Serum anti-mullerian hormone levels and follicular cohort characteristics after pituitary suppression in the late luteal phase with oral contraceptive pills

Abstract

BACKGROUND: Anti-mullerian hormone (AMH) is a marker of ovarian function and reserve and reflects the number and size of antral follicles. The objective of this study was to evaluate the effect of FSH suppression on AMH levels, during the late luteal phase of human menstrual cycle, with the use of oral contraceptives pills (OCP). METHODS: Twenty normovulatory infertile women were included in the study. On the third day of a spontaneous menstrual cycle, the patients were submitted to a transvaginal ultrasound examination and blood sample collection. From the 20th day of this menstrual cycle, the patients took daily OCP, containing 0.030 mg of ethinyl-estradiol plus 0.15 mg of desogestrel. On the third day of the following cycle, the measurements were repeated. RESULTS: After OCP use, the levels of FSH and estradiol were significantly reduced (P < 0.001). The number of antral follicles measured on both occasions did not differ, although after OCP use, the follicles presented significantly lower diameters (mean 4.4 1 1.7 mm before OCP versus 3.5 1 1.2 mm after OCP P < 0.001). The levels of AMH were significantly reduced after pituitary suppression, with a median (inter-quartile range) of 3.02 ng/mL (1.21-6.39) before OCP and 2.22 ng/mL (0.9-3.11) after OCP, P 5 0.04. CONCLUSIONS: The short administration of OCP in late luteal phase caused suppression of FSH secretion during the cycle transition, leading to a more homogeneous follicular cohort. The lower AMH levels observed, although simultaneous with FSH suppression, were probably not a direct effect of the reduced FSH levels, but were more likely a consequence of the lower production by the arrested follicular cohort.

Serum anti-Mullerian hormone levels correlate with ovarian response in idiopathic hypogonadotropic hypogonadism

“…In this respect, various results have been reported regarding the impact of steroid suppression on serum AMH levels. Some studies reported null effect of OCP treatment on serum AMH levels [18,21,22], whereas others revealed suppressed AMH levels in normal cycling women pretreated with OCP [1,15]. In a recent case report it was demonstrated that during 16 week course of menotropin treatment both serum AMH and AFC increased in an IHH patient.…”

Serum anti-Müllerian hormone predicts ovarian response and cycle outcome in IVF patients

“…One of most attractive advantages of AMH is that its levels have been shown to be stable under various influences such as hormonal contraception [38,39], GnRH agonist [40], pregnancy [41], and the menstrual cycle [42][43][44][45]. Therefore, measurements can be made anytime during the menstrual cycle.…”

Anti-Müllerian hormone: determination of ovarian reserve in early breast cancer patients

“…Indeed, AMH levels are stable across the menstrual cycle and are not affected by pregnancy or treatment with gonadotropinreleasing hormone agonists. In addition, although an effect of combined oral contraceptive pill on ovarian reserve has been described (Bentzen et al 2012, Deb et al 2012, Kallio et al 2013, its use seems to be associated with minimal suppression of the later FSH-dependent stages of follicle development (Arbo et al 2007, Streuli et al 2008, Sowers et al 2010, Li et al 2011, Shaw et al 2011. It is still debated if clinical and behavioral variables, such as BMI and smoking habit, may influence AMH plasma levels.…”