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 live 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.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: Researchers at 15 Human Reproduction Centres of the Indian Council of Medical Research followed 627 women aged 18-35 who stopped using the subdermal Norplant-II system for different reasons, and thus were exposed to the risk of pregnancy, for 2 years to determine return of fertility. 20% conceived within 1 month of Norplant-II implant removal. The 6-month, 1-year, and 2-year pregnancy rates were 63.4%, 80.3%, and 88.3%, respectively. Neither duration of Norplant-II implant use nor bleeding patterns had an adverse effect on return of fertility. The 1-year and 2-year cumulative pregnancy rates for women who stopped due to bleeding irregularities and other reasons were lower than those who stopped due to planning a pregnancy. Return of fertility was delayed in women whose implants were removed after age 30 compared to those younger than 30 (1-year pregnancy rate, 66.3% vs. 83%; median time to conception, 6 vs. 3.8 months; p 0.05). The difference was not significant at 2 years, however. 89.7% of women who wanted pregnancy and became pregnant after discontinuation delivered full-term live infants. 4.4% had a spontaneous abortion. Women who discontinued the implant system to conceive were less likely to opt for an induced abortion than those who discontinued for irregular bleeding and other reasons (5.9% vs. 36.4-41.6%), suggesting that many women did not want another child and need to be counseled about adopting and offered another contraceptive method. The spontaneous abortion rates for women who discontinued for irregular bleeding and other reasons were 1.7% and 2.7%. No group of former Norplant II users suffered a spontaneous abortion rate greater than the pre-Norplant II use rate (3.6%). These findings show that the Norplant-II implant system does not delay return to fertility in women who stop using it to become pregnant.