OVARIAN RESERVE PARAMETERS IN WOMEN USING NO CONTRACEPTION, USING ORAL CONTRACEPTION OR IUCD

Background:-
The Pill is one of the most popular forms of contraception ,its use is different in different countries, and among women of different ages and levels of education.  Oral contraceptives  may alter parameters related to ovarian reserve assessment but the extent of the reduction is uncertain. The main goal of ovarian reserve testing is to identify those individuals who are at risk of decreased or diminished ovarian reserve.
Objective:-
To quantify  endocrine  and  sonographic  parameters of ovarian reserve in women using combined oral contraceptive pills and comparing them with IUCD users and non contraceptive users .
Patients and methods:-
Cross sectionl study included 100 healthy volunteer women divided into 35 COC users  (all using monophasic preparations, ethinylestradiol 30&35ug   and progestin, norgestimate and gestodene)  and 65 non-users (35 IUCD users and 30 non contraceptive users). On day 2–5 of the menstrual cycle or during withdrawal bleeding, blood sampling to measure anti-mullerian  hormone(AMH) and transvaginal  ultrasonography to measure antral follicle count(AFC) and ovarian volume were performed.
Results:-
ovarian reserve parameters were  significantly lower among COC users than  non-users of hormonal contraception(IUCD users &non contraceptive users) .For AMH ,Pvalue.004;AFC,P -.006; ovarian volume, P-.001  . Further more we found that AFC  of intermediate (5–7 mm) and large (8–10 mm) size categories were significantly lower in COC users than  non-users with p value .001  .while  that of  small ( 2–4 mm) size were increased P-.001. Also negatively linear association was observed between duration of COC use and ovarian reserve parameters.
Conclusion:-
This study indicates that ovarian reserve markers (AMH, AFC&ovarian volume) are lower in women using COC compared to IUCD users and non contraceptive users.