# Tarheel Health Portal/Oral Contraceptives and Infertility

Birth control pills are probably one of the most popular prescriptions for women at UNC. Did you know that there could be some risk of infertility involved in using this form of contraceptive? This page will explain the most recent scientific studies surrounding the topic, explain who's actually at risk, if anyone, and provide resources and more information on campus about birth control and infertility research.

## Students and Fertility

To many UNC students, parenthood may seem to be a long way away, but the choices in birth control that people of reproductive age are making now can have effects down the road that are worth considering while students are still young enough to prevent a life-changing health problem like the inability to have a child. 87% of women and 81% of men in America will become parents at some point in their working lives, so the issue of fertility is a far-reaching one that deserves close attention paid by both men and women. Furthermore, in 2008 the average age of first-time mothers in America was 25.1, so college students are not as far-removed temporally from parenthood as they may think. Frighteningly, birth defects are more common in children born to mothers as young as 34, so acting early to preserve fertility is in college students' best interest.

## Recent Studies

In every major study since 2005 that has directly focused on the effects of oral contraceptives on fertility, the researchers have concluded that the Pill has no effect on fertility (or something along these lines). What's important for college students to notice about each of these studies is whether the results would really apply to them personally (or other people they know). How long did participants in the study take the Pill? What was their cycle like before starting the Pill? Many college students today have been taking birth control since they were 16 or even younger. Many will take birth control all four years that they are at UNC, and many will continue to take birth control for years after college. In all likelihood, the number of years most college students today will wind up being on the Pill will far exceed the duration of the treatment periods in these studies. Furthermore, many teenagers and young adults' menstrual cycles are very irregular (or were very irregular before they began taking the Pill), so studies that include only participants with perfectly regular cycles may not apply to the average college-aged woman. The fear is that having a naturally irregular cycle and being on birth control for a long period of time are both risk factors for infertility, and because of the nature of these studies, modern research on the topic of birth control and infertility is not very reliable for ensuring future fertility for the typical modern college woman.
Here are the results of each of the 4 major studies performed in the last 10 years, including relevant details concerning how long the women used birth control, whether or not they had a regular cycle before they started taking the Pill (when that information was provided), and whether they saw any effects on their fertility when they stopped taking it.

### European Active Surveillance Study on Oral Contraceptives

* 2,064 participants
* took cyclic oral contraceptives containing drospirenone or other progestins
* "Short-term users" defined as taking the Pill for "less than 24 months"
* "Long-term users" defined as taking the Pill for "more than 24 months" (exactly how long was not described)
* measured pregnancy outcomes one menstrual cycle after stopping birth control and one year after stopping birth control
* found no effects on fertility, regardless of "short-" or "long-term" use.

### Wiegratz et al. Study

* 652 participants
* took cyclic oral contraceptives containing 30 μg ethinyl and 2 mg dienogest
* the majority of users took the Pill for less than 40 months
* there was one category for women who took it for "more than 40 months", but this was a minority, and the exact duration of treatment was not disclosed
* women saw delays in regaining fertility for the first 3 months after stopping birth control
* after 3 months, their fertility returned to normal.

### Davis et al. Study

* 187 participants
* all participants had regular menstrual cycles before beginning birth control
* took continuous oral contraceptives containing 90 μg levonorgestrel and 20 μg ethinyl
* all participants took the pill for just 1 year
* 98.9% of the participants returned to their normal menstrual cycle or became pregnant within 90 days of stopping birth control.

### Barnhart et al. Study

* 21 participants
* took continuous oral contraceptives containing 90 μg levonorgestrel and 20 μg ethinyl
* no woman in the study took the Pill for more than 364 days, and over half the women took the Pill for less than 180 days (some for as few as 28, 33, or 44 days)
* measured pregnancy outcomes 3 months after stopping birth control and one year after stopping birth control
* found no effects on fertility.

## What You Can Do

* Based on the concrete durations of treatment found in some of these studies, one conclusively safe option for women who value their future fertility would be to limit their duration of birth control use to a time period consistent with the durations of treatment described in the studies.
* In order to continue preventing pregnancy in the short-term but preserve the ability to have a child in the long-term, students could also pursue alternate forms of contraception that have been tested for their effects on fertility after longer durations of use, thereby making these studies more applicable to real college students. To talk to a health professional right here on campus about alternate forms of contraception, you can visit Sexual Wellness Services, which offers free confidential appointments.

## Research At UNC

Researchers at UNC Hospitals do a lot of studies on oral contraceptives and infertility as separate topics. Perhaps one day they will study the two in relation to one another. The following are some of the studies that have been performed or are currently underway that students may be able to get involved with if interested!
* Time To Conceive!: "a time-to-pregnancy research study" that is currently underway in order "to learn a way to measure fertility in women ages 30 to 44 who are trying to get pregnant." Interestingly, almost everything in the study is done online.
* A trial studying the potential for oral contraceptives to ease the severity of Premenstrual Dysphoric Disorder, which began in 2008 but appears to be still ongoing.
* A study that found that newer oral contraceptives may offer a cardiovascular benefit, in contrast to the previous school of thought, which said that oral contraceptives could actually cause cardiovascular problems. The study has been completed but is an interesting read.
* A completed study suggesting that newer oral contraceptives may be less harmful for women who smoke.
* A study examining the links between low-dose oral contraceptives and strokes in women.
* Research studying the relationship between anxiety and consistency in taking oral contraceptives, which in turn looks at the link between anxiety and unplanned pregnancy.

## Further Readings

* "John Rock's Error" by Malcolm Gladwell: A long but absolutely fascinating read about "what the co-inventor of the Pill didn’t know about menstruation" and how that "can endanger women’s health."
* Kim Kardashian's Infertility As a Result of Long-Term Birth Control Use: Her doctor visit featured on Keeping Up With The Kardashians brought this issue to the mainstream for many E! viewers. This article was included as an interesting crossroads between pop culture and academia, but the science in the article should not necessarily be taken as reliable.
* Campus Health Birth Control Page: A truly noteworthy, all-inclusive page that covers pretty much anything you could ever wonder about taking birth control (besides its possible effects on fertility, which is where this page comes in).
* UNC Named Top Infertility Clinic: A news article mentioning UNC Hospitals as one of 12 top clinics in the country, the only in the Southeast.
* UNC Health Care offers new option to make infertility treatment more affordable: Another article on why UNC's infertility clinic is so great.