How soon can you get pregnant after Nexplanon removal?

What does the evidence say about nexplanon removal and return to fertility during pregnancy?

1. NICHD states plainly that pregnancy is possible any time after the implant is removed, unlike some other hormonal methods that carry a longer return-to-fertility window. 1
2. In an integrated analysis of international studies, ovulation returned within six weeks of etonogestrel implant removal for the majority of women, and hormone levels became undetectable within about a week. 2
3. Among the pregnancies tracked after implant removal in that same analysis, every conception date fell within the first two weeks after the implant came out, reflecting a much faster fertility rebound than a method like the Depo-Provera injection. 2
4. In the implant's pivotal trials, 83.5% to 94.4% of participants had their menstrual pattern return to their pre-implant normal within the follow-up period tracked after removal. 3
5. The implant is generally considered compatible with breastfeeding at any point postpartum, though a review estimated roughly a 0.9% chance of reduced milk supply, so it's worth mentioning your breastfeeding status if you're weighing this method. 4

Is nexplanon removal and return to fertility safe in each trimester?

• First trimester. In the days right after removal, hormone levels drop quickly and become undetectable within about a week, but your body still needs to complete one ovulatory cycle, so a pregnancy test right after removal isn't meaningful yet.
• Second trimester. Most people ovulate within six weeks of removal, and in study data, conceptions that occurred after removal happened within the first two weeks of that return to fertility, so it's realistic to start trying right away without a waiting period.
• Third trimester. If your cycles haven't settled into your normal pattern within a few months, or if you're not pregnant after about a year of trying (six months if you're over 35), it's worth checking in with your provider, since implant removal itself isn't expected to cause a lasting delay.