The Depo shot, known clinically as Depo-Provera, is an injectable, long-acting reversible contraceptive (LARC) administered every three months. This contraceptive method utilizes a synthetic hormone called medroxyprogesterone acetate (MPA) to prevent pregnancy. The Depo shot works by releasing a high dose of progestin that offers continuous protection over a long period. The primary concern for many users planning to transition to pregnancy is understanding the timeline for fertility return after discontinuing the injections. This delay in conception is a recognized feature of the shot, related to how the progestin compound functions and is processed by the body.
How the Depo Shot Affects Ovulation
The contraceptive action of the Depo shot is based on maintaining consistent, elevated levels of medroxyprogesterone acetate (MPA) in the bloodstream. This high progestin level acts on the hypothalamus and pituitary gland, two key areas of the brain that regulate the reproductive system. The MPA inhibits the secretion of gonadotropin-releasing hormone (GnRH), which suppresses the release of the gonadotropins, Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). The suppression of these hormones prevents the ovaries from maturing and releasing an egg, effectively blocking ovulation.
Additionally, the progestin thickens the cervical mucus, creating a physical barrier that hinders sperm. Because the medication is injected as a depot suspension, it creates a reservoir of the drug that is slowly released into the body over several months. The delay in the return to fertility after stopping the shot is due to the time it takes for this stored compound to clear completely from the body’s tissues, especially from fat stores, allowing hormone levels to drop low enough for normal ovulation to resume.
The Average Time to Conception
The time it takes to achieve pregnancy after stopping the Depo shot is often longer compared to other reversible contraceptives. While the contraceptive effect lasts for about 15 weeks after the last injection, the full clearance of the drug takes significantly longer. The median time until conception for women discontinuing Depo-Provera is around 9 to 10 months after the date of the last scheduled injection. Approximately 50% of women can expect to become pregnant within 10 months of stopping the shots.
However, the full range for fertility restoration is broader, with many women taking up to 18 months to successfully conceive. This extended delay contrasts with methods like the copper IUD or the contraceptive pill, where fertility often returns within the first cycle after cessation. Studies have shown that after 12 months, the proportion of women who have not conceived is similar between former Depo-Provera users and those who stopped using IUDs. By 18 months following the last injection, the fertility rate among former Depo-Provera users is comparable to that of former users of other contraceptive methods. The delay is a period of temporary suppression related to drug clearance, not an indication of long-term impairment of reproductive health.
Variables That Affect Recovery Speed
The time it takes for an individual’s fertility to return to baseline levels is not uniform and is influenced by several personal factors. One variable is body mass index (BMI), as medroxyprogesterone acetate is lipophilic, meaning it is stored in the body’s fat tissue. For individuals with a higher BMI, the drug may take longer to be metabolized and fully clear from the system, potentially extending the wait for ovulation to resume.
Age is another consideration, which is a significant predictor of fertility return regardless of contraceptive use. Older women, particularly those aged 35 and above, may naturally experience a longer delay in conception after stopping any form of birth control. The duration of Depo-Provera use, however, does not appear to significantly impact the time it takes for fertility to return, contrary to a common misconception.
A person’s underlying reproductive health before starting the shot also plays a role in the speed of recovery. Women with pre-existing conditions that affect the menstrual cycle or ovulation, such as Polycystic Ovary Syndrome (PCOS), may find that the return to regular cycles is delayed further. The return of regular, predictable menstruation is one of the most reliable initial indicators that the body is beginning to ovulate normally again.
When to Consult a Healthcare Provider
While a delay in conception after stopping the Depo shot is normal, there are clear guidelines for when a medical consultation is warranted. The primary sign of fertility recovery is the return of a regular menstrual cycle, which confirms that the body is ovulating again. If a regular cycle has not resumed within two years after the last scheduled injection, it is advisable to consult a healthcare provider for further evaluation.
A consultation is recommended if an individual is under the age of 35 and has been actively trying to conceive for 12 months after the return of regular ovulation without success. For those aged 35 or older, this window is shortened to six months of unsuccessful attempts following the resumption of regular cycles. These timeframes align with general fertility guidelines and help determine if the delay is related to the Depo shot or to other potential factors.
A doctor may perform initial diagnostic tests, such as hormonal panels, to assess current hormone levels and ovarian function, or blood work to check for underlying conditions that might be affecting fertility. This proactive approach ensures that any potential issues unrelated to the previous contraceptive use are identified and addressed promptly.