My wife has been on Norplant for the last five years. She has had it removed because we decided to try to have a baby about one year ago. Now we are having trouble conceiving. What should we do?
I have been receiving quite a few questions recently about pregnancy following the use of different hormonal contraceptives, and the question above is fairly typical.
All the hormonal contraceptives work, at least in part, by suppressing the production of hormones in the pituitary gland, an endocrine gland located beneath the brain which produces hormones that stimulate many other glands and tissues to work or grow correctly. Two of these hormones are necessary for the cyclic stimulation of the ovary to produce an egg, and to cause menstruation. In the case of oral contraceptives, the pill itself continues the cycling that produces menstruation. With the Depoprovera (Depo) shot, that cycling is depressed, and many women, up to 70 percent, will stop having menstrual periods. With Norplant, the hormone does not suppress the pituitary hormones as effectively, and most women will continue to have periods, although perhaps irregularly.
In most women taking oral contraceptives, spontaneous menstruation, that is to say menstruation not stimulated by outside hormones, will resume within three months of quitting the oral contraceptive. In those women whose periods do not resume within three months, about 75 percent will resume sometime later. Pregnancy can occur even before a woman has had her first spontaneous period, so it is always necessary to do a sensitive pregnancy test first. If the woman is not pregnant, many Ob- Gyns will then stimulate a menstrual period by giving her progesterone.
If a woman had irregular periods or had stopped having periods from time to time before starting the oral contraceptive, it is likely that she will resume that irregularity after stopping the pill. In large studies of modern low dose pills, there is no evidence that women have more difficulty becoming pregnant after taking the pill than do women who have never taken the pill. It does not matter how long the woman took the pill, and most experts now do not advise stopping the pill periodically, or limiting the number of years that a woman takes it. If tests show that a woman has not resumed ovulating after being on any of the hormonal contraceptives, treatment with a drug to stimulate ovulation like clomiphene (Clomid) is very often successful.
Depoprovera causes the lining of the uterus to become thin, as well as suppressing the pituitary hormones. This is probably the reason that a large percentage of women taking it stop having periods. Depo is known to make it less likely for a woman to become pregnant for a while after stopping it, and the product literature advises informing women of this possibility before they start on Depo. The product literature states that the range of time it takes to become pregnant is from four to 31 months after the last shot, with about 93 percent of those who do become pregnant doing so within 18 months. The length of time on Depo does not appear to change these percentages. I have not been able to find figures on the percentage of women who are never able to become pregnant again, since few studies run for many years, and many women go on to have ovulation stimulated with clomiphene, and then become pregnant.
With Norplant, figures on the resumption of menstrual periods (if they stopped at all), and later pregnancy are even harder to find. Since the dose of progestin used in Norplant is relatively weaker than that in Depo, I would expect pregnancy to occur sooner after the implants are removed.
Bear in mind when considering all this that most experts do not consider an infertility problem to exist unless a couple has been trying to conceive for at least a year. In other words, the woman may be ovulating normally, and her partner may be producing numerous, healthy sperm, and they just don’t manage to conceive during the first 11 months of trying.