目的:确定生育年龄队列中不同年龄和百分位数的避孕特异性血清抗苗勒管激素(AMH)水平的比较。
方法:前瞻性招募队列的横断面分析。
方法:美国育龄妇女购买了生育激素测试,并同意在2018年5月至2021年11月期间参加研究。在荷尔蒙测试的时候,参与者是各种避孕药的使用者(联合口服避孕药(n=6,850),仅含孕激素的药丸(n=465),激素(n=4,867)或铜(n=1,268)宫内节育器,植入物(n=834),阴道环(n=886))或月经周期正常的女性(n=27,514)。
方法:使用避孕药。
方法:AMH的年龄和避孕特异性估计。
结果:抗苗勒管激素具有避孕特异性作用,联合口服避孕药的效果估计范围为0.83,95%CI0.82,0.85(降低17%),激素宫内节育器无效果(1.00,95%CI0.98,1.03)。我们没有观察到抑制的年龄特异性差异。然而,在抗苗勒管激素百分位数之间,避孕方法的抑制作用不同,在百分位数时效果最大,在百分位数时效果最小。例如,对于服用联合口服避孕药的女性,第10个百分位的AMH降低了32%(系数0.68,95%CI0.65,0.71),在第50个百分位时降低19%(系数0.81,95%CI0.79,0.84),在第90个百分位时降低5%(系数0.95,95%CI0.92,0.98),与其他形式的避孕显示类似的不一致。
结论:这些发现加强了大量文献,这些文献表明激素避孕药在人群水平上对抗苗勒管激素水平有不同的影响。这些结果增加了这一文献,即这些效果并不一致;相反,最大的影响发生在较低的抗苗勒管激素百分位数。然而,与已知的任何年龄卵巢储备的生物学变异性相比,这些避孕依赖性差异很小.这些参考值能够可靠地评估个体相对于同龄人的卵巢储备,而不需要停止或潜在的侵入性避孕。
To determine how the contraceptive-specific serum antimüllerian hormone (AMH) levels compare across ages and percentiles in a reproductive-age cohort.
Cross-sectional analysis of a prospectively recruited cohort.
Community.
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).
Contraceptive use.
Age and contraceptive-specific estimates of AMH.
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.
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.