Ovarian Reserve Assessment among Healthy Women Using Hormonal Contraceptives Baghdad, Iraq
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Background: A woman's ovarian reserve and fertility may be affected by the long-term use of hormonal contraception. Anti-Mullerian hormone levels, the best available measure of ovarian reserve, were reduced by hormonal contraceptives methods, and were much lower in the majority of hormonal contraceptive methods, although this suppression effect is reversible.
Objective : The aim is to investigate the association between different types of contraceptives and ovarian reserve, probably affect fertility by measuring ovarian reserve parameters (Anti-Mullerian hormone, follicle-stimulating hormone).
Methods: A total of 60 women were eligible for inclusion and were divided into two groups. Group 1 included 40 married women who had regularly used combined oral contraceptives (ethinyl estradiol 30 µg and 150 µg levonorgestrel) or medroxyprogesterone acetate injection for at least 6 months. 21 women used combined oral contraceptives, and 19 women used injectable form. Group 2 included 20 married women who didn't take any hormonal contraceptives. Both groups were investigated for serum anti-Mullerian and follicle-stimulating hormone levels on the third day of the menstrual cycle.
Results: Among women aged 26-30, the mean age was 30.8±3.3 years. There were statistically significant differences between cases and non-users regarding anti-mullerian hormone level (P-value=0.001), significantly lower level among women who were taking combined oral contraceptives compared to those who were receiving birth control injections (P-value =0.001) regarding the anti-mullerian hormone level. There were no significant differences between cases and non-users regarding follicle-stimulating hormone levels (P-value = 0.772).
Conclusion: Hormonal contraceptive methods, both oral and injectable, seem to reduce anti-mullerian hormone levels, but not follicle-stimulating hormone and anti-mullerian hormone levels were suppressed more by oral compared to injectable contraceptives. Further studies using ultrasound and other tests for example luteinizing hormone, sex hormones, and inhibin to check ovarian reserve changes during contraception.
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