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Published on: September 16, 2021
Ovarian reserve testing in long-term hormonal contraceptive users - proceed with caution
Ahmad Hasan1, Steven R Lindheim2, Nigel Pereira1
1Mount Sinai Fertility, Toronto, ON, Canada; Division of Gynecologic Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|June 29, 2026
Summary
Long-term hormonal contraceptive use can temporarily lower ovarian reserve markers, potentially leading to misdiagnoses of diminished ovarian reserve or primary ovarian insufficiency. Strategies are needed to accurately assess ovarian reserve in these women.
Area of Science:
- Reproductive endocrinology
- Women's health
- Clinical diagnostics
Background:
- Hormonal contraceptives (HCs) are widely used by women of reproductive age.
- Long-term HC use is known to affect reproductive hormones and markers.
Purpose of the Study:
- To highlight challenges in assessing ovarian reserve in long-term HC users.
- To provide strategies for accurate diagnosis and avoid misdiagnosis of diminished ovarian reserve (DOR) or primary ovarian insufficiency (POI).
Main Methods:
- Review of current literature on hormonal contraceptive effects on ovarian reserve markers.
- Analysis of potential confounding factors in diagnostic assessments.
- Development of diagnostic recommendations for HC users.
Main Results:
- Long-term HC use can transiently suppress key ovarian reserve markers like anti-Müllerian hormone (AMH) and antral follicle count (AFC).
- This suppression can persist for months post-cessation, mimicking DOR or POI.
- Erroneous diagnoses can result from standard assessments without considering HC use.
Conclusions:
- Accurate ovarian reserve assessment in long-term HC users requires careful consideration of contraceptive history.
- Implementing specific strategies can prevent misdiagnosis of DOR and POI.
- Avoiding unnecessary patient anxiety and financial burden is crucial.
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