Return of fertility after discontinuation of contraception: a systematic review and meta-analysis

Abstract Introduction Along with increasing availability and utilization of contraception, it is also important to confirm the effects of contraception use on resumption of fertility after discontinuation. However, current evidence on resumption of fertility after contraception use is inconclusive and practical fertility after termination of contraception remains a big concern for women who are using contraception. This fear poses a negative impact on the utilization and continuation of contraception. Therefore, estimating the rate of pregnancy resumption after contraceptive use from the available reports and identifying the associating factors are important for designing a strategy to overcome the problem. Methods The review was conducted through a systematic literature search of articles published between 1985 and 2017. Five bibliographic databases and libraries: PubMed/Medline, Global Health Database, Embase, the Cochrane Library, and African Index Medicus were used. After cleaning and sorting, analysis was performed using STATA version 11. The pooled rate of conception was estimated with a random-effects model. Heterogeneity was assessed by the I2 and publication bias through funnel plot. Results Twenty two studies that enrolled a total of 14,884 women who discontinued contraception were retained for final analysis. The pooled rate of pregnancy was 83.1% (95% CI = 78.2-88%) within the first 12 months of contraceptive discontinuation. It was not significantly different for hormonal methods and IUD users. Similarly the type of progesterone in specific contraception option and duration of oral-contraceptive use do not significantly influence the return of fertility following cessation of contraception. However the effect of parity in the resumption of pregnancy following cessation of contraception was inconclusive. Conclusion and recommendation Contraceptive use regardless of its duration and type does not have a negative effect on the ability of women to conceive following termination of use and it doesn’t significantly delay fertility. Therefore, appropriate counseling is important to assure the women to use the methods as to their interest.