Serum anti-müllerian hormone level is not altered in women using hormonal contraceptives

Adolescent Experiences with the Vaginal Ring

Worldwide, gonadotrophin-releasing hormone (GnRH) antagonists are gaining ground, and the number of patients being treated for IVF with a GnRH antagonist is increasing. Cycle planning in GnRH antagonist IVF cycles has been a challenge. During the past 2 years, debate has been ongoing about the possible disadvantages of oral contraceptive pill (OCP) pre-treatment in GnRH antagonist IVF cycles. A recent meta-analysis clearly showed a significant decrease in ongoing pregnancy rates between patients who received OCP pre-treatment and those who did not. In this review, the published meta-analysis are is evaluated. It is argued that caution must be exercised in drawing conclusions too quckly on whether or not OCP pre-treatment might have a negative effect on outcome in GnRH antagonist IVF cycles.

https://www.rbmojournal.com/article/S1472-6483(14)00531-8/pdf

To pill or not to pill in GnRH antagonist cycles: that is the question!

NuvaRing represents another useful contraceptive option for women. The vaginal administration confers benefits and women do not appear to dislike this route of hormone delivery. Efficacy and cycle control are the least comparable to conventional COCs and adverse events are minimal, though vaginal side effects are reported more commonly. Women may find that trying to insert the ring in the clinic will allay any concerns they have with regard to insertion and removal.

https://srh.bmj.com/content/familyplanning/34/4/247.full.pdf

Review of the vaginal contraceptive ring (NuvaRing).

Unlike infertility, patients presenting for fertility preservation (FP) are often using combined hormonal contraceptives (CHC). We studied whether long-term (≥6 months) CHC use is associated with reversible suppression of antral follicle count (AFC). This is a longitudinal study of FP cycles from 2012 to 2016. We studied three groups: those without CHC exposure (NO CHC), those with CHC usage with a CHC break (BREAK), and without a break (NO BREAK) prior to ovarian stimulation. We assessed ovarian reserve by AFC at initial consultation and discussed the possibility of CHC suppression of AFC. Patients chose between ovarian stimulation with no CHC break versus ovarian stimulation after a CHC break. AFC was measured serially in the BREAK group. We assessed whether AFC suppression was reversed in the BREAK group. Total oocyte yield was compared among the NO CHC, BREAK, and NO BREAK groups. T tests, ANOVA, and linear/logistic regressions were used. Seven hundred forty-three women underwent FP. Twenty-one percent (n = 154) were taking long-term CHC (≥6 months). AFC suppression was more likely with CHC use (OR 1.6, 95% CI 1.1–2.4, P = 0.011). The BREAK group (n = 79) stopped CHC for an average of 4 months. AFC improvement started at 1 month and plateaued at approximately 6- to 7-month break. The BREAK group had approximately twice as many oocytes per initial AFC as NO BREAK (2.8 ± 3.8 vs. 1.4 ± 0.9, P < 0.001). When women present for FP on CHC, AFC may be suppressed. A CHC break of several months is associated with an increase in AFC and a potential improvement in overall egg yield.

/pdf/long-term-hormonal-contraceptive-use-is-associated-with-a-vx36dzvaee.pdf

Long-term hormonal contraceptive use is associated with a reversible suppression of antral follicle count and a break from hormonal contraception may improve oocyte yield.

The relationship between yeast colonisation, symptoms and antifungal self-medication remains poorly understood. Previous studies have involved pregnant women or women using hormonal contraception, and many have been underpowered. This American cohort study aimed to determine the prevalence of yeast colonisation over a 1-year period in 18–30-year-old, sexually active, non-pregnant women. A total of 1248 women were recruited and more than 80% of the scheduled visits at baseline, 4, 8 and 12 months were attended. At each visit a questionnaire was used to enquire about symptoms, antifungal use, sexual/personal behaviour and contraception in the preceding 4 months. A swab of vaginal fluid was transferred to candida-selective culture media. Some 70% of women were colonised by vaginal yeast at one or more visits, but only 4% were colonised at all four visits. Factors associated with yeast colonisation included marijuana use [odds ratio (OR) 1.3, 95% CI 1.1–1.5], depot medroxyprogesterone acetate (DMPA) use (OR 1.4, 95% CI 1.1–1.7), sexual activity in past 5 days (OR 1.5, 95% CI 1.2–1.8) and concurrent colonisation with lactobacillus and group B streptococcus. Symptoms of pruritis and vulvovaginal burning were associated with yeast colonisation but antifungal use was not. The results support the concept that Candida albicans exists as part of the normal vaginal flora in many healthy asymptomatic women, and that host factors influence the development of symptoms. The authors suggest that the lack of an association with antifungal use casts doubt on the reliability of self-diagnosis and self-treatment of thrush symptoms. However, the study was limited by possible recall bias and the fact that most women were not examined at the time they had symptoms or used antifungal treatment. Moreover, the study population was relatively young (80% under 25 years) and from similar socioeconomic backgrounds, so may not be representative of the wider female population. The finding of an association with DMPA conflicts with previous studies showing a protective effect against yeast colonisation. Further research is therefore required to confirm an association between yeast colonisation and injectable progestogen-only contraceptives.

Colin Duncan

Papers

Ovarian function with the contraceptive vaginal ring or an oral contraceptive: a randomized study