but up to 1 year or longer, depending on the above factors.