Abstract
BackgroundAs oral contraceptives (OCs) suppress anti-Müllerian hormone (AMH), and hormonal contraceptives (HCs), likely, suppress functional ovarian reserve, this study was initiated to determine whether HC affect oocyte yields.MethodsWe investigated in a retrospective cohort study 43 oocyte donors in 71 in vitro fertilization (IVF) cycles, evaluating anti-Müllerian hormone (AMH) and oocyte yields as reflections of functional ovarian reserve (OR). In 25 IVF cycles egg donors were on HC within one month prior to IVF, and in 46 cycles they were not. Donors, based on their HCs, were further subdivided into 12 with less, and 13 with more androgenic progestins.ResultsWhile the three groups did not differ in age, age at menarche, BMI and AMH, oocyte yields among donors who utilized estrane- and gonane-derived (higher androgenic) HCs were lower 11.3 (95% CI 8.3 – 14.3) than either donors using no HCs 16.6 (95% CI 14.7 -18.4) (P < 0.05) or those using anti-androgenic HCs 19.0 (95% CI 12.2-25.8) (P< 0.01). Significance was maintained after adjustments for the donor age and total FSH dose used in ovulation induction.ConclusionsEven in young oocyte donors, high androgenic OC exposure appears to suppress functional ovarian reserve and oocyte yields. Since OCs are often routinely used in preparation for IVF, such practice may require reevaluation. Especially in women with diminished ovarian reserve OCs, and especially high androgenic progestin HCs, should, likely, be avoided.
Highlights
As oral contraceptives (OCs) suppress anti-Müllerian hormone (AMH), and hormonal contraceptives (HCs), likely, suppress functional ovarian reserve, this study was initiated to determine whether Hormonal contraceptives (HC) affect oocyte yields
Mean AMH was non-significantly higher without HC use but did not differ significantly between the three groups
Oocyte yields among donors, who utilized more androgenic HCs, like estrane and gonane derived HCs, were lower 11.3 than those of either donors using no HCs at all 16.6 (p < 0.05) or than those using anti-androgenic contraceptives 19.0 (p < 0.01) (Figure 1)
Summary
As oral contraceptives (OCs) suppress anti-Müllerian hormone (AMH), and hormonal contraceptives (HCs), likely, suppress functional ovarian reserve, this study was initiated to determine whether HC affect oocyte yields. Because the response to ovarian stimulation, to a large degree, depends on choice of stimulation protocols, any definition of poor response in association with in vitro fertilization (IVF) has to be considered relative. The primary mode of action for HCs is thought to be suppression of pituitary gonadotropin secretion, secondarily leading to suppression of ovarian function [12,13]. -called combined HCs are combinations of estrogen (generally ethinyl estradiol, EE) and a variety of progestins. Classical HCs have progestins, derived from estranes and gonanes, all to various degrees androgenic [14]
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