Birth Control & Fertility: What to Know Before Starting Egg Freezing or IVF

When it comes to fertility and birth control, myths abound. Our Spring Fertility providers and care teams hear questions around birth control and common misconceptions every day from patients! Many believe that using birth control can hinder fertility or complicate fertility treatments; however, separating fact from fiction is crucial for anyone considering starting a family or undergoing fertility treatment. 

Knowledge is power, and it’s important you have the information you need to make empowered and fully educated decisions around your fertility. So, let’s debunk common myths surrounding birth control and fertility, and clarify which birth control methods need to be stopped during fertility treatment.

Does Birth Control Impact Fertility? Debunking the Myths

One of the most pervasive myths is that using birth control can lead to infertility. However, research has consistently shown that this is not the case. Birth control methods like pills, patches, injections, and implants work by regulating hormones to prevent pregnancy. Once stopped, fertility typically returns to that individual’s “normal” within a few months. While some may worry that long-term use of birth control can decrease fertility, studies have found no evidence to support this claim. In fact, many women use birth control for years and conceive shortly after stopping.

The reason that myth has been perpetuated is because, while birth control doesn’t cause infertility, it could mask signs of fertility-related challenges. Many people in their 20s and 30s have been on some form of hormonal birth control since their teenage years, and likely don’t remember if their period was regular prior to going on the pill. So when they come off the pill and their period is irregular, some might think it was the birth control that caused their cycle irregularities; in reality, those irregularities were likely always there underneath the birth control — the pill was just creating the illusion of a regular cycle. 

Another myth related to birth control and fertility is that, since hormonal birth control prevents ovulation, that means that you are not releasing eggs each month and therefore preserving your ovarian reserve. While we wish there was truth to this, the reality is that your ovaries are still releasing dozens of eggs each month — what your birth control is doing is stopping the signal from your brain to your ovaries to send FSH to grow and mature one of those eggs for ovulation each month. Without that FSH, the eggs offered up each month just dissolve back into the bloodstream as immature egg cells. 

What we do know to be true when it comes to birth control pills and reproductive health impact: For individuals with conditions like endometriosis or PCOS (polycystic ovary syndrome), hormonal birth control pills can actually help manage symptoms. Additionally, birth control pills have been linked to decreased risk of ovarian and uterine cancers. 

Birth Control & Fertility Treatments: What You Need to Know

For many individuals planning egg freezing or embryo freezing cycles, who do not wish to become pregnant at this time and are preserving their fertility for future family-building goals, the question of birth control and what is/is not okay to continue through treatment is a big consideration! While your doctor will make recommendations based on your unique case and health history, these are the general recommendations for each type of common contraceptive method:

1. Oral Contraceptives (Birth Control Pills): Before starting an ovarian stimulation cycle (for egg/embryo freezing or IVF), birth control pills need to be stopped prior to starting fertility treatments. The length of time you will be asked to pause this birth control method varies — for some, you will only need to stop the pill for the length of time you are undergoing treatment. For others, your doctor may recommend stopping birth control for up to 3 months prior to treatment, if it appears that your ovaries have been temporarily suppressed due to long-term birth control pill usage. Your doctor will advise you on when birth control can be resumed after your egg retrieval. 
2. Intrauterine Devices (IUDs): Since fertility preservation is all about the ovaries and actually has nothing to do with the uterus itself, your IUD can stay in place for the entirety of the egg freezing process (including retrieval!). If you are interested in having an IUD placed or removed, however, that is something you can talk to your doctor about performing while you’re under anesthesia for your retrieval. 
3. Hormonal Implants (i.e. Implanon, Nexplanon): These can often stay in during an ovarian stimulation cycle; however, it may require adjusted protocol and medications to “work around” this systemic birth control method.
4. Barrier Methods (Condoms, Diaphragms): When you are in the middle of an egg or embryo freezing cycle, you absolutely want to be using condoms if having penetrative sex with a sperm-producing partner because you don’t want to get pregnant while multiple eggs are being grown for retrieval. It’s worth noting that, especially in the second half of your ovarian stimulation cycle, doctors will often advise against sex due to increased risk of ovarian torsion.

Again, it’s important to note that these are general/common recommendations — an initial consult with a fertility provider is the only way to know birth control’s impact on your body and what will be necessary to start/stop during an egg freezing cycle to ensure the most successful experience and results possible.