Contraceptive-specific antimüllerian hormone values in reproductive-age women: a population study of 42,684 women.
Level 4 - case-series / case-control
Cross-sectional observational study
PubMed 36801456 · doi:10.1016/j.fertnstert.2023.02.019
What was done
Cross-sectional analysis of 42,684 US reproductive-age women who purchased a direct-to-consumer fertility hormone test and consented to research between May 2018 and November 2021. Participants were evaluated across contraceptive types: unexposed women with regular menstrual cycles (n = 27,514), combined oral contraceptives (n = 6,850), hormonal IUDs (n = 4,867), copper IUDs (n = 1,268), vaginal rings (n = 886), implants (n = 834), and progestin-only pills (n = 465). The authors analyzed age- and contraceptive-specific antimüllerian hormone (AMH) estimates and percentiles.
What was found
Contraceptive use had method-specific effects on AMH levels. Effect estimates ranged from 0.83 (95% CI, 0.82–0.85; 17% lower) for combined oral contraceptives to 1.00 (95% CI, 0.98–1.03; no effect) for hormonal IUDs. Suppressive effects did not vary by age, but varied significantly across AMH percentiles. For combined oral contraceptive users, AMH was 32% lower at the 10th percentile (coefficient 0.68; 95% CI, 0.65–0.71), 19% lower at the 50th percentile (coefficient 0.81; 95% CI, 0.79–0.84), and 5% lower at the 90th percentile (coefficient 0.95; 95% CI, 0.92–0.98).
Why it matters
These reference curves allow clinicians to contextualize AMH levels for women using various contraceptives without requiring them to pause or remove their birth control before testing.
Limits
The study is cross-sectional and cannot establish within-person change over time. The cohort consists of individuals who purchased a commercial fertility test, introducing potential selection bias toward individuals with fertility concerns or higher socioeconomic status. Details regarding duration of contraceptive use, specific hormone formulations, and unmeasured gynecologic conditions were not reported in the abstract.
Cited by
- supports Prolonged periods of anovulation, such as from hormonal birth control, pregnancy, or the postpartum state, suppress circulating anti-Müllerian hormone (AMH) levels.