Individuals considering or using intrauterine devices (IUDs) often wonder if these contraceptive methods can lead to infertility. This article clarifies the relationship between IUDs and fertility, explaining how they work and what happens to fertility after removal. It also addresses the origins of the misconception that IUDs cause infertility, providing an accurate look at this widely discussed topic.
How IUDs Work
IUDs are small, T-shaped devices inserted into the uterus to prevent pregnancy, operating through distinct mechanisms depending on their type. There are two primary categories: hormonal IUDs and copper IUDs. Both types are highly effective, with a failure rate of less than 1%.
Hormonal IUDs release a synthetic form of progesterone, called progestin, into the uterus. This progestin works in several ways to prevent conception. It thickens cervical mucus, creating a barrier that makes it difficult for sperm to reach an egg. It also thins the uterine lining, making it less receptive to a fertilized egg, and can suppress ovulation.
Copper IUDs are hormone-free. They are wrapped with a fine copper wire that continuously releases copper ions into the uterus. This creates an inflammatory reaction within the uterine environment that is toxic to sperm and eggs, hindering sperm mobility and viability, and preventing fertilization. Neither hormonal nor copper IUDs permanently alter or damage reproductive organs in a way that would lead to infertility.
Fertility After IUD Removal
A significant benefit of IUDs is their reversibility, allowing individuals to regain fertility quickly after removal. For most, fertility returns within the first menstrual cycle. Some may even become pregnant in the same month their IUD is taken out.
Studies indicate that 80-85% of women conceive within a year after IUD removal, with many achieving pregnancy even sooner. For copper IUDs, which do not impact hormonal cycles, fertility can return almost immediately. While hormonal IUDs can suppress ovulation, the progestin leaves the system quickly after removal, and regular menstrual cycles resume within a month. The duration of IUD use does not negatively affect the speed of fertility return. IUDs do not deplete or save eggs, nor do they affect ovarian reserve.
Addressing the Misconception
The idea that IUDs cause infertility largely stems from historical issues with an older IUD design from the 1970s, known as the Dalkon Shield. This particular device was associated with higher rates of pelvic inflammatory disease (PID) due to design flaws, including a multifilament string that could wick bacteria into the uterus. PID, when left untreated, can lead to tubal damage and subsequent infertility.
Modern IUDs are significantly different in design and pose a very low risk of PID. The risk of PID with contemporary IUDs is primarily limited to the first few weeks after insertion, largely linked to pre-existing sexually transmitted infections (STIs) at the time of insertion. IUDs themselves do not cause STIs; rather, if an individual has an undiagnosed STI during insertion, bacteria can be introduced into the uterus, potentially leading to PID. Healthcare providers often screen for STIs before IUD insertion to mitigate this risk.
Rare complications, such as uterine perforation, are also sometimes mistakenly linked to infertility. Uterine perforation, where the IUD punctures the uterine wall, occurs in fewer than 1 in 1000 insertions. While serious, most perforations do not cause long-term harm or impact future fertility unless severe infection or damage occurs, which is uncommon and treatable.
For most users, modern IUDs are a safe, highly effective, and reversible form of contraception that does not cause infertility. Any difficulties conceiving after IUD removal are due to factors unrelated to the device, such as age or pre-existing health conditions. Science consistently shows no long-term impact on the ability to conceive after IUD use.