Antimullerian hormone and antral follicle count are lower in female cancer survivors and healthy women taking hormonal contraception

Capsule:
Antimullerian hormone (AMH) and antral follicle count (AFC) are significantly lower among women with recent exposure to hormonal contraception. AMH and AFC should be interpreted cautiously when measured in the setting of recent hormone use.

Authors:
Lauren Noelle Collins Johnson, M.D., Mary D. Sammel, Sc.D., Katherine E. Dillon, M.D., Lara Lechtenberg, B.A., Allison Schanne, B.A., Clarisa R. Gracia, M.D., M.S.C.E.

Volume 102, Issue 3, Pages 774-781

Abstract:

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.

  • Amanda N. Kallen

    Hi Lauren – great paper and certainly has the potential to change the way we practice in terms of interpretation of AMH/AFC levels with recent HC use. Two questions for you: one – are you planning to drill down at all on the issue of how much time is required for recovery of these values? Clinically, it seems impractical to tell patients to stop their HC three months before checking labs. I’m wondering if you foresee this data being used to formulate “adjusted normal range values” for patients with recent HC use. The second question is whether there is any data specifically regarding IUD use and AMH levels – I noticed that that method was (understandably) excluded in this study. Thanks again and great work!

  • Lauren Johnson

    In this issue of F&S, we present evidence that AMH and antral follicle count are significantly lower among women with recent hormonal contraceptive (HC) use. To conduct this analysis, we examined healthy reproductive age women as well as female cancer survivors enrolled in an ongoing, longitudinal cohort study aimed to examine changes in ovarian reserve over time. We observed that AMH and AFC were at least 20% lower among women with recent HC use. Our results were robust after adjusting for confounders and when considering particular subgroups.

    We feel that these findings are of particular importance for cancer survivors, oocyte donors, and women pursuing elective oocyte preservation as these women are more likely to be using hormonal contraception when ovarian reserve is measured.

    The authors are excited to present this paper, and we welcome questions about our work.

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