About 80% of women removing the hormonal IUD who want to become pregnant will be pregnant within the first year following removal. This is functionally identical to the 1-year rate of pregnancy among women who have never used hormonal contraceptives, indicating that a user’s typical level of fertility is restored more or less immediately following removal in most cases. Unlike methods that work by releasing hormones into the blood stream, hormonal IUD does not have a “tail” following method removal in which clinically significant levels of the hormone remain in the body – the method’s effect only occurs as long as it is in the uterus. Some users may need to experience 2-3 menstrual cycles for their uterine wall to thicken sufficiently to support implantation, but this process will begin immediately following removal and resolves quickly. Despite this low risk of negative impact on fertility, it’s essential that providers are responsive to client concerns regarding their ability to get pregnant following method use. Providers should offer thorough screening for health conditions that may impact fertility, and engage in clear discussion about each client’s fertility intentions prior to and during their use of the hormonal IUD.

There is no evidence to suggest that duration of hormonal IUD use impacts fertility. In long-term clinical studies that included post-removal evaluation of fertility, no significant differences were identified between users who had the method for shorter durations (1-3 years) and users who had the method for longer durations (4-8 years).

The hormonal IUD has no impact on future fertility. Most users will continue to ovulate during use of the method, and there is no evidence that users who have not yet had children experience any difference in return to fertility compared to users who have previously had children. The hormonal IUD is safe to use for people who have not been pregnant or given birth.