Ovarian reserve markers in women using various hormonal contraceptives

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.

摘要

目的：本研究的目的是评估卵巢储备指标抗苗勒管激素（AMH）和窦卵泡计数（AFC）在应用单纯孕激素药片（POP）或左炔诺孕酮宫内系统（LNG-IUS）的女性中是否更低, 还是类似于在联合口服避孕药（COC）应用者中观察到的下降。

方法：此项回顾性研究包括2015-2019年间来2个丹麦生育力评估和咨询门诊的565名激素避孕药（COC、POP、LNG-IUS或阴道避孕环）应用者和983名非激素避孕者。采用调整后的多元回归分析评估激素与非激素避孕应用者之间的AMH、AFC的差异。

结果：相比于非激素避孕应用者, COC应用者AMH低31.1%[95%置信区间（CI）-39.6%, -25.9%；p<0.001], POP应用者AMH低35.6%（95% CI -49.0%, -18.6%；p<0.001）, LNG-IUS应用者AMH低17.1%（95% CI -31.4%, 0.002%；p=0.052）, 阴道避孕环应用者没有显著差异。相比于非激素避孕应用者, COC应用者AFC低31.3%（95% CI -35.0%, -25.3%；p<0.001）, POP应用者低29.7%（-39.1%, -17.9%；p<0.001）, LNG-IUS或阴道避孕环应用者没有显著差异。COC和阴道避孕环应用者卵巢体积下降超过50%（p<0.001）, 但POP和LNG-IUS应用者卵巢体积没有改变。

结论：对所有类型激素避孕的应用者卵巢储备指标的评估应谨慎解释, 并考虑避孕方法的类型。

Keywords:

• Anti-Müllerian hormone (AMH)
• contraceptive pill
• hormonal contraception
• LNG-IUS
• ovarian reserve markers

Acknowledgements

ANA, SKL and KBP planned the study. ANA, SKL, KBP, ECL, BN, HWH and HSN collected the data. SKL and JLF performed the statistical analyses. SKL wrote the first draft of the manuscript. All authors participated in critical discussions of the findings and revision of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was part of the ReproUnion collaborative study, co-financed by the European Union, Interreg V ÖKS [grant no. 20200407]. It was also co-financed by Roche Diagnostics. All financial help was given as an unrestricted grant.