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

Published:October 15, 2019DOI:https://doi.org/10.1016/j.rbmo.2019.10.004

      Abstract

      Research question

      How early do the ovarian reserve markers anti-Müllerian hormone (AMH) and antral follicle count (AFC) normalize after discontinuation of the long-term use of combined oral contraceptives (COC).

      Design

      This was a prospective cohort study of 68 women with a history of long-term COC use. Serum AMH concentrations, ovarian volume and AFC were measured during COC use and serially in a 4-month period after discontinuing COC: 1 and 2 weeks after discontinuation, and on cycle day 2–5 during three consecutive menstrual cycles. Changes in AMH and AFC were investigated using linear mixed models of repeated measurements adjusted for relevant covariates.

      Results

      Mean age was 29.4 years and mean duration of COC use 8.0 years. Baseline median AMH concentrations during COC use of 13 pmol/l (interquartile range [IQR] 8.4–22 pmol/l) increased to a median of 22.5 pmol/l (IQR 11–37 mol/l) 3 months after discontinuation. The estimated average increase was 53% (95% confidence interval [CI] 1.40–1.68, P < 0.001). AFC increased from a median value of 17 (IQR 11–25) to 24 (IQR 17–34). The estimated average increase was 41% (95% CI 1.30–1.52, P < 0.001). Ovarian volume increased from 2.4 to 5.8 ml (P < 0.001). The ovarian reserve markers increased continuously from baseline measurements until 2 months after discontinuation. Thereafter a plateau was reached.

      Conclusion

      After discontinuation of COC, AMH increased by 53% and AFC by 41%, with values returning to normal within 2 months. This study provides clinicians with the highly relevant knowledge that AMH and AFC can be measured 2 months after discontinuation of COC without having to account for their influence.
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      Biography

      Selma Kloeve Landerso, MD, graduated from the University of Copenhagen in 2012. She is currently a PhD student at the Fertility Clinic, Copenhagen University Hospital, Denmark, working on research into the suppressive effect of oral contraception on ovarian reserve markers. Her research has resulted in international publications and talks.
      Key message
      After discontinuation of long-term use of combined oral contraceptives, anti-Müllerian hormone (AMH) increased with 53% and antral follicle count (AFC) with 41%. Both returned to normal values 2 months after discontinuation. This provides clinicians with knowledge about when AMH and AFC can be reliably measured after discontinuing oral contraceptives.