Ovarian reserve markers in women using various hormonal contraceptives

Selma Kloeve Landersoe; Julie Lyng Forman; Kathrine Birch Petersen; Elisabeth Clare Larsen; Bugge Nøhr; Helene Westring Hvidman; Henriette Svarre Nielsen; Anders Nyboe Andersen

doi:10.1080/13625187.2019.1702158

Reproductive Endocrinology Ovarian Hormones

Ovarian reserve markers in women using various hormonal contraceptives

Landersoe SK, Forman JL, Birch Petersen K, Larsen EC, Nøhr B, Hvidman HW, Nielsen HS, Nyboe Andersen A

Published February 2020 The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception, 25(1), 65-71

DOI 10.1080/13625187.2019.1702158 PMID 31852271

RRM Academy Synopsis

Some hormonal contraceptive users had lower AMH and follicle counts

A study of past clinic records in Denmark found that ovarian reserve markers were lower among combined and progestin-only pill users. It compared 565 hormonal contraceptive users with 983 non-hormonal users. Vaginal ring users showed no significant differences in either ovarian reserve marker.

Key Findings

Anti-Müllerian hormone (AMH) ran 31.1% lower among combined oral contraceptive (COC) users than in the non-hormonal group (95% confidence interval [CI] -39.6%, -25.9%; p < 0.001).
Progestin-only pill (POP) users had AMH 35.6% lower (95% CI -49.0%, -18.6%; p < 0.001) than the non-hormonal group.
Levonorgestrel-releasing intrauterine system (LNG-IUS) users had AMH 17.1% lower (95% CI -31.4%, 0.002%; p = 0.052). Vaginal ring users showed no significant differences in AMH.
Antral follicle count (AFC) was 31.3% lower in COC users (95% CI -35.0%, -25.3%). POP users had AFC 29.7% lower (-39.1%, -17.9%). LNG-IUS and ring users showed no significant AFC differences.
COC and vaginal ring users had ovarian volume reduced by more than 50% (p < 0.001), while POP and LNG-IUS users showed no change.

Interpretation

This record rests on the published abstract of a retrospective study at two Danish fertility clinics. The researchers compared each hormonal group with non-hormonal users using adjusted multiple regression. The results are associations that differed by method. The authors conclude that these markers need cautious interpretation in users of all hormonal contraception.

RRM Context

These markers reflect follicle numbers. A reading taken during suppressive medication use describes the ovary under that medication. Restorative reproductive medicine follows the principle of evaluation before treatment. A low marker therefore prompts the question of why it is low, and the medication belongs in that question.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objectives

The aim of the study was to assess whether the ovarian reserve markers anti-Müllerian hormone (AMH) and antral follicle count (AFC) were lower among women using the progestin-only pill (POP) or levonorgestrel-releasing intrauterine system (LNG-IUS) and similar to the decrease observed in combined oral contraceptive (COC) pill users.

Methods

This retrospective study comprised 565 hormonal contraceptive users (COC, POP, LNG-IUS or contraceptive vaginal ring) and 983 non-hormonal contraceptive users, who were seen in two Danish fertility assessment and counselling clinics between 2015 and 2019. Adjusted multiple regression analysis was used to examine the differences in AMH and AFC between hormonal and non-hormonal contraceptive users.

Results

Compared with non-hormonal contraceptive users, AMH was 31.1% lower among COC users [95% confidence interval (CI) -39.6%, -25.9%; p < 0.001], 35.6% lower among POP users (95% CI -49.0%, -18.6%; p < 0.001) and 17.1% lower among LNG-IUS users (95% CI -31.4%, 0.002%; p = 0.052); no significant differences were seen among vaginal ring users. Compared with non-hormonal contraceptive users, AFC was 31.3% lower among COC users (95% CI -35.0%, -25.3%; p < 0.001) and 29.7% lower among POP users (-39.1%, -17.9%; p < 0.001); no significant differences were seen among LNG-IUS or vaginal ring users. Ovarian volume was more than 50% reduced among COC and vaginal ring users (p < 0.001) but was unchanged among POP and LNG-IUS users.

Conclusion

Assessment of ovarian reserve markers among users of all types of hormonal contraception should be interpreted cautiously and the type of contraceptive method considered.

Topics

Reproductive Endocrinology › Ovarian Hormones › Progesterone · Contraception › Comparative Studies › Contraception Versus Fertility Awareness · Diagnostics › Hormone Testing › Serum Panels

Selma Kloeve Landersoe, Julie Lyng Forman, Kathrine Birch Petersen, Elisabeth Clare Larsen, Bugge Nøhr, Helene Westring Hvidman, Henriette Svarre Nielsen, Anders Nyboe Andersen

S Landersoe, J Forman, K Petersen, E Larsen, B Nøhr, H Hvidman, H Nielsen, A Andersen

PMID 31852271 31852271 DOI 10.1080/13625187.2019.1702158 10.1080/13625187.2019.1702158 Landersoe et al. 2020, Landersoe 2020

Keywords

Contraceptives, Oral, Combined, Contraceptives, Oral, Hormonal, Progestins, Levonorgestrel, Anti-Mullerian Hormone

Ovarian reserve markers in women using various hormonal contraceptives

Some hormonal contraceptive users had lower AMH and follicle counts

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

Related research

Keywords