the effect of hormonal contraception use on ovarian reserve markers.pptx

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1. The Effect of Hormonal Contraception Use on Ovarian Reserve Markers and the Uptake of Assisted Reproductive Technology in Individuals Seeking an Infertility Evaluation Name Histy Annisa Hilmy Nur Supervisor : Dr. dr. Samrichard Rambulangi , Sp.OG , Subsp . FER Bagian Obstetri & Ginekologi Fakultas Kedokteran Universitas Hasanuddin

2. IDENTITAS PASIEN 2 Title. : The Effect of Hormonal Contraception Use on Ovarian Reserve Markers and the Uptake of Assisted Reproductive Technology in Individuals Seeking an Infertility Evaluation Author : Dana R. Siegel, Joellen Fresia , Angela Fought, Jeanelle Sheeder , Karen Hampanda , Leslie Appiah Year : 2023 Publisher : Cureus

3. Introduction 3 According to the National Survey of Family Growth → Approximately 65% of women of childbearing age currently use some form of contraception → But women often report concerns about potential infertility-related side effects → Hesitancy among them to i nitiate or continue contraceptive use. In the United States → Increasing prevalence of women of childbearing age choosing to use hormonal contraceptives ( HCs ) over non- hormonal options → HCs prevent or delay pregnancy , reduce or eliminate monthly uterine bleeding , prevent or reduce acne , and manage menstrual cramps ,

4. Introduction 3 As many continue to delay childbirth → OR assessment is becoming an important tool to estimate one's remaining reproductive lifespan as well as estimating success rates undergoing infertility treatment including ART. Serum AMH → Superior parameter of age-related ovarian follicular depletion and reproductive capacity Several studies → Pharmacological interventions including HC may affect AMH levels, thus making the utility of this marker difficult to interpret in HC users.

5. Introduction 3 As more women rely on HCs → Along with an increase in the number of women seeking treatment for infertility → It is important to look at the long-term impact of HCs on a woman's future fertility potential and her fertility potential. Objectives of the study : Test whether there is an association between long-term HC use (≥2 years) and OR markers ART use ART outcomes among women of childbearing age seeking infertility evaluation when compared with short-term (<2 years) or no HC use.

6. MATERIAL And METHOD

7. Study design Study → Used a patient survey conducted online and linked to a retrospective medical chart review > → Collected data from women of reproductive age treated at the University of Colorado Advanced Reproductive Medicine (CU ARM) clinic from December 2019 to December 2020. Study instrument Questionnaire containing 29 items → Data collection tool used in the study. Screening questions → The questionnaire addressed topics related to the participant's contraceptive , reproductive , surgical , and health history . Reproductive history → The questionnaire asked whether the participant had ever been pregnant , the outcome of the pregnancy , whether they had ever used ART , and the type , frequency , and outcome of ART, if any .

8. RESULT And DISCUSSION

9. Result 8 CONSORT diagram depicting the flow of participants

10. Result 9 Participant characteristics stratified by length of continuous hormonal contraceptive use

11. Result 9 Participant characteristics stratified by length of continuous hormonal contraceptive use

12. 10 Result Simple and multivariable linear regression results for variables associated with ovarian reserve markers

13. 10 Result Median ovarian reserve levels as analyzed based on the time since the discontinuation of hormonal contraception use by age group ( n =107)

14. 10 Result Simple linear regression results for the association between time since the discontinuation of HC use and ovarian reserve markers in specific age groups

15. 10 Result Simple and multivariable logistic regression results for variables associated with the odds of pregnancy and live birth among women using artificial reproductive technology ( n =74)

16. Discussion In the study → Found OR markers including serum AMH, FSH, and AFC in long-term HC users (≥2 years ) were overall → Similar to short -term HC users (<2 years ) or not at all , Long-term HC → Had a lower rate of live births due to ART , namely from ovulation induction , however after adjusting for age , diagnosis of PCOS or POI, and type of ART used Study → First study to specifically report a comparison of ART use and outcomes between long-term HC users and short -term users / never used ART. Dutta,D.C., Konar,H.2015.DC Dutta's Textbook Of Obstetrics 8th ed. New Delhi: Jaypee Brothers Medical Publishers. 12

17. Discussion Dutta,D.C., Konar,H.2015.DC Dutta's Textbook Of Obstetrics 8th ed. New Delhi: Jaypee Brothers Medical Publishers. 14 In the study → Long-term HC users on average had 25% lower AMH, 17% higher FSH, and 31% lower AFC → Findings were not statistically significant even after adjusting for age and PCOS diagnosis or POI in linear regression models . However , age was found to play a role → in the temporary suppressive effect of HC use on AMH levels . The suppression of AMH due to HC use is likely to be temporary and reversible after discontinuation

18. Discussion Findings from the study → Provides reassurance that overall pregnancy and live birth rates should not be affected by a history of long-term HC use . In the study → No difference was found between IUI or IVF outcomes on overall live birth outcomes after adjusting for age , diagnosis of PCOS or POI, and type of ART used . . Dutta,D.C., Konar,H.2015.DC Dutta's Textbook Of Obstetrics 8th ed. New Delhi: Jaypee Brothers Medical Publishers. 12

19. CONCLUSION

20. 17 Long-term HC users → Increased use of assisted reproductive technology (ART), especially IVF Length of time since the patient temporarily stopped long-term hormonal contraception (HC) → Affects certain ovarian reserve (OR) markers, especially if the patient is less than 30 years old.

21. THANKS Bagian Obstetri & Ginekologi Fakultas Kedokteran Universitas Hasanuddin