title: Antimüllerian hormone and antral follicle count are lower in female cancer survivors and healthy women taking hormonal contraception.
abstract: OBJECTIVE
  To determine the impact of hormonal contraception (HC) on markers of ovarian reserve, including antimüllerian hormone (AMH) and antral follicle count (AFC).
  
  
  METHODS
  Longitudinal prospective cohort.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Young adult female cancer survivors and healthy similar-age women.
  
  
  METHODS
  None.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: laurenjohnsonmd@gmail.com.
authors.forename: Lauren N C
authors.initials: LN
authors.lastname: Johnson
authors.affiliation: Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Dillon
authors.affiliation: Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lara
authors.initials: L
authors.lastname: Lechtenberg
authors.affiliation: Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Allison
authors.initials: A
authors.lastname: Schanne
authors.affiliation: Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Clarisa R
authors.initials: CR
authors.lastname: Gracia
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D016022:Case-Control Studies; D002452:Cell Count; D003267:Contraception / Q000009:adverse effects*; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D005260:Female; D006262:Health; D006801:Humans; D009369:Neoplasms / Q000401:mortality / Q000534:rehabilitation; D006080:Ovarian Follicle / Q000166:cytology* / Q000000981:diagnostic imaging / Q000187:drug effects; D017741:Survivors; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal; D054304:Anti-Mullerian Hormone
keywords: Contraception; antimüllerian hormone; antral follicle count; birth control; cancer; ovarian reserve