Fertility return after hormonal contraceptive discontinuation and associated factors among women attended Family Guidance Association of Ethiopia Dessie model clinic, Northeast Ethiopia: A cross-sectional study

Yitayish Damtie; Bereket Kefale; Mastewal Arefaynie; Melaku Yalew; Bezawit Adane

doi:10.1371/journal.pone.0287440

Abstract

Background

Women who use hormonal contraception face delayed return of fertility upon discontinuation. There was limited evidence of fertility return after hormonal contraceptive discontinuation in the study area. Hence this study assessed fertility return after hormonal contraceptive discontinuation and associated factors among pregnant women attending Family Guidance Association Ethiopia (FGAE) Dessie model clinic, Northeast Ethiopia, 2019.

Methods

A cross-sectional study was conducted on 423 samples selected by using systematic random sampling. Data were collected by face-to-face interview using a pretested and structured questionnaire and reviewing client records. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 23. Both bi-variable and multivariable binary logistic regressions were used to identify predictors of delayed fertility return. Adjusted odds ratio (AOR) along with a 95% Confidence Interval (CI) was used to measure the strength and the direction of the association and statistical significance was declared at a P-value less than 0.05.

Result

The proportion of fertility return among currently pregnant women after discontinuation of any hormonal contraceptive methods was 88.6% (95% CI; (85.6%-92%)). The proportion of fertility return among Depo-Provera, implant, Intrauterine Contraceptive Device (IUCD), and Oral Contraceptive Pill (OCP) users was 75%, 99.1%, 100%, and 97.8% respectively. Age, (AOR = 5.37, (95% CI; (1.48, 13.6)) and using Depo-Provera (AOR = 4.82, 95% CI; (1.89, 14.2)) had a significant association with delayed fertility return.

Conclusions

The proportion of fertility return among women after discontinuation of any hormonal contraceptive methods was high. Age and using Depo-Provera had a positive association with delayed fertility return. This study recommends a contraceptive counseling approach that addresses concerns about delay in the return of fertility after hormonal contraceptive discontinuation to avoid confusion among family planning users.

Citation: Damtie Y, Kefale B, Arefaynie M, Yalew M, Adane B (2023) Fertility return after hormonal contraceptive discontinuation and associated factors among women attended Family Guidance Association of Ethiopia Dessie model clinic, Northeast Ethiopia: A cross-sectional study. PLoS ONE 18(7): e0287440. https://doi.org/10.1371/journal.pone.0287440

Editor: Janet E. Rosenbaum, SUNY Downstate Health Sciences University, UNITED STATES

Received: August 6, 2021; Accepted: May 31, 2023; Published: July 11, 2023

Copyright: © 2023 Damtie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

List of abbreviations: ANC, Antenatal Care; AOR, Adjusted odds ratio; CI, Confidence Interval; FGAE, Family Guidance Association of Ethiopia; IQR, Inter Quartile Range; IUCD, Uterine Contraceptive Device; OCP, Oral Contraceptive Pill; STI, Sexual Transmitted Infection; SSA, Sub-Saharan Africa

Introduction

A family planning program is an essential and cost-effective health promotion program that has been provided in the African context for more than 50 years [1]. Universal access to family planning can reduce maternal deaths by 40% and infant mortality by 10% [2, 3]. Despite much programmatic success all over the world, only 22% of reproductive-age women used modern contraception, and 17.3% of women had an unmet need for family planning in 2019 [4]. Unmet need for family planning is also high in Sub-saran Africa (SSA) with an estimated 23.5% of women who want to limit or space their births are not using any contraceptive method [5]. In Ethiopia, only 36% of currently married women used contraceptives and 22% of women have an unmet need for family planning [6]. Lack of awareness about contraceptive methods, lack of access to contraceptive information, fear of infertility, and cost of the services are barriers responsible for the huge unmet need for family planning among individuals [5, 7–9].

Delayed return of fertility after discontinuation of contraception becomes a big challenge for women who are using hormonal contraception [10–15]. Although hormonal contraceptive methods are effective, safe, and reversible, they delay fertility upon discontinuation [16–18]. A study showed that 25%, 28%, 25%, and 36% of previous OCP, ICUD, implants, and injectable users experienced a delay in the return of fertility within one year of contraceptive discontinuation [19]. Another study conducted in fifteen SSA countries indicated that 27% of women were unable to become pregnant within a year following the discontinuation of hormonal contraception [20]. Different evidence suggested that Post-pill amenorrhea was observed among previous OCP users [21–25].

Delay in return of fertility after hormonal contraceptive discontinuation had a significant impact on women’s health. It is a repeatedly mentioned reason for not using contraception [26, 27]. It leads to early contraceptive method discontinuation and dissatisfaction with family planning services [28]. The delay in return of fertility following hormonal contraceptive discontinuation is also linked with stigma and discrimination, isolation, intimate partner violence, and mental health disorders [29–31].

Studies showed that different factors have been associated with delayed fertility return. These include age [20, 32], smoking, alcohol drinking [33], parity, gravidity [32, 34], duration of contraceptive use, and type of contraceptive method [15, 35].

There was limited evidence regarding fertility return after hormonal contraceptive discontinuation in the study area. So, this study aimed to assess fertility return after hormonal contraceptive discontinuation and associated factors among pregnant women attending FGAE Dessie Model Clinic. The finding of this study will have paramount importance for policymakers and program designers to design evidence-based interventions to increase the utilization of family planning services.

Material and methods

Study area, study design, and participants

An institution-based cross-sectional study was conducted in FGAE Dessie Model Clinic from May 1–30/2019. FGAE is a volunteer-based, non-government and nonprofit organization that initiate and expand the Sexual and Reproductive Health (SRH) program in Ethiopia since 1966. FGAE Dessie Model clinic which is found in Dessie city administration (located 401KM away from Addis Ababa, the capital city of Ethiopia, and 480km away from Bahir Dar) is one of FGAE SRH clinics established in 1975 and has served more than 100,000 population of all types including key and priority population, most vulnerable and underserved populations of South Wollo administrative zone. It is one of the local Non-governmental Organizations (NGOs) that provide SRH services including youth-friendly services, family planning, antenatal, delivery, postnatal, HIV, and other STI services through its clinic.

The source population was all pregnant women attending the Antenatal Care (ANC) unit of FGAE Dessie Model Clinic whereas; the study population was all systematically selected pregnant women attending the ANC unit of FGAE Dessie Model Clinic during the study period. All systematically selected pregnant women coming for ANC during the data collection period were included and those women who became pregnant without using any contraceptive method and due to contraceptive failure were excluded from the study.

Sample size and sampling procedure

The sample size was determined by using single population proportion formula by considering the proportion of delayed fertility return as 50% since no study was done in Ethiopia, 95% confidence level, and a 5% margin of error. Thus, the final sample size after adding a 10% non-response rate became 423. A systematic random sampling technique was used to select study participants. As the 2018 data showed, on average, a total of 936 pregnant women attended the ANC room of FGAE Dessie model clinic each month. Using this information, interval (k) was determined by dividing the average client flow per month (N) by the total sample size (n) i.e. k = N/n, K = 936/423, K = 2.2≈2. So, study participants were selected every two women until reaching the final sample size.

Data collection procedures and measurements

Data were collected by face-to-face interview using a pretested and structured Amharic version questionnaire taken from previous similar works of literature. The questionnaire was composed of Socio-demographic factors, behavioral factors, obstetric, contraceptive, disease, and nutritional-related factors [15, 20, 32–36]. Two trained nurses have collected the data from May 1–30/2019 under the supportive supervision of one supervisor and principal investigators. Special markings were used to avoid the collection of unnecessary data from cases with repeated visits during the study period.

Data collectors and supervisor were trained for two days on the objective of the study, the content of the questionnaire, and the data collection procedure. Before the data collection, the questionnaire was pretested on 22 study participants at Dessie health center, and based on feedback obtained from the pretest, a necessary modification was done. During the study period, the collected data were checked continuously daily for completeness by the supervisor and principal investigators. Moreover, we have tried to provide adequate time and detailed explanation of questioners for each study participant to minimize memory-related bias (recall bias).

The outcome variable was fertility return after hormonal contraceptive discontinuation. In this study, fertility return was defined if conception occurred within 12 months following discontinuation of any hormonal contraceptive methods (Depo-Provera, OCP, IUCD, and implant) [15, 36].

Abortion: Termination of pregnancy before 28 weeks of gestation. It includes both spontaneous and induced abortion.

The menstrual cycle is the duration between two consecutive menses (the duration from the first day of menses to the first day of the next menses). The cycle is said to be irregular: if a woman’s menstrual cycle is shorter than 21 days or longer than 35 days and, regular: if a cycle ranges from 21 to 35 days.

History of medical illness: Having a previous history of tuberculosis, diabetes, or both.

Khat is a fresh green leafy plant that contains a psycho-active ingredient cathinone. It is classified as an illicit substance due to the potential for psychological dependence. Its regular consumption negatively impacts the human central nervous system, systemic blood pressure, psychological health, and reproductive system causing reproductive toxicity and sexual dysfunction.

Statistical analysis

Data were coded and entered into Epi Data version 3.1 and exported to SPSS version 23 for analysis. Descriptive statistics such as frequency, percentage, and median with Interquartile Range (IQR) were carried out. Bi-variable binary logistic regression was performed and variables with a p-value of less than 0.25 were transported to multivariable logistic regression. Multicollinearity was checked using standard error and Hosmer and Lemeshow goodness of test was used to check model fitness. Variables with a P-value less than 0.05 and AOR with a 95% confidence interval non-inclusive of one were considered as statistically significant predictors of delayed fertility return in the final model.

Ethical approval

Ethical Clearance was taken from the Ethical Review Committee (ERC) of Wollo University College of Medicine and Health Sciences. An official letter was written from the School of Public Health to FGAE Dessie Model Clinic head to get permission. After explaining the purpose of the study, verbal informed consent was taken from each participant before the data collection. They were informed that participating in the study was voluntary and the right to withdraw from the study at any time during the interview was assured. Privacy and confidentiality of information they gave was secured at all levels.

This manuscript was organized and written according to strengthening the Reporting of Observational Studies in Epidemiology (STROBE) 2007 (v4) Statement checklist for cross-sectional studies (S1 Table).

Results

Socio-demographic characteristics

In this study, a total of 402 pregnant women were involved and making a response rate of 94.5%. The median age of the respondents was 28 years with an IQR of 4 years. Three hundred eighty (94.5%) of pregnant women were married and 361(89.8%) of pregnant women were Amhara in their ethnicity respectively. Two hundred sixteen (53.7%) pregnant women were orthodox tewahido followers, 203(50.5%) of women earn less than or equal to 94.3 American Dollars, and 392 (97.5%) of women live in urban areas respectively. One hundred ninety-six (48.8%) of pregnant women were educated up to college and university level and 143(35.6%) of women were government employed respectively (Table 1).

Download:

Table 1. Socio-demographic characteristics of pregnant women who attended FGAE Dessie model clinic, Northeast Ethiopia, 2019.

https://doi.org/10.1371/journal.pone.0287440.t001

Behavioral characteristics

One hundred thirty-one (32.6%) of pregnant women ever drink alcohol in their lifetime, 121(30.1%) of women drink alcohol in the last twelve months and 64 (15.9%) of women drink alcohol less than once a month in the last twelve months respectively. Seventy-one (17.7%) of pregnant women ever chew khat in their lifetime, 51(12.7%) of women chewed khat in the last twelve months and 17 (4.2%) of women chew khat less than once a month in the last twelve months respectively. In the case of frequency of sexual intercourse, 71 (17.7%) and 219 (54.5%) of pregnant women had sexual intercourse three times a day and three times a week respectively (Table 2).

Download:

Table 2. Behavioral characteristics of pregnant women who attended FGAE Dessie model clinic, Northeast Ethiopia, 2019.

https://doi.org/10.1371/journal.pone.0287440.t002

Contraceptive, obstetric, and disease-related characteristics

The majority 172(42.8%) of pregnant women used Depo-Provera and 113 (28.1%) women used implants as a contraceptive method before the current pregnancy. One hundred eighty-four (45.8%) of pregnant women used contraceptive methods for 12–24 months before the current pregnancy. One hundred fifty-eight (39.3%) of women have given birth once, 30 (7.5%) of pregnant women had a history of abortion, and 301(74.9%) of pregnant women had regular menstrual cycles before the current pregnancy. Four (1%) and 6(1.5%) of pregnant women had a history of Sexual Transmitted Infection (STI) and other medical illnesses (tuberculosis and diabetic Malthus) respectively (Table 3).

Download:

Table 3. Contraceptive, obstetric, and disease-related characteristics of pregnant women attended FGA Dessie model clinic, Northeast Ethiopia, 2019.

https://doi.org/10.1371/journal.pone.0287440.t003

The proportion of fertility return

The proportion of fertility return among pregnant women after discontinuation of any hormonal contraceptive methods before the current pregnancy was 88.6% (95% CI; (85.6–92%)).

The proportion of fertility return among pregnant women who used Depo-Provera, implant, IUCD, and OCP before the current pregnancy was 75% (95% CI; (68.6%-80.8%)), 99.1% (95% CI; (97.3–99.999%)), 100% and 97.8% respectively.

The median time of fertility return among pregnant women after discontinuation of any hormonal contraceptive methods before the current pregnancy was 6 months with an IQR of 8 months. The median time of fertility return among Depo-Provera implant, IUCD, and OCP users before the current pregnancy was 9 months, 4 months, 6 months, and 2 months with IQR of 7 months, 4 months, 8 months, and 4 months respectively.

Factors associated with delayed fertility return

Both bi-variable and multivariable binary logistic regression analyses were done. The finding indicated that pregnant women aged 35 years and more were 5.4 times more likely to experience fertility delay upon hormonal contraceptive discontinuation compared to their counterparts (AOR = 5.37, (95% CI; (1.48, 13.6)). Similarly, pregnant women who used Depo-Provera before the current pregnancy were 4.8 times more likely to experience fertility delay upon discontinuation as compared to women who used implant, IUCD, and OCP (AOR = 4.82, 95% CI; (1.89, 14.2)) (Table 4).

Download:

Table 4. Factors associated with delayed fertility return after hormonal contraceptive discontinuation among pregnant women attended FGAE Dessie model clinic, Northeast Ethiopia, 2019.

https://doi.org/10.1371/journal.pone.0287440.t004

Discussion

The proportion of fertility return after discontinuation of any hormonal contraceptive methods before the current pregnancy was 88.6%. The proportion of fertility return among Depo-Provera, implant, IUCD, and OCP users before the current pregnancy was 75%, 99.1%, 100%, and 97.8% respectively. Age and using Depo-Provera had a positive association with delayed fertility return.

The proportion of fertility return among pregnant women after discontinuation of any hormonal contraceptive methods was 88.6%. the finding is similar to a study conducted by Farrow A et al in England which showed that 82% of the participants conceived within one year after discontinuation of any hormonal contraceptive method [36]. However, it is higher than studies conducted by Barden-O’Fallon et al in fifteen SSA countries and Girum T et al which is 73% and 83.1% respectively [15, 20].

The proportion of fertility return among Depo-Provera users before the current pregnancy was similar but, the proportion of fertility return among implant, IUCD, and OCP users was high as compared to a meta-analysis study conducted by Girum T et al which indicated that the proportion of fertility return among Depo-Provera, implant, IUCD, and OCP users was 77.7%, 74.7%, 84.7%, and 88% [15]. Similarly, the proportion of fertility return among Depo-Provera, implant, IUCD, and OCP users was high as compared to a study conducted by Gayatri M et al in Indonesia [37]. The proportion of fertility return among IUCD users was also high as compared to a study conducted by Stoddard AM et al in the United States of America and Tadesse E which was 81% and 86.1% respectively [34, 38]. The discrepancy could be due to differences in the study setting, study period, and study population.

In this study, age has a significant association with delayed fertility return. The finding is similar to studies conducted by Farrow A et al, Buckshee K et al, Sivin I et al and Barden-O’Fallon et al [20, 36, 39, 40]. The reason behind this could be the number of eggs decreases as women get older due to a fixed number of eggs in the ovary. The other reason could be as age increases, women will be at higher risk of disorders that can affect fertility, such as uterine fibroids and endometriosis. Moreover, as age increases, the remaining eggs in older women are more likely to have abnormal chromosomes [41, 42].

Using Depo-Provera had a positive association with delayed fertility return. A global handbook on family planning for healthcare providers demonstrated that Depo-Provera causes a delayed fertility return [31]. The finding is also consistent with studies conducted by Yland JJ et al and Pardthaisong T et al [43, 44], This could be due to Depo-Provera can stay in the body system longer than the other birth control methods so that the clearance of progestin from the serum takes a long time and the meantime to ovulation become delayed. On the other hand, Depo-Provera causes excessive weight gain; these leads women to stop ovulation and get irregular menstrual cycles. Once women stop ovulation, they would not be able to conceive and therefore it delays fertility return.

This study has limitations. Some variables like a history of alcohol use, chat chewing, duration of contraceptive use, sexual behavior, and duration of hormonal contraceptive discontinuation until the current pregnancy will be affected by recall bias. Being a facility-based study will also underestimate fertility return as it is prone to miss defaulters and delayed visitors to their ANC appointment.

Conclusion

The proportion of fertility return among pregnant women after discontinuation of any hormonal contraceptive methods before the current pregnancy was high. Age and using Depo-Provera had a positive association with delayed fertility return. The Ministry of Health should design a contraceptive counseling approach that addresses concerns about delays in the return of fertility after contraceptive discontinuation to avoid confusion among family planning users.

Supporting information

S1 Table. STROBE checklist.

https://doi.org/10.1371/journal.pone.0287440.s001

(DOCX)

S1 Dataset. The data set used to assess fertility return after hormonal contraceptive discontinuation and associated factors among pregnant women attending Family Guidance Association Ethiopia (FGAE) Dessie model clinic.

https://doi.org/10.1371/journal.pone.0287440.s002

(SAV)

Acknowledgments

We would like to extend our appreciation to FGA Dessie Model Clinic Head and staff, study participants, data collectors, and supervisor for their cooperation during the data collection process.

References

1. Olson DJ, Piller A. Ethiopia: an emerging family planning success story. Studies in family planning 2013; 44(4):445–459. pmid:24323662
- View Article
- PubMed/NCBI
- Google Scholar
2. USAID. Update on family planning in Sub-Saharan Africa. Repositioning family planning: guidelines for advocacy action. Washington: Academy for Educational Development; 2009.
3. Smith R, Ashford L, Gribble J, Clifton D: Family planning saves lives. Washington DC: Population Reference Bureau 2009, 5.
4. United Nations DoE, Social Affairs PD: Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER. A/435). In.: United Nations, Department of Economic and Social Affairs, Population Division; 2019.
5. Sedgh G, Hussain R: Reasons for contraceptive nonuse among women having an unmet need for contraception in developing countries. Studies in family planning 2014, 45(2):151–169.
- View Article
- Google Scholar
6. Central Statistical Agency Addis Ababa Ethiopia. Demographic and Health Survey 2016. Federal Democratic Republic of Ethiopia; 2017.
7. Campbell M, Sahin‐Hodoglugil NN, Potts M: Barriers to fertility regulation: a review of the literature. Studies in family planning 2006, 37(2):87–98. pmid:16832983
- View Article
- PubMed/NCBI
- Google Scholar
8. Gueye A, Speizer IS, Corroon M, Okigbo CC: Belief in family planning myths at the individual and community levels and modern contraceptive use in urban Africa. International Perspectives on Sexual and reproductive health 2015, 41(4):191. pmid:26871727
- View Article
- PubMed/NCBI
- Google Scholar
9. Diamond-Smith N, Campbell M, Madan S: Misinformation and fear of side-effects of family planning. Culture, health & Sexuality 2012, 14(4):421–433. pmid:22390371
- View Article
- PubMed/NCBI
- Google Scholar
10. Okenwa L, Lawoko S, Jansson B: Contraception, reproductive health, and pregnancy outcomes among women exposed to intimate partner violence in Nigeria. The European Journal of Contraception & Reproductive Health Care 2011, 16(1):18–25. pmid:21158524
- View Article
- PubMed/NCBI
- Google Scholar
11. Zhu H, Lei H, Huang W, Fu J, Wang Q, Shen L, et al: Fertility in older women following removal of long-term intrauterine devices in the wake of a natural disaster. Contraception 2013, 87(4):416–420. pmid:23246305
- View Article
- PubMed/NCBI
- Google Scholar
12. Delbarge W, Batar I, Bafort M, Bonnivert J, Colmant C, Dhont M, et al: Return to fertility in nulliparous and parous women after removal of the GyneFix® intrauterine contraceptive system. The European Journal of Contraception & Reproductive Health Care 2002, 7(1):24–30. pmid:12041861
- View Article
- PubMed/NCBI
- Google Scholar
13. Issa AA, Amr MF: Fertility after removal of intrauterine contraceptive devices. Current therapeutic research 1998, 59(4):257–261.
- View Article
- Google Scholar
14. Mansour D, Gemzell-Danielsson K, Inki P, Jensen JT: Fertility after discontinuation of contraception: a comprehensive review of the literature. Contraception 2011, 84(5):465–477. pmid:22018120
- View Article
- PubMed/NCBI
- Google Scholar
15. Girum T, Wasie A: Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and reproductive medicine 2018, 3(1):1–9. pmid:30062044
- View Article
- PubMed/NCBI
- Google Scholar
16. Jacobstein R: Long-acting and permanent contraception: an international development, service delivery perspective. Journal of Midwifery & women’s Health 2007, 52(4):361–367. pmid:17603958
- View Article
- PubMed/NCBI
- Google Scholar
17. Kulier R, O’Brien P, Helmerhorst FM, Usher‐Patel M, d’Arcangues C: Copper containing, framed intra‐uterine devices for contraception. Cochrane Database of systematic reviews 2007(4). pmid:17943851
- View Article
- PubMed/NCBI
- Google Scholar
18. Brief BP: Prevention of Postpartum Hemorrhage in Rural Ethiopia. 2012.
- View Article
- Google Scholar
19. Gayatri M, Utomo B, Budiharsana M: How soon can you expect to get pregnant after discontinuing the reversible contraceptive method? A survival analysis of the 2017 Indonesia demographic and health survey data. EXECUTIVE EDITOR 2020, 11(01):310.
- View Article
- Google Scholar
20. Barden-O’Fallon J, Speizer IS, Calhoun LM, Moumouni NA: Return to pregnancy after contraceptive discontinuation to become pregnant: a pooled analysis of West and East African populations. Reproductive Health 2021, 18(1):1–10.
- View Article
- Google Scholar
21. Shearman R: Amenorrhea after treatment with oral contraceptives. Lancet (London, England) 1966, 2(7473):1110. pmid:4162532
- View Article
- PubMed/NCBI
- Google Scholar
22. Vessey M, Wright N, McPherson K, Wiggins P: Fertility after stopping different methods of contraception. Br Med J 1978, 1(6108):265–267. pmid:620301
- View Article
- PubMed/NCBI
- Google Scholar
23. Linn S, Schoenbaum SC, Monson RR, Rosner B, Ryan KJ: Delay in conception for former’pill’users. Jama 1982, 247(5):629–632. pmid:6976442
- View Article
- PubMed/NCBI
- Google Scholar
24. Harlap S, Baras M: Conception-waits in fertile women after stopping oral contraceptives. International Journal of Fertility 1984, 29(2):73–80. pmid:6148320
- View Article
- PubMed/NCBI
- Google Scholar
25. Chasan-Taber L, Willett WC, Stampfer MJ, Spiegelman D, Rosner BA, Hunter DJ, et al: Oral contraceptives and ovulatory causes of delayed fertility. American journal of Epidemiology 1997, 146(3):258–265. pmid:9247010
- View Article
- PubMed/NCBI
- Google Scholar
26. Castle S: Factors influencing young Malians’ reluctance to use hormonal contraceptives. In.: Wiley Online Library; 2003.
27. Ochako R, Mbondo M, Aloo S, Kaimenyi S, Thompson R, Temmerman M, et al: Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study. BMC public health 2015, 15(1):1–9. pmid:25884675
- View Article
- PubMed/NCBI
- Google Scholar
28. Burke H, Ambasa-Shisanya C: Qualitative study of reasons for discontinuation of injectable contraceptives among users and salient reference groups in Kenya. African Journal of reproductive health 2011, 15(2). pmid:22590894
- View Article
- PubMed/NCBI
- Google Scholar
29. Fotherby K, Yong-En S, Howard G, Elder M, Muggeridge J: Return of ovulation and fertility in women using norethisterone oenanthate. Contraception 1984, 29(5):447–455. pmid:6744861
- View Article
- PubMed/NCBI
- Google Scholar
30. Pardthaisong T, Gray R, Mcdaniel E: Return of fertility after discontinuation of depot medroxyprogesterone acetate and intra-uterine devices in Northern Thailand. The Lancet 1980, 315(8167):509–512. pmid:6102234
- View Article
- PubMed/NCBI
- Google Scholar
31. Organization WH: Family planning: a global handbook for providers: 2011 update: evidence-based guidance developed through worldwide collaboration. 2011.
- View Article
- Google Scholar
32. Vessey MP, Smith M, Yeates D: Return of fertility after discontinuation of oral contraceptives: influence of age and parity. Br J Fam Plann 1986, 11(4):120–124.
- View Article
- Google Scholar
33. Buck GM, Sever LE, Batt RE, Mendola P: Life-style factors and female infertility. Epidemiology 1997:435–441. pmid:9209860
- View Article
- PubMed/NCBI
- Google Scholar
34. Stoddard AM, Xu H, Madden T, Allsworth JE, Peipert JF: Fertility after intrauterine device removal: a pilot study. The European Journal of Contraception & Reproductive Health Care 2015, 20(3):223–230. pmid:25751567
- View Article
- PubMed/NCBI
- Google Scholar
35. Wallach EE, Huggins GR, Cullins VE: Fertility after contraception or abortion. Fertility and sterility 1990, 54(4):559–573. pmid:2209874
- View Article
- PubMed/NCBI
- Google Scholar
36. Farrow A, Hull M, Northstone K, Taylor H, Ford W, Golding J: Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception. Human Reproduction 2002, 17(10):2754–2761. pmid:12351558
- View Article
- PubMed/NCBI
- Google Scholar
37. Gayatri M, Utomo B, Budiharsana M, Dasvarma G: Pregnancy resumption following contraceptive discontinuation: Hazard survival analysis of the Indonesia Demographic and Health Survey Data 2007, 2012 and 2017. Plos one 2022, 17(2):e0264318. pmid:35196329
- View Article
- PubMed/NCBI
- Google Scholar
38. Tadesse E: Return of fertility after an IUD removal for planned pregnancy: a six-year prospective study. East African medical journal 1996, 73(3):169–171. pmid:8698014
- View Article
- PubMed/NCBI
- Google Scholar
39. Buckshee K, Chatterjee P, Dhall G, Hazra M, Kodkany B, Lalitha K, et al: Return of fertility following discontinuation of norplantR-II subdermal implants: ICMR task force on hormonal contraception. Contraception 1995, 51(4):237–242.
- View Article
- Google Scholar
40. Sivin I, Stern J, Diaz S, Pavéz M, Alvarez F, Brache V, et al: Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices. American Journal of obstetrics and Gynecology 1992, 166(4):1208–1213. pmid:1566771
- View Article
- PubMed/NCBI
- Google Scholar
41. Hook EB: Rates of chromosome abnormalities at different maternal ages. Obstetrics and gynecology 1981, 58(3):282–285. pmid:6455611
- View Article
- PubMed/NCBI
- Google Scholar
42. Capezzuoli T, Vannuccini S, Fantappiè G, Orlandi G, Rizzello F, Coccia ME, et al: Ultrasound findings in infertile women with endometriosis: evidence of concomitant uterine disorders. Gynecological Endocrinology 2020, 36(9):808–812. pmid:32133885
- View Article
- PubMed/NCBI
- Google Scholar
43. Yland JJ, Bresnick KA, Hatch EE, Wesselink AK, Mikkelsen EM, Rothman KJ, et al: Pregravid contraceptive use and fecundability: prospective cohort study. bmj 2020, 371. pmid:33177047
- View Article
- PubMed/NCBI
- Google Scholar
44. Pardthaisong T: Return of fertility after use of the injectable contraceptive Depo Provera: updated data analysis. Journal of Biosocial Science 1984, 16(1):23–34. pmid:6230362
- View Article
- PubMed/NCBI
- Google Scholar

[ref1] 1. Olson DJ, Piller A. Ethiopia: an emerging family planning success story. Studies in family planning 2013; 44(4):445–459. pmid:24323662
View Article
PubMed/NCBI
Google Scholar

[2] View Article

[3] PubMed/NCBI

[4] Google Scholar

[ref2] 2. USAID. Update on family planning in Sub-Saharan Africa. Repositioning family planning: guidelines for advocacy action. Washington: Academy for Educational Development; 2009.

[ref3] 3. Smith R, Ashford L, Gribble J, Clifton D: Family planning saves lives. Washington DC: Population Reference Bureau 2009, 5.

[ref4] 4. United Nations DoE, Social Affairs PD: Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER. A/435). In.: United Nations, Department of Economic and Social Affairs, Population Division; 2019.

[ref5] 5. Sedgh G, Hussain R: Reasons for contraceptive nonuse among women having an unmet need for contraception in developing countries. Studies in family planning 2014, 45(2):151–169.
View Article
Google Scholar

[9] View Article

[10] Google Scholar

[ref6] 6. Central Statistical Agency Addis Ababa Ethiopia. Demographic and Health Survey 2016. Federal Democratic Republic of Ethiopia; 2017.

[ref7] 7. Campbell M, Sahin‐Hodoglugil NN, Potts M: Barriers to fertility regulation: a review of the literature. Studies in family planning 2006, 37(2):87–98. pmid:16832983
View Article
PubMed/NCBI
Google Scholar

[13] View Article

[14] PubMed/NCBI

[15] Google Scholar

[ref8] 8. Gueye A, Speizer IS, Corroon M, Okigbo CC: Belief in family planning myths at the individual and community levels and modern contraceptive use in urban Africa. International Perspectives on Sexual and reproductive health 2015, 41(4):191. pmid:26871727
View Article
PubMed/NCBI
Google Scholar

[17] View Article

[18] PubMed/NCBI

[19] Google Scholar

[ref9] 9. Diamond-Smith N, Campbell M, Madan S: Misinformation and fear of side-effects of family planning. Culture, health & Sexuality 2012, 14(4):421–433. pmid:22390371
View Article
PubMed/NCBI
Google Scholar

[21] View Article

[22] PubMed/NCBI

[23] Google Scholar

[ref10] 10. Okenwa L, Lawoko S, Jansson B: Contraception, reproductive health, and pregnancy outcomes among women exposed to intimate partner violence in Nigeria. The European Journal of Contraception & Reproductive Health Care 2011, 16(1):18–25. pmid:21158524
View Article
PubMed/NCBI
Google Scholar

[25] View Article

[26] PubMed/NCBI

[27] Google Scholar

[ref11] 11. Zhu H, Lei H, Huang W, Fu J, Wang Q, Shen L, et al: Fertility in older women following removal of long-term intrauterine devices in the wake of a natural disaster. Contraception 2013, 87(4):416–420. pmid:23246305
View Article
PubMed/NCBI
Google Scholar

[29] View Article

[30] PubMed/NCBI

[31] Google Scholar

[ref12] 12. Delbarge W, Batar I, Bafort M, Bonnivert J, Colmant C, Dhont M, et al: Return to fertility in nulliparous and parous women after removal of the GyneFix® intrauterine contraceptive system. The European Journal of Contraception & Reproductive Health Care 2002, 7(1):24–30. pmid:12041861
View Article
PubMed/NCBI
Google Scholar

[33] View Article

[34] PubMed/NCBI

[35] Google Scholar

[ref13] 13. Issa AA, Amr MF: Fertility after removal of intrauterine contraceptive devices. Current therapeutic research 1998, 59(4):257–261.
View Article
Google Scholar

[37] View Article

[38] Google Scholar

[ref14] 14. Mansour D, Gemzell-Danielsson K, Inki P, Jensen JT: Fertility after discontinuation of contraception: a comprehensive review of the literature. Contraception 2011, 84(5):465–477. pmid:22018120
View Article
PubMed/NCBI
Google Scholar

[40] View Article

[41] PubMed/NCBI

[42] Google Scholar

[ref15] 15. Girum T, Wasie A: Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and reproductive medicine 2018, 3(1):1–9. pmid:30062044
View Article
PubMed/NCBI
Google Scholar

[44] View Article

[45] PubMed/NCBI

[46] Google Scholar

[ref16] 16. Jacobstein R: Long-acting and permanent contraception: an international development, service delivery perspective. Journal of Midwifery & women’s Health 2007, 52(4):361–367. pmid:17603958
View Article
PubMed/NCBI
Google Scholar

[48] View Article

[49] PubMed/NCBI

[50] Google Scholar

[ref17] 17. Kulier R, O’Brien P, Helmerhorst FM, Usher‐Patel M, d’Arcangues C: Copper containing, framed intra‐uterine devices for contraception. Cochrane Database of systematic reviews 2007(4). pmid:17943851
View Article
PubMed/NCBI
Google Scholar

[52] View Article

[53] PubMed/NCBI

[54] Google Scholar

[ref18] 18. Brief BP: Prevention of Postpartum Hemorrhage in Rural Ethiopia. 2012.
View Article
Google Scholar

[56] View Article

[57] Google Scholar

[ref19] 19. Gayatri M, Utomo B, Budiharsana M: How soon can you expect to get pregnant after discontinuing the reversible contraceptive method? A survival analysis of the 2017 Indonesia demographic and health survey data. EXECUTIVE EDITOR 2020, 11(01):310.
View Article
Google Scholar

[59] View Article

[60] Google Scholar

[ref20] 20. Barden-O’Fallon J, Speizer IS, Calhoun LM, Moumouni NA: Return to pregnancy after contraceptive discontinuation to become pregnant: a pooled analysis of West and East African populations. Reproductive Health 2021, 18(1):1–10.
View Article
Google Scholar

[62] View Article

[63] Google Scholar

[ref21] 21. Shearman R: Amenorrhea after treatment with oral contraceptives. Lancet (London, England) 1966, 2(7473):1110. pmid:4162532
View Article
PubMed/NCBI
Google Scholar

[65] View Article

[66] PubMed/NCBI

[67] Google Scholar

[ref22] 22. Vessey M, Wright N, McPherson K, Wiggins P: Fertility after stopping different methods of contraception. Br Med J 1978, 1(6108):265–267. pmid:620301
View Article
PubMed/NCBI
Google Scholar

[69] View Article

[70] PubMed/NCBI

[71] Google Scholar

[ref23] 23. Linn S, Schoenbaum SC, Monson RR, Rosner B, Ryan KJ: Delay in conception for former’pill’users. Jama 1982, 247(5):629–632. pmid:6976442
View Article
PubMed/NCBI
Google Scholar

[73] View Article

[74] PubMed/NCBI

[75] Google Scholar

[ref24] 24. Harlap S, Baras M: Conception-waits in fertile women after stopping oral contraceptives. International Journal of Fertility 1984, 29(2):73–80. pmid:6148320
View Article
PubMed/NCBI
Google Scholar

[77] View Article

[78] PubMed/NCBI

[79] Google Scholar

[ref25] 25. Chasan-Taber L, Willett WC, Stampfer MJ, Spiegelman D, Rosner BA, Hunter DJ, et al: Oral contraceptives and ovulatory causes of delayed fertility. American journal of Epidemiology 1997, 146(3):258–265. pmid:9247010
View Article
PubMed/NCBI
Google Scholar

[81] View Article

[82] PubMed/NCBI

[83] Google Scholar

[ref26] 26. Castle S: Factors influencing young Malians’ reluctance to use hormonal contraceptives. In.: Wiley Online Library; 2003.

[ref27] 27. Ochako R, Mbondo M, Aloo S, Kaimenyi S, Thompson R, Temmerman M, et al: Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study. BMC public health 2015, 15(1):1–9. pmid:25884675
View Article
PubMed/NCBI
Google Scholar

[86] View Article

[87] PubMed/NCBI

[88] Google Scholar

[ref28] 28. Burke H, Ambasa-Shisanya C: Qualitative study of reasons for discontinuation of injectable contraceptives among users and salient reference groups in Kenya. African Journal of reproductive health 2011, 15(2). pmid:22590894
View Article
PubMed/NCBI
Google Scholar

[90] View Article

[91] PubMed/NCBI

[92] Google Scholar

[ref29] 29. Fotherby K, Yong-En S, Howard G, Elder M, Muggeridge J: Return of ovulation and fertility in women using norethisterone oenanthate. Contraception 1984, 29(5):447–455. pmid:6744861
View Article
PubMed/NCBI
Google Scholar

[94] View Article

[95] PubMed/NCBI

[96] Google Scholar

[ref30] 30. Pardthaisong T, Gray R, Mcdaniel E: Return of fertility after discontinuation of depot medroxyprogesterone acetate and intra-uterine devices in Northern Thailand. The Lancet 1980, 315(8167):509–512. pmid:6102234
View Article
PubMed/NCBI
Google Scholar

[98] View Article

[99] PubMed/NCBI

[100] Google Scholar

[ref31] 31. Organization WH: Family planning: a global handbook for providers: 2011 update: evidence-based guidance developed through worldwide collaboration. 2011.
View Article
Google Scholar

[102] View Article

[103] Google Scholar

[ref32] 32. Vessey MP, Smith M, Yeates D: Return of fertility after discontinuation of oral contraceptives: influence of age and parity. Br J Fam Plann 1986, 11(4):120–124.
View Article
Google Scholar

[105] View Article

[106] Google Scholar

[ref33] 33. Buck GM, Sever LE, Batt RE, Mendola P: Life-style factors and female infertility. Epidemiology 1997:435–441. pmid:9209860
View Article
PubMed/NCBI
Google Scholar

[108] View Article

[109] PubMed/NCBI

[110] Google Scholar

[ref34] 34. Stoddard AM, Xu H, Madden T, Allsworth JE, Peipert JF: Fertility after intrauterine device removal: a pilot study. The European Journal of Contraception & Reproductive Health Care 2015, 20(3):223–230. pmid:25751567
View Article
PubMed/NCBI
Google Scholar

[112] View Article

[113] PubMed/NCBI

[114] Google Scholar

[ref35] 35. Wallach EE, Huggins GR, Cullins VE: Fertility after contraception or abortion. Fertility and sterility 1990, 54(4):559–573. pmid:2209874
View Article
PubMed/NCBI
Google Scholar

[116] View Article

[117] PubMed/NCBI

[118] Google Scholar

[ref36] 36. Farrow A, Hull M, Northstone K, Taylor H, Ford W, Golding J: Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception. Human Reproduction 2002, 17(10):2754–2761. pmid:12351558
View Article
PubMed/NCBI
Google Scholar

[120] View Article

[121] PubMed/NCBI

[122] Google Scholar

[ref37] 37. Gayatri M, Utomo B, Budiharsana M, Dasvarma G: Pregnancy resumption following contraceptive discontinuation: Hazard survival analysis of the Indonesia Demographic and Health Survey Data 2007, 2012 and 2017. Plos one 2022, 17(2):e0264318. pmid:35196329
View Article
PubMed/NCBI
Google Scholar

[124] View Article

[125] PubMed/NCBI

[126] Google Scholar

[ref38] 38. Tadesse E: Return of fertility after an IUD removal for planned pregnancy: a six-year prospective study. East African medical journal 1996, 73(3):169–171. pmid:8698014
View Article
PubMed/NCBI
Google Scholar

[128] View Article

[129] PubMed/NCBI

[130] Google Scholar

[ref39] 39. Buckshee K, Chatterjee P, Dhall G, Hazra M, Kodkany B, Lalitha K, et al: Return of fertility following discontinuation of norplantR-II subdermal implants: ICMR task force on hormonal contraception. Contraception 1995, 51(4):237–242.
View Article
Google Scholar

[132] View Article

[133] Google Scholar

[ref40] 40. Sivin I, Stern J, Diaz S, Pavéz M, Alvarez F, Brache V, et al: Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices. American Journal of obstetrics and Gynecology 1992, 166(4):1208–1213. pmid:1566771
View Article
PubMed/NCBI
Google Scholar

[135] View Article

[136] PubMed/NCBI

[137] Google Scholar

[ref41] 41. Hook EB: Rates of chromosome abnormalities at different maternal ages. Obstetrics and gynecology 1981, 58(3):282–285. pmid:6455611
View Article
PubMed/NCBI
Google Scholar

[139] View Article

[140] PubMed/NCBI

[141] Google Scholar

[ref42] 42. Capezzuoli T, Vannuccini S, Fantappiè G, Orlandi G, Rizzello F, Coccia ME, et al: Ultrasound findings in infertile women with endometriosis: evidence of concomitant uterine disorders. Gynecological Endocrinology 2020, 36(9):808–812. pmid:32133885
View Article
PubMed/NCBI
Google Scholar

[143] View Article

[144] PubMed/NCBI

[145] Google Scholar

[ref43] 43. Yland JJ, Bresnick KA, Hatch EE, Wesselink AK, Mikkelsen EM, Rothman KJ, et al: Pregravid contraceptive use and fecundability: prospective cohort study. bmj 2020, 371. pmid:33177047
View Article
PubMed/NCBI
Google Scholar

[147] View Article

[148] PubMed/NCBI

[149] Google Scholar

[ref44] 44. Pardthaisong T: Return of fertility after use of the injectable contraceptive Depo Provera: updated data analysis. Journal of Biosocial Science 1984, 16(1):23–34. pmid:6230362
View Article
PubMed/NCBI
Google Scholar

[151] View Article

[152] PubMed/NCBI

[153] Google Scholar

Figures

Abstract

Background

Methods

Result

Conclusions

Introduction

Material and methods

Study area, study design, and participants

Sample size and sampling procedure

Data collection procedures and measurements

Statistical analysis

Ethical approval

Results

Socio-demographic characteristics

Behavioral characteristics

Contraceptive, obstetric, and disease-related characteristics

The proportion of fertility return

Factors associated with delayed fertility return

Discussion

Conclusion

Supporting information

S1 Table. STROBE checklist.

S1 Dataset. The data set used to assess fertility return after hormonal contraceptive discontinuation and associated factors among pregnant women attending Family Guidance Association Ethiopia (FGAE) Dessie model clinic.

Acknowledgments

References