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Ovarian reserve screening before contraception?
Women are increasingly delaying conception to later years. Hormonal contraception induces artificial cyclicity, which does not, like natural cyclicity, reflect normal, physiological ovarian behaviour. Therefore, long-term users of hormonal contraceptives, in particular, fail to derive potential diagnostic benefits from changes in menstrual cyclicity, which usually alerts patients and physicians to developing ovarian pathology. Timely diagnosis of ovarian problems is further hampered, as anti-Müllerian hormone is suppressed by hormonal contraceptives, making the accurate assessment of functional ovarian reserve more difficult.Hype or hope? Ethical and practical considerations with clinical research in women with diminished ovarian reserve
This communication suggests that investigations of treatments for women with diminished functional ovarian reserve (DOR) call for specific practical and ethical considerations, as women with DOR, because of limited remaining reproductive life spans, appropriately feel under time constraints. Another medical journal recently published an opinion piece on the use of dehydroepiandrosterone in women with DOR, raising important questions about what approaches should be taken to develop best available evidence in such patients.
