TY - JOUR
T1 - Antimüllerian hormone and antral follicle count are lower in female cancer survivors and healthy women taking hormonal contraception
AU - Johnson, Lauren N.C.
AU - Sammel, Mary D.
AU - Dillon, Katherine E.
AU - Lechtenberg, Lara
AU - Schanne, Allison
AU - Gracia, Clarisa R.
N1 - Funding Information:
Supported by National Institutes of Health grants K01 L:1-CA-133839–03 (C.R.G.), 1R01HD062797 (C.R.G., M.D.S.), and T32 HD007440 (L.N.C.J.).
PY - 2014/9
Y1 - 2014/9
N2 - Objective To determine the impact of hormonal contraception (HC) on markers of ovarian reserve, including antimüllerian hormone (AMH) and antral follicle count (AFC). Design Longitudinal prospective cohort. Setting University hospital. Patient(s) Young adult female cancer survivors and healthy similar-age women. Intervention(s) None. Main Outcome Measure(s) Participants were followed annually to determine hormone levels and for transvaginal ultrasound. Subjects who used HC within the preceding 3 months were considered to be exposed. Linear mixed effects models were used to incorporate repeated measures and adjust for potential confounders. Result(s) A total of 249 women (126 survivors, 123 control subjects; average age 25.5 years) were followed for an average of 2.1 visits and 2.15 years. After adjusting for confounders, AMH was found to be 21% lower among survivors using HC and 55% lower among control subjects using HC (relative risk [RR] 0.79, 95% confidence interval [CI] 0.68-0.93; and RR 0.45, 95% CI 0.30-0.68; respectively). AFC was 20% lower among survivors and control subjects using HC (RR 0.80, 95% CI 0.69-0.93). When considering an individual subject, AMH was 17%-35% lower when a subject had recently used HC than when she had not (survivors: RR 0.83, 95% CI 0.75-0.93; control subjects: RR 0.65, 95% CI 0.55-0.78), and AFC was 11% lower (RR 0.89, 95% CI 0.82-0.96). Additive HC exposure across multiple visits was not associated with differences in AMH or AFC. Conclusion(s) AMH and AFC are significantly lower among women with recent exposure to HC. AMH and AFC should be interpreted with caution when measured in the setting of recent hormone use.
AB - Objective To determine the impact of hormonal contraception (HC) on markers of ovarian reserve, including antimüllerian hormone (AMH) and antral follicle count (AFC). Design Longitudinal prospective cohort. Setting University hospital. Patient(s) Young adult female cancer survivors and healthy similar-age women. Intervention(s) None. Main Outcome Measure(s) Participants were followed annually to determine hormone levels and for transvaginal ultrasound. Subjects who used HC within the preceding 3 months were considered to be exposed. Linear mixed effects models were used to incorporate repeated measures and adjust for potential confounders. Result(s) A total of 249 women (126 survivors, 123 control subjects; average age 25.5 years) were followed for an average of 2.1 visits and 2.15 years. After adjusting for confounders, AMH was found to be 21% lower among survivors using HC and 55% lower among control subjects using HC (relative risk [RR] 0.79, 95% confidence interval [CI] 0.68-0.93; and RR 0.45, 95% CI 0.30-0.68; respectively). AFC was 20% lower among survivors and control subjects using HC (RR 0.80, 95% CI 0.69-0.93). When considering an individual subject, AMH was 17%-35% lower when a subject had recently used HC than when she had not (survivors: RR 0.83, 95% CI 0.75-0.93; control subjects: RR 0.65, 95% CI 0.55-0.78), and AFC was 11% lower (RR 0.89, 95% CI 0.82-0.96). Additive HC exposure across multiple visits was not associated with differences in AMH or AFC. Conclusion(s) AMH and AFC are significantly lower among women with recent exposure to HC. AMH and AFC should be interpreted with caution when measured in the setting of recent hormone use.
KW - Contraception
KW - antimüllerian hormone
KW - antral follicle count
KW - birth control
KW - cancer
KW - ovarian reserve
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U2 - 10.1016/j.fertnstert.2014.05.026
DO - 10.1016/j.fertnstert.2014.05.026
M3 - Article
C2 - 24934488
AN - SCOPUS:84906939870
SN - 0015-0282
VL - 102
SP - 774-781.e3
JO - Fertility and sterility
JF - Fertility and sterility
IS - 3
ER -