title: Ovarian reserve screening before contraception?
abstract: Women are increasingly delaying conception to later years. Hormonal contraception induces artificial cyclicity, which does not, like natural cyclicity, reflect normal, physiological ovarian behaviour. Therefore, long-term users of hormonal contraceptives, in particular, fail to derive potential diagnostic benefits from changes in menstrual cyclicity, which usually alerts patients and physicians to developing ovarian pathology. Timely diagnosis of ovarian problems is further hampered, as anti-Müllerian hormone is suppressed by hormonal contraceptives, making the accurate assessment of functional ovarian reserve more difficult. Women on long-term hormonal contraceptives who develop premature ovarian senescence at young ages, therefore, often go undiagnosed until termination of hormonal contraception, when they present with either post-contraception amenorrhea, other menstrual abnormalities or infertility. As evolving screening options now permit the detection of young women at risk for premature ovarian senescence, it is proposed that young women are offered 'risk screening' for premature ovarian senescence before starting long-term hormonal contraception. A potential protocol is outlined.
authors.affiliation: Center for Human Reproduction (CHR), New York, NY, USA. Electronic address: vkushnir@thechr.com.
authors.forename: Vitaly A
authors.initials: VA
authors.lastname: Kushnir
authors.affiliation: Center for Human Reproduction (CHR), New York, NY, USA; Foundation for Reproductive Medicine, New York, NY, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
authors.affiliation: Center for Human Reproduction (CHR), New York, NY, USA; Foundation for Reproductive Medicine, New York, NY, USA.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
mesh_terms: D000375:Aging; D000465:Algorithms; D054304:Anti-Mullerian Hormone / Q000378:metabolism; D003267:Contraception / Q000379:methods*; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D005298:Fertility; D006176:Gynecology / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis*; D008403:Mass Screening / Q000379:methods; D008597:Menstrual Cycle; D065851:Ovarian Reserve / Q000502:physiology*; D010053:Ovary / Q000502:physiology*; D016649:Primary Ovarian Insufficiency / Q000175:diagnosis
chemical_list: D003278:Contraceptives, Oral, Hormonal; D054304:Anti-Mullerian Hormone
keywords: family planning; fertility counselling; hormonal contraception; ovarian reserve testing