Return of fertility following discontinuation of norplant R-II subdermal implants : ICMR task force on hormonal contraception

Abstract

A total of 627 women who had discontinued the use of the Norplant-II implants for various reasons and were exposed to the risk of pregnancy were followed-up for two years for return of fertility. The cumulative conception rates in women who had discontinued due to planning pregnancy were 80.3 per 100 women at one year and 88.3 per 100 women at two years. The majority of women who did conceive (90 percent), had full-term normal liver births; about 4 percent of women had spontaneous abortions, the remaining 6 percent decided on elective termination of pregnancy (ETP). The cumulative conception rates in women who discontinued due to bleeding irregularities and 'other reasons' were 64.5 and 55.8 per 100 women at one year and 77.9 and 75.1 per 100 women at two years, respectively. These rates were significantly lower as compared to those observed in women who discontinued due to planning pregnancy. A large proportion, about 40 percent, of women who conceived after discontinuation of the method due to bleeding irregularities and “other reasons,” opted for ETP indicating that many women in these two groups did not desire another child and that such women need to be counselled for adopting another method of contraception. The spontaneous abortion rates observed in ex-users of Norplant-II implants (1.7 to 4.4% pregnancies) were comparable to the spontaneous abortion rates prior to Norplant-II implant use (3.6% pregnancies) indicating that ex-users of Norplant-II implants were not at a higher risk of spontaneous abortion. There was no association between the pregnancy rates and either duration of Norplant-II implants use or bleeding patterns during the three months prior to discontinuation of the method in this sample. However, there was a delay in return of fertility in women aged more than 30 years as compared to those who were below the age of 30 years. The study indicates that the return of fertility was not impaired in ex-Norplant-II implant users who were planning pregnancy. In addition, those women who continued with the pregnancy until term delivered full-term normal babies in all the study groups.