Ovarian reserve markers after discontinuing long-term use of combined oral contraceptives

Landersoe, Selma Kloeve; Petersen, Kathrine Birch; Sørensen, Anne Lyngholm; Larsen, Elisabeth; Martinussen, Torben; Lunding, Stine Aagaard; Kroman, Mie Stougaard; Nielsen, Henriette Svarre; Andersen, Anders Nyboe

doi:10.1016/j.rbmo.2019.10.004

Cited by 37 publications

(22 citation statements)

References 47 publications

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“…It is likely that the extended length of continuous CHC use in our patient did contribute to the marked ovarian suppression and to the extended 6-month duration of recovery of ovarian function, which is significantly longer than the 2 months recovery observed by Landersoe et al (5). This case report also demonstrates that the vaginal ring can exert similarly suppressive effects on ovarian function as COCs, contrary to the findings of the recent Danish cross-sectional study (8).…”

Section: Discussioncontrasting

confidence: 87%

“…We initially speculated this profound decrease and subsequent improvement of ovarian function may be attributable to the extended length of CHC use and/or use of vaginal CHC. Although Bentzen et al observed more pronounced decreases in ovarian reserve parameters with increasing duration of hormonal contraception (1), other studies evaluating the duration of CHC have not shown significant differences in the relative change in AMH or AFC levels after adjusting for age (5,9). Furthermore, Kallio et al (10) demonstrated serum markers of ovarian reserve (AMH, FSH, and E2 levels) decrease in women after 9 weeks of CHC treatment independently of administration route.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term use of CHC has been associated with a modest and reversible suppression of ovarian reserve markers including AFC and AMH (1-7). Bentzen The authors of a 2019 prospective cohort study performed serial ovarian reserve evaluations on 68 women with a history of long-term CHC use over a 4-month period after discontinuing CHC (5). Over the first 2 months after CHC discontinuation, AMH level increased by 53% and AFC level by 41%, before reaching a plateau.…”

Section: Discussionmentioning

confidence: 99%

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Evidence of profound ovarian suppression on combined hormonal contraception resulting in dramatically different ovarian reserve testing and oocyte retrieval outcomes: case report and review of the literature

2020

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Objective: To describe a case report and demonstrate that degree of ovarian suppression with continuous combined hormonal contraception (CHC) may be more profound than previously described and may present similarly as decreased ovarian reserve. Design: Case report and review of the literature. Setting: Private practice in vitro fertilization center. Patient(s): A 36-year-old single gravida 0 presenting for oocyte cryopreservation on CHC. Intervention(s): Discontinuation of vaginal ring combined hormonal contraceptive for 6 months. Main Outcome Measure(s): Antral follicle count, antim€ ullerian hormone, day 3 follicle-stimulating hormone, total oocytes, and mature oocytes retrieved before and after discontinuation of CHC. Result(s): After a 6-month break from CHC, our patient's antim€ ullerian hormone level increased from undetectable levels to 3.45 ng/mL, day 3 follicle-stimulating hormone level decreased from 14.9 IU/mL-6.17 IU/mL, and antral follicle count improved from 0-28. In addition, the number of oocytes retrieved after a 4-month CHC break and 6-month break increased from 8 to 29, respectively. Conclusion(s):In patients on long-term combined continuous hormonal contraception, profound ovarian suppression can result in a clinical picture of diminished ovarian reserve and extremely poor response to high-dose stimulation, which may be reversed by more time off from suppression. (Fertil Steril Rep Ò 2020;1:94-8. Ó2020 by American Society for Reproductive Medicine.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evidence of profound ovarian suppression on combined hormonal contraception resulting in dramatically different ovarian reserve testing and oocyte retrieval outcomes: case report and review of the literature

2020

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“…Anti-Müllerian hormone (AMH), which negatively correlates with age and may be lowered up to 30% by combined hormonal contraception or decreases by gonadotoxic therapy, represents the most appropriate serum parameter for assessing the ovarian reserve. 20 , 21 However, especially in patients with low values, there might be some variability. AMH is produced by the primary to early antral follicles.…”

Section: Recommendationsmentioning

confidence: 99%

Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy

et al. 2021

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Melanoma is one of the most common cancers in adolescents and adults at fertile age, especially in women. With novel and more effective systemic therapies that began to profoundly change the dismal outcome of melanoma by prolonging overall survival, the wish for fertility preservation or even parenthood has to be considered for a growing portion of melanoma patients—from the patients' as well as from the physicians' perspective. The dual blockade of the mitogen-activated protein kinase pathway by B-Raf proto-oncogene serine/threonine kinase and mitogen-activated protein kinase inhibitors and the immune checkpoint inhibition by anti-programmed cell death protein 1 and anti-cytotoxic T-lymphocyte-associated protein-4 monoclonal antibodies constitute the current standard systemic approaches to combat locally advanced or metastatic melanoma. Here, the preclinical data and clinical evidence of these systemic therapies are reviewed in terms of their potential gonadotoxicity, teratogenicity, embryotoxicity and fetotoxicity. Recommendations for routine fertility and contraception counseling of melanoma patients at fertile age are provided in line with interdisciplinary recommendations for the diagnostic work-up of these patients and for fertility-protective measures. Differentiated recommendations for the systemic therapy in both the adjuvant and the advanced, metastatic treatment situation are given. In addition, the challenges of pregnancy during systemic melanoma therapy are discussed.

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“…However, a recent study has revealed that oral contraceptives suppress FSH and LH secretion and, thus, inhibit follicular growth and cause low concentrations of AMH in long-term users. However, AMH increased by 53%, with values returning to normal within 2 months after discontinuation of oral contraceptives (Landersoe et al 2020).…”

Section: Introductionmentioning

confidence: 95%

The anti-Mullerian hormone as a predictor of early pregnancy loss in subfertile women

Hong

Chang

Han

et al. 2020

Systems Biology in Reproductive Medicine

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The aim of this study was to evaluate the predictive value of the anti-Mullerian hormone (AMH) level for early pregnancy loss and to compare the significance of AMH level to age as prognostic factors of pregnancy loss in subfertile women. The outcome of 848 subfertile patients confirmed with intrauterine pregnancies by ultrasound within 1 year of measuring serum AMH level were retrospectively analyzed. Among 848 patients, 206 women were diagnosed with early pregnancy loss. The mean age of the 848 patients was 35.66 ± 3.61 years (range: 26-46 years), and the mean AMH level was 2.95 ± 1.89 (range: 0.14-8.82 ng/mL). There were no significant differences in gravidity, parity, body mass index (BMI), and previous abortion history depending on early pregnancy loss. However, multivariable logistic regression analysis confirmed that the probability of early pregnancy loss is significantly affected by age (odd ratio, 1.079: 1.025-1.135, P = 0.004) and AMH (odd ratio, 0.885: 0.797-0.982, p = 0.022). According to this study, AMH level and age are both powerful predictors of early pregnancy loss. While chronological age is already well known as a factor related to early pregnancy loss, AMH was also considered when individualizing risk prediction for early pregnancy loss.

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Ovarian reserve markers after discontinuing long-term use of combined oral contraceptives

Cited by 37 publications

References 47 publications

Evidence of profound ovarian suppression on combined hormonal contraception resulting in dramatically different ovarian reserve testing and oocyte retrieval outcomes: case report and review of the literature

Evidence of profound ovarian suppression on combined hormonal contraception resulting in dramatically different ovarian reserve testing and oocyte retrieval outcomes: case report and review of the literature

Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy

The anti-Mullerian hormone as a predictor of early pregnancy loss in subfertile women

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