Return to fertility after subcutaneous depot medroxyprogesterone acetate: a narrative review

This narrative review examines the time to return to fertility after discontinuation of subcutaneous depot medroxyprogesterone acetate (DMPA SC) 104 mg among women of reproductive age.

The review was conducted using multiple data sources including PubMed, CINAHL, Web of Science, The Cochrane Library, Google Scholar, Ovid Medline, EMBASE, POPLINE, Global Health/EBSCO, Scopus, WHO Global Index Medicus, International Clinical Trials Registry Platform (ICTRP), Global Index Medicus - WHO, African Index Medicus (AIM), ScienceDirect, Public Library of Science (PLOS), BioMed Central, Dryad and JSTOR. Search terms included DMPA, SC-DMPA, depot medroxyprogesterone acetate, ovulation, pregnancy, Depo Provera, return to ovulation, fertility, return to fertility, subcutaneous and SubQ. We included studies that used the standard and not experimental dosing of DMPA SC.

Four of the 31 articles met the inclusion criteria. The trials compared DMPA SC 104 mg with intramuscular DMPA (DMPA IM) at various dosages and routes. Follow-up varied from 7.5 to 18 months after the last injection. Median time to ovulation for DMPA SC was 212 days and was not statistically significantly different from DMPA IM 150 mg (183 days). There were no differences in time to ovulation by region, body mass index or age. No studies reported on time to pregnancy, effect of duration or frequency of dosing.

Median time to ovulation for DMPA SC 104 mg of 212 days was similar to that of DMPA IM 150 mg of 183 days, suggesting that choice of formulation (SC vs IM) does not impact the timeline for return to fertility.