Bracken MB, Hellenbrand KG, Holford TR.
Related Articles, Links
Conception delay after oral contraceptive use: the effect of estrogen dose.
Fertil Steril. 1990 Jan;53(1):21-7.
PMID: 2295345 [PubMed - indexed for MEDLINE
Conception delay after oral contraceptive use: the
effect of estrogen dose
Bracken, M B; Hellenbrand, K G; Holford, T R
Yale University, New Haven, Connecticut
Abstract
A significant delay was observed in conception among 248 former oral contraceptive
(OC) users compared with women discontinuing other methods of contraception (n =
1,365). The mean time to conception was 5.88 cycles (95% confidence interval [CI]
5.38, 6.38) for former OC users and 3.64 cycles (95% CI 3.49, 3.79) after other
contraceptives. Women discontinuing OCs with higher doses of estrogen (greater than
or equal to 50 micrograms) had greater conception delays than those on lower
estrogen doses who, in turn, had longer delays than other method users. Oral
contraceptive use was associated with significant reductions in conception for each of
the first six cycles after discontinuation. This study provides further evidence for a
direct effect of oral contraception on delayed conception, suggests that the delay lasts
longer than previously thought, and finds that the probability of conception after OC
discontinuation depends on the estrogen dose of the OC. [Journal Article; In English;
United States]
Specialty Indexing
Source ID: PIP - 059672; POP - 00192928
PIP Keywords: * Alcohol Drinking; Americas; Behavior; Connecticut; Contraception;
Contraceptive Methods; * Contraceptive Usage; Demographic Factors; Developed
Countries; Family Planning; * Fertilization--statistics; North America; Northern
America; * Oral Contraceptives; Population; * Population Characteristics; Population
Dynamics; Pregnancy; * Pregnancy Outcomes; Reproduction; * Reversibility; * Time
Factors; United States
General Note: TJ: FERTILITY AND STERILITY.
CAS Registry Numbers: Contraceptives, Oral; Estrogens
Citation Subset Indicators: Index Medicus; Population journal
Grant Information: Grant ID: DA 05484, Acronym: DA, Agency: NIDA;
Grant ID: HD 11357, Acronym: HD, Agency: NICHD;
Grant ID: HD 16282, Acronym: HD, Agency: NICHD
MeSH Terms: Adolescent; Adult; Contraceptives, Oral, * pharmacology (PD); DoseResponse Relationship, Drug; Estrogens, * pharmacology (PD); Female; Fertilization,
* drug effects (DE); Humans; Menstruation, drug effects (DE); Pregnancy; Research
Support, U.S. Gov't, P.H.S.
Contraception. 1982 Oct;26(4):389-415.
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Fertility following discontinuation of different methods of fertility
control.
Fraser IS, Weisberg E.
The possibility of permanent sterility following use of modern contraceptive
agents is a concept which causes great concern amongst members of the lay
public. However, a thorough review of the literature gives a great deal of
reassurance on this topic. The combined oral contraceptive pill causes slight
delay, and the injectable contraceptives a moderate delay in the return of
fertility following discontinuation, but there is no evidence of a greater
likelihood of permanent infertility than in the normal population. The
progestogen-only minipill should be risk-free, but final data are lacking.
Epidemiological studies do not indicate an increased risk of infertility
following IUD use, but it seems likely that there must be a very small number
of IUD users who develop permanent infective damage to the Fallopian tubes.
Barrier methods and periodic abstinence probably do not have any significant
effect on subsequent fertility. Barrier methods could be protective.
Therapeutic abortion may have a small deleterious effect on long-term
reproductive success, but the data are inconclusive. Detailed information on
fertility following use of other methods is not available.
Publication Types:

Review
Med J Malaysia. 1994 Dec;49(4):348-50.
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The return of fertility after discontinuation of oral contraception
in Malaysian women.
Hassan J, Kulenthran A, Thum YS.
Department of Obstetrics and Gynaecology, University Hospital, Kuala
Lumpur.
The return of fertility after discontinuation of oral contraception was studied in
a cross-sectional survey of 61 patients who were desirous of a further
pregnancy. For controls, 380 women who did not take any oral contraception
were used. Cumulative conception rates in the pill users were reduced but not
significantly during the first three (p = 0.15) and six months (p = 0.20). By 12
months this difference was negligible (p = 0.28). We conclude that there is no
significant delay in return of fertility following cessation of oral contraception
in our group of Malaysian women.
PIP: A case control study was conducted among all pregnant women attending
the prenatal clinic at the University Hospital in Kuala Lumpur, Malaysia,
during May-October 1989 to determine the return of fertility after
discontinuation of the combined oral contraceptive (OC). There were 61
women who had used OCs for at least 6 months before the current pregnancy.
The remaining 380 women had not used any contraception at all before the
current pregnancy. The former OC users were less likely to have conceived at
3 and 6 months than the controls (56% vs. 66%, and 70% vs. 78%,
respectively). Neither difference in conception rates was significant, however
(p = 0.15 and 0.20, respectively). At 12 months, the conception rates were
90% for cases and 94% for controls (p = 0.28). At 10 months, among former
OC users, nulliparous women were more likely to have conceived than parous
women (100% vs. 80%). In fact, at 1 year, 14% of the parous women still had
not conceived. These findings show that OC use does not significantly delay
return of fertility in this group of Malaysian women.
PMID: 7674970 [PubMed - indexed for MEDLINE]
Fertil Steril. 1995 Jun;63(6):1161-6.
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Primary infertility and oral contraceptive steroid use.
Bagwell MA, Thompson SJ, Addy CL, Coker AL, Baker ER.
Richland Memorial Hospital, Columbia, South Carolina, USA.
OBJECTIVE: To determine the association between combined monophasic
oral contraceptive (OC) use and primary infertility. DESIGN: Case-control.
SETTING: Women serving as controls of the Cancer and Steroid Hormone
Study. PARTICIPANTS: Women were 19 to 40 years of age at first
conception or infertility diagnosis. Based on 24 consecutive months of
unprotected intercourse without a recognized conception, 419 nulligravid
women had primary infertility; controls were 2,120 fertile women. A calendar
of each women's reproductive history was used to determine fertility status
and contraceptive use before infertility diagnosis or first conception. MAIN
OUTCOME MEASURE: Primary infertility. RESULTS: Combined
monophasic OC use was associated with a lower frequency of primary
infertility, particularly among younger (age 20 years) compared with older
women (age 30 years) after adjusting for barrier method use and education. A
similar association was found for duration of OC use. When adjusted for age
at first conception or infertility and barrier method, both higher (> 50
micrograms) and lower (< or = 50 micrograms) estrogen dose use were
associated with decreased risk of primary infertility. CONCLUSION:
Combined monophasic OC use was associated with a lower frequency of
primary infertility.
PIP: Researchers compared data on 419 nulligravid US women diagnosed with
primary infertility (no conception during 24 consecutive months of
unprotected intercourse) with data on 2120 fertile women to examine the
relationship between use of combined monophasic oral contraceptives (OCs)
and primary infertility. All cases had documented reproductive histories from
menarche to menopause for contraceptive methods before infertility. Controls
were more likely than infertile women to have used OCs (14.2% vs. 9.07%;
unadjusted odds ratio [OR] = 0.6) and to have used OCs longer (33.6 vs. 30.1
months; OR = 0.6). Infertile women were just as likely as fertile women to
have used high-estrogen-dose OCs (i.e., 50 mcg) (5.28% vs. 8.52%). Fertile
women were more likely than infertile women to have used barrier methods
(41.8% vs. 17.2%; OR = 0.29). When the researchers adjusted for education
and barrier method use, infertile women were still less likely to have used OCs
than fertile women, especially women who were 20 years old at first
conception or infertility (adjusted OR [AOR] = 0.27) (AOR = 0.68 for older
women). Both high- and low-estrogen-dose OCs were associated with a
reduced risk of primary infertility (AOR = 0.48 for or= 50 mcg and 0.4 for 50
mcg). These results suggest that combined OC use reduces the risk of primary
infertility, especially among younger women, regardless of duration of use or
estrogen dose.