抗苗勒管激素已成为评估卵巢储备的临床生物标志物标准。随着抗苗勒管激素测试变得越来越普遍,越来越多的人正在寻求解释使用避孕药时获得的价值。适当地为妇女提供咨询,需要更好地了解使用不同避孕药的女性的抗苗勒管激素水平.
研究不同形式的避孕药与育龄妇女抗苗勒菌水平之间的关系。
这是一项横断面研究,包括27,125名20至46岁的美国女性,通过现代生育率获取生殖激素结果,并提供知情同意参与研究。通过干血点卡(95.9%)或静脉穿刺(4.1%)采集抗苗勒管激素水平,和以前的工作已经表明这两种方法收集的激素水平之间的高度相关性。进行多重线性回归,以比较使用避孕药的女性与不使用任何避孕药的女性的抗苗勒管激素水平。控制年龄,初潮年龄,身体质量指数,吸烟,样品采集方法,周期日,和自我报告的多囊卵巢综合征诊断。我们还分析了使用避孕药的持续时间是否可以预测使用激素宫内节育器和联合口服避孕药的使用者的抗苗勒管激素水平,考虑到这些避孕组的规模。
使用联合口服避孕药的女性的平均抗苗勒管激素水平在统计学上显着降低(降低23.68%;系数,0.76;95%置信区间,0.72-0.81;P<.001),阴道环(低22.07%;系数,0.78;95%置信区间,0.71-0.86;P<.001),激素宫内节育器(低6.73%;系数,0.93;95%置信区间,0.88-0.99;P=.014),种植体(降低23.44%;系数,0.77;95%置信区间,0.69-0.85;P<.001),或仅含孕激素的药丸(低14.80%;系数,0.85;95%置信区间,0.76-0.96;P=.007)比控制协变量时不使用任何避孕药的女性。比较不使用任何避孕药具的女性与使用铜宫内节育器的女性时,抗苗勒管激素水平没有显着差异(低1.57%;系数,0.98;95%置信区间,0.92-1.05,P=.600)。根据自我报告的多囊卵巢综合征诊断,避孕药具使用与抗苗勒管激素水平之间的关联没有差异。激素宫内节育器使用的持续时间,但不是联合使用口服避孕药,与抗苗勒管激素水平略有正相关,尽管这种小幅度效应可能没有临床意义(系数,1.002;95%置信区间,1.0005-1.003;P=.007)。
与未服用避孕药的女性相比,目前使用激素避孕药的平均抗苗勒管激素水平较低。不同避孕方法的百分比差异不同。这些数据为临床医生提供了有关如何解释在使用避孕药时评估的抗苗勒管激素水平的指导,并可能促进更多患者在评估其卵巢储备时继续使用避孕药具。
Anti-Müllerian hormone has become the clinical biomarker-based standard to assess ovarian reserve. As anti-Müllerian hormone testing becomes more common, more individuals are seeking to interpret the values obtained while using contraceptives. To appropriately counsel women, a better understanding of anti-Müllerian hormone levels in women using different contraceptives is needed.
To study the association between different forms of contraceptives and anti-Müllerian levels in women of reproductive age.
This is a cross-sectional study including 27,125 US-based women aged 20 to 46 years, accessing reproductive hormone results through Modern Fertility and who provided informed consent to participate in the research. Anti-Müllerian hormone levels were collected through dried blood spot card (95.9%) or venipuncture (4.1%), and previous work has shown high correlation between hormone levels collected by these 2 methods. Multiple linear regressions were run to compare anti-Müllerian hormone levels in women using contraceptives with women not on any contraceptive, controlling for age, age of menarche, body mass index, smoking, sample collection method, cycle day, and self-reported polycystic ovary syndrome diagnosis. We also analyzed whether duration of contraceptive use predicted anti-Müllerian hormone levels in users of the hormonal intrauterine device and combined oral contraceptive pill, given the size of these contraceptive groups.
Mean anti-Müllerian hormone levels were statistically significantly lower in women using the combined oral contraceptive pill (23.68% lower; coefficient, 0.76; 95% confidence interval, 0.72-0.81; P<.001), vaginal ring (22.07% lower; coefficient, 0.78; 95% confidence interval, 0.71-0.86; P<.001), hormonal intrauterine device (6.73% lower; coefficient, 0.93; 95% confidence interval, 0.88-0.99; P=.014), implant (23.44% lower; coefficient, 0.77; 95% confidence interval, 0.69-0.85; P<.001), or progestin-only pill (14.80% lower; coefficient, 0.85; 95% confidence interval, 0.76-0.96; P=.007) than women not on any contraceptive when controlling for covariates. Anti-Müllerian hormone levels were not significantly different when comparing women not using any contraceptives to those using the copper intrauterine device (1.57% lower; coefficient, 0.98; 95% confidence interval, 0.92-1.05, P=.600). Associations between contraceptive use and anti-Müllerian hormone levels did not differ based on self-reported polycystic ovary syndrome diagnosis. Duration of hormonal intrauterine device use, but not of combined oral contraceptive pill use, was slightly positively associated with anti-Müllerian hormone levels, although this small magnitude effect is likely not clinically meaningful (coefficient, 1.002; 95% confidence interval, 1.0005-1.003; P=.007).
Current hormonal contraceptive use is associated with a lower mean anti-Müllerian hormone level than that of women who are not on contraceptives, with variability in the percent difference across contraceptive methods. These data provide guidance for clinicians on how to interpret anti-Müllerian hormone levels assessed while on contraceptives and may facilitate more patients to continue contraceptive use while being evaluated for their ovarian reserve.