Ovarian reserve screening before contraception?

Vitaly A. Kushnir, David H. Barad, Norbert Gleicher

Research output: Contribution to journalComment/debate

14 Scopus citations

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.

Original languageEnglish
Pages (from-to)527-529
Number of pages3
JournalReproductive BioMedicine Online
Volume29
Issue number5
DOIs
StatePublished - 1 Nov 2014
Externally publishedYes

Keywords

  • family planning
  • fertility counseling
  • hormonal contraception
  • ovarian reserve testing

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