So you’ve stopped your depo shots and now want to get pregnant. How long does it take to get pregnant after depo? And is there anything you can do to speed it up? Dr. Mare explains wait time expectations and more in this article.

 

By Dr. Mare Mbaye

Getting pregnant after any type of birth control is a topic that comes up often in the office. There are so many misconceptions about how birth control can affect fertility and whether or not it needs to be “cleansed” out of the body (hint: it doesn’t—you can read all about it here). I get questions about depo specifically, though, because as a longer-acting medication, timing matters a little more when it comes to pregnancy.  

What is depo?

First off, what is depo and how does it work? Depo-provera (aka depot medroxyprogesterone acetate or DMPA) is a common form of progesterone-only birth control that can be great for those who want something quick and effective without the hassle of daily or weekly administration. The active hormone is progestin, which is simply a man-made version of our natural progesterone hormone. High levels of progesterone signal the ovaries to stop ovulating and also cause the cervical mucus to thicken, preventing sperm from ever reaching an egg if ovulation does occur. It’s given as a shot once every three months in the office, making it very convenient. The shot creates a reserve or depot (hence the name—clever, right?) of progestin in the body at the site of the injection that delivers a steady amount of hormone, which is why the doses can be spread out so far. About 50% of women on depo will stop having their period after about one year. 

Effectiveness, but with one big downfall

Depo is over 99% effective when used perfectly (no missed shots) and 94% effective even with missed shots. The one big downfall of depo, however, is it can take some time before normal fertility resumes. Depo does not cause any harm to the ovaries, but it essentially puts them to sleep, and it can take a little more time for them to “wake up” than with other forms of birth control.

Getting pregnant after depo

This is the big reason why I always ask women who are not done having children and want to go on depo how soon they would like to be pregnant again. If the answer is in a year or less, then depo is usually not my first choice, even if you’re only getting one shot. This is because of how unpredictable the return to normal fertility can be. While you can definitely get pregnant three to four months after a depo shot wears off, not everyone does. It can sometimes take up to ten months or more to ovulate again, and it can take up to 18 months for normal periods to restart.

The good news? Chances of pregnancy are still great, even if it may take a little more time. Pregnancy rates at the one year mark after stopping depo are over 80%, and at the two year mark they’re over 90% (which is the normal fertility rate).  

Unique experience for everyone

Why do some women take longer than others to return to normal fertility? We don’t know for sure. There are likely many factors that contribute to each woman’s response to depo, making it hard to pinpoint one specific issue. Just like anything else in life, every patient has a unique experience. 

One important factor to consider, though, is weight. The FDA includes on the depo label that women of a healthy weight tend to return to normal fertility faster than those who are overweight and obese. This has to do with absorption of progesterone which differs based on each person’s metabolism. With the newer, subcutaneous version of depo (compared to the intramuscular shot), the delay in ovulation appears to be substantially decreased, with one study showing return to ovulation for 97% of women who received subcutaneous depo.

Women of a healthy weight tend to return to normal fertility faster than those who are overweight and obese.

On the other hand, the time frame of depo use does not seem to matter. Your individual return to normal fertility is the same whether you’ve had six months of depo shots or six years.

Ovulation after depo

So what can you do to speed up your return to ovulation after depo? Unfortunately, not much. This is always difficult to hear, but the body has to have the time it needs to metabolize normally. There are no cleanses, diets, or supplements that will make the process go faster. In fact, some of those things may have ingredients that could potentially be harmful to a new pregnancy. 

Thankfully, knowing when things are back to normal is much easier than waiting for it to happen. You can be sure you’re ovulating normally again when you resume your regular periods or by testing for ovulation using ovulation tests. However, this does not mean you can’t get pregnant before your periods come back—ovulation occurs about two weeks before any period, so pregnancy can occur before you actually have that first period.

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Use the wait time to prepare for pregnancy

Hurrying up and waiting is never fun, but the time can be used effectively to prepare as best as possible for pregnancy. Here are some ways:

  • Start taking a prenatal vitamin.
  • Plan ahead and stop your depo shots well in advance of when you want to get pregnant. An alternate form of birth control may be a good idea in the interim. 
  • Exercise regularly, and eat a balanced diet to help increase your metabolism and maintain a healthy weight. Moderate weight loss in overweight patients has the added benefit of boosting fertility.
  • Have regular, unprotected intercourse once you’re ready to conceive. As mentioned before, if your periods haven’t returned or are not regular, you may still get pregnant.
  • Use ovulation predictor kits (aka OPKs or ovulation tests) to figure out when ovulation returns so you can time intercourse effectively. The form of birth control you were previously using does not change the efficacy of these methods.

All of these are safe, healthy ways to optimize yourself for pregnancy. 

As always, use your doctor when you have concerns, but especially if it’s been 24 months since your last depo shot, and you’re still not having regular periods or if you haven’t conceived 12 months after having normal periods again (if you’re 35 or over, contact your provider after 6 months instead).

Learn more about getting pregnant after all forms of birth control here.