Mother’s Day is a day when we celebrate our mothers, past and present, biological and otherwise. It is also a time when many women who have yet to take on this role may begin to wonder if they ever will.

When I was in training, one of my Attendings used to say that women spend their youth trying not to get pregnant, and then their middle age trying to. Is it not true? Even in my profession, I educate women about both abstinence as well as sexual practices to control pregnancy. There are so many effective methods for preventing pregnancy, but eventually that patient who has been seeing me for the last five to ten years will ask…

“Doctor, how do I know if I’m still fertile? How much longer do I have before I should try to have a baby?”

Well, I am going to try to answer that and many more questions in this post. I hope that this information will allow women to feel comfortable with their reproductive choices without feeling like they are forfeiting future fertility. A woman should be able to have a baby because she wants to and is ready to, not because she feels like she has to “birth now or forever hold her peace.” Get it?

1. Do IUD’s and other forms of birth control decrease future fertility?

Intrauterine devices, commonly known as IUDs, do not impair women’s future fertility, according to a new study. When women are age matched after using an IUD for years, the 30-year-old who had had an IUD for 5 years had the same fertility as the 30-year-old who had never had an IUD, but both were less fertile than the 25-year-old. The same is true for women on the pill. In fact, in some cases, birth control can increase your fertility (see #8).

2. Is getting pregnant while on birth control harmful to the baby?

It does depend on the type of birth control. If you are on the pill and get pregnant, presumably because of a missed or late pill, there should be no adverse affects on the baby. If you get pregnant while using an IUD (which occurs less than 1% of the time), as long as the IUD is removed, there shouldn’t be risk. If the IUD cannot be removed, the risk of miscarriage or preterm delivery is increased.

3. Should I give myself a break after birth control before trying to get pregnant?

You can but you don’t have to. Some people want to see their period become normal before getting pregnant. I don’t know that this is necessary, especially in light of the fact that some believe that you are most fertile immediately after stopping birth control.

Some women worry about increased risk of birth defects if you get pregnant right after or while on birth control. There is not evidence to support this claim. Some of the best babies come from birth control failures (lol, kidding but this may be true.)

4. Am I more fertile immediately after stopping birth control?

There isn’t great evidence one way or the other to support this claim. One thing is true though, you are FERTILE even within the first month after stopping birth control. Be ready or use condoms or another form of contraception if your are not ready.

5. Am I more fertile after having a miscarriage?

First, I’m sorry for your loss. Grieving is important for all loss, even an early miscarriage. Allow yourself that time and capacity to just be sad. Once the sting isn’t so fresh, you can try again but you should give yourself three criteria to meet.

1) Make sure your pregnancy hormone levels have fallen to pre-pregnancy levels.

2) Have at least 2 months under your belt from the miscarriage.

3) See a normal period before trying again. If all three of these criteria haven’t been met, you run the risk of starting a new pregnancy before the previous one is over and that can be harmful to your body in addition to increasing your risk for having another miscarriage.

6. How old is too old to have a baby? Am I too old?

I wrote a whole article about Advanced Maternal Age pregnancies, formerly known as geriatric pregnancies. You are never too old to be mother, but those eggs can get a little on the mature side. Do your eggs expire? Check out this post to learn more.

At the end of the day, fertility decreases steadily with age, more rapidly after the age of 37-38. Also risk of pregnancy complications and birth anomalies increases with age, but not so much that you should be afraid to have a child over the age of 35.  In fact, I regularly care for women well into their early 40s with normal, healthy pregnancies. I even had the chance to talk about this on WTTW regarding Tammy Duckworth’s pregnancy in her early 50s. Click here to see that appearance.

7. Can you use your birth control to skip your period and still prevent pregnancy?

I could write an entire post just about this question, but the short answer is ABSOLUTELY. Skipping periods when done with external hormonal control is not unhealthy. Said differently, if you take hormones, ie birth control pills, and skip your period as a result, that is okay. If you just skip periods without being on birth control, this may signify a problem. You should see your doctor. I wrote another parody song about this topic. Stay tuned and subscribe to my YouTube channel to know when that drops.

If your doctor agrees, while on the pill you can skip the “placebo pills” and go straight into the next pack. Some pills come in three month packs with the intention of you having only one period every 3 months. Some low-dose pills will make you not have a period for months, or even years. This is not unsafe in most circumstances. Certain types of IUDs can also lead to infrequent periods.

8. If I have Endometriosis, does birth control help or hurt my future fertility?

Endometriosis is a disorder that causes pain and can decrease fertility. Taking certain types pf birth control (pills and the implant especially) can lessen the effects of endometriosis by making it dormant along with the ovaries. This often improves the pain. Regarding fertility, keeping the ovaries dormant and less affected by endometriosis can improve fertility. While birth control doesn’t treat the problem, it holds it off from wreaking havoc in the pelvis.

Motherhood can come in so many forms. Even if you have not or will not birth a human from your uterus, you can be and probably already are a mother-figure to someone. It’s all about love.

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