Contraceptive-specific antimüllerian hormone values in reproductive-age women: a population study of 42,684 women

Nelson, S. M. , Ewing, B. J., Gromski, P. S. and Briggs, S. F. (2023) Contraceptive-specific antimüllerian hormone values in reproductive-age women: a population study of 42,684 women. Fertility and Sterility, 119(6), pp. 1069-1077. (doi: 10.1016/j.fertnstert.2023.02.019) (PMID:36801456)

Abstract

Objective: To determine how the contraceptive-specific serum antimüllerian hormone (AMH) levels compare across ages and percentiles in a reproductive-age cohort. Design: Cross-sectional analysis of a prospectively recruited cohort. Setting: Community. Patient(s): This study included US-based women of reproductive age who purchased a fertility hormone test and consented to participate in research between May 2018 and November 2021. At the time of hormone testing, participants were users of various contraceptives (combined oral contraceptive [n = 6,850], progestin-only pill [n = 465], hormonal [n = 4,867] or copper [n = 1,268] intrauterine device, implant [n = 834], vaginal ring [n = 886]) or women with regular menstrual cycles (n = 27,514). Intervention(s): Contraceptive use. Main Outcome Measure(s): Age and contraceptive-specific estimates of AMH. Result(s): There were contraceptive-specific effects on AMH with effect estimates ranging from 0.83 (95% confidence interval [CI], 0.82–0.85) (17% lower) for the combined oral contraceptive pill to no effect (1.00; 95% CI, 0.98–1.03) for the hormonal intrauterine device. We did not observe age-specific differences in suppression. However, there were differential suppressive effects of the contraceptive method across AMH percentiles, with the greatest effect at lower percentiles and least effect at higher percentiles. For example, for women taking the combined oral contraceptive pill, the AMH level was 32% lower at the 10th percentile (coefficient, 0.68; 95% CI, 0.65–0.71), 19% lower at the 50th percentile (coefficient, 0.81; 95% CI, 0.79–0.84), and 5% lower at the 90th percentile (coefficient, 0.95; 95% CI, 0.92–0.98), with other forms of contraception showing similar discordances. Conclusion(s): These findings reinforce the body of literature that shows that hormonal contraceptives have different impacts on the AMH levels at a population level. These results add to this literature that these effects are not consistent; instead, the greatest impact occurs at the lower AMH percentiles. However, these contraceptive-dependent differences are small compared with the known biological variability in ovarian reserve at any given age. These reference values enable robust assessment of an individual’s ovarian reserve relative to their peers without requiring cessation or potentially invasive removal of contraception.

• Item Type: Articles
• Keywords: Combined oral contraceptive pill, AMH, hormonal IUD, contraception.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Nelson, Professor Scott and Gromski, Dr Piotr
• Authors: Nelson, S. M., Ewing, B. J., Gromski, P. S., and Briggs, S. F.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Fertility and Sterility
• Publisher: Elsevier
• ISSN: 0015-0282
• ISSN (Online): 1556-5653
• Published Online: 18 February 2023