Depo Provera: Difficulty conceiving
Before trying to conceive, I had two shots of Depo Provera. Later, after 18 months of trying to conceive, I went to a fertility specialist who put me on Clomid for one cycle and I conceived. I now have a 15-month-old son whom I am nursing. Is it possible that I am still not ovulating? I take my basal body temperature every morning and the chart looks normal, but each cycle we have unprotected sex right before the spike in temperature, and still no pregnancy.
Question:Peg Plumbo CNM
Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more
In an article in the "Journal of Reproductive Medicine," it was reported that in some women, Depo Provera (DMPA) can be detected in the serum for as long as nine months after a single injection of 150 mg.(41(5 Suppl):381-90,1996).
Since ovulation is inhibited, serum progesterone levels remain low (less than 0.4 ng/mL) for several months following an injection of DMPA. When MPA levels fall below 0.1 ng/mL, ovulation resumes. Thus, return to fertility is delayed for several months. Serum estrogen levels begin to rise about four months after a single injection when drug levels fall below 0.5 ng/mL. For women who have used DMPA for several years, serum estradiol levels remain low.
In another study by Kaunitz in the "American Journal of Obstetrics & Gynecology," the author states that ovulation suppression may rarely persist for as long as 18 months after the last injection but does not permanently affect fertility (170(5 Pt 2):1543-9, 1994).
DMPA has effects on the hormonal cycle and on the cervical mucus and the lining of the uterus. After childbirth, it would not seem reasonable to believe that the latter two are still being affected. But the combined factors of Depo Provera, the pregnancy, and lactation are probably affecting the ovarian cycle.
If for some reason, you were slightly subfertile prior to the Depo, this could be accentuated. Women with irregular cycles prior to Depo administration have the hardest time achieving fertility post injection.
You may want to consider using Clomid again but, of course, your provider would be the best one to discuss this with.
I wish you the best.
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