COMPARATIVE STUDY OF OVARIAN RESERVE BETWEEN THE USERS AND NON USERS OF ORAL CONTRACEPTIVES Abstract id: 1183

This study aims 1.To quantify and compare the sonographic ovarian reserve markers in the users and non users of oral contraceptives. 2.To show that sonographic ovarian reserve assessment still retains its efficacy as it is safer and cheaper than hormonal studies. AIMS AND OBJECTIVES

This study included 500 women aged between 18 – 45 years for a period of 12 months, of which were non users and were users (of which 30% were former pill users). Sonographic ovarian reserve includes ovarian volume and antral follicular count which were done using transvaginal ultrasound on day 2–5 of the menstrual cycle. MATERIALS AND METHOD

METHOD OF COLLECTION OF DATA A profoma was prepared for the study of all patients based on - regularity of mensuration, - use of oral contraceptives, - measurement of antral follicle count and - ovarian volume. Study type : Prospective study.

METHOD OF COLLECTION OF DATA INCLUSION CRITERIA: -Patients who are married and are in reproductive age group (18 to 45 years). -Patients willing to undergo transvaginal ultrasound. EXCLUSION CRITERIA: -Patients who refuse to undergo transvaginal ultrasound. -Patients who lost follow up.

INVESTIGATION DONE TRANSVAGINAL OVARIAN SONOGRAPHY

On day 2–5 of the menstrual cycle or during withdrawal bleeding, a transvaginal sonography was performed. Only those with both ovaries clearly visible on transvaginal sonography were included in the study. The number of antral follicles was counted and grouped according to three predefined size categories: -2–4 mm (small), -5–7 mm (intermediate) and -8–10 mm (large). TRANSVAGINAL OVARIAN SONOGRAPHY

Each ovary was measured in three planes and ovarian volume was calculated using the prolate ellipsoid formula V = D1 x D2 x D3 x D1, D2 and D3 being the three maximal longitudinal, antero- posterior and transverse diameters respectively. Mean ovarian volume is the volume calculated as the mean value of the left and right ovary. TRANSVAGINAL OVARIAN SONOGRAPHY

RESULTS

Age group Total No of patients 500 Non users of OCP 260 Users 240 Current users Former OCP users Table 1: Number of patients involved in the study:

Antral follicle counts done between day 2 to 5 after menstruation were compared between the users and non users of oral contraceptive pills. Most of the users and former users had fewer than five follicles under 10 mm in diameter prior to the onset of therapy. The ovarian volume was believed to be dependent upon follicle number. The decline in antral follicle size and counts has been directly correlated with a decline in ovarian volume. Decreased ovarian volume and ovarian antral follicle count has been observed in users and former users of oral contraceptive pills. RESULTS

Ovary of non user: A dominant follicle is visualized in the central portion of the image and several subordinate follicles (2–5 mm) are observed in the left lateral aspect of the ovary. RESULTS

Ovary of OCP user: Only the stroma of the ovary is identified. A very few follicles of less than 1 mm diameter can be observed on the inferior aspect of the ovary. RESULTS

Ovary of non users

RESULTS Ovary of OCP users

When compared with non users, in oral contraceptive pill users, and former oral contraceptive pill users, the antral follicular counts were reduced by ~ 15 – 20 % and ovarian volume was reduced by ~ 25 – 30 %. When follicle size was further categorized into subclasses (small, intermediate and large), the number of antral follicles was significantly lower in all three antral follicle size categories in users compared with non-users of oral contraception. RESULTS

After discontinuation of oral contraceptive pills, - 20% of patients conceived after 1 month ( after 1 st cycle) - 75% of patients conceived in and after 1 year (after cycles) RESULTS

Age group 30 % former pill user (72 patients) 20 % patient conceived ( 14) 75 % patient conceived within 1 year (55) 5 % patient did not conceive during study ( 3 ) RESULTS

Conception typically occurs at a rate of 20–22% per cycle in women who are less than 35 years of age. Approximately 50% of women not practicing contraception conceive within 3 months, others over a period of 6 months, 12 months, and within 18 months when no specific attention was paid to the time of optimal fertility. DISCUSSION

This study based on ovarian reserve parameters from the use of oral contraception in a population of healthy women. The ovarian reserve parameters AFC and ovarian volume were all comparatively lower in users than in non-users of oral contraception. Additionally, there was significant decrease in AFC and ovarian volume with increasing duration of oral contraception use in current users. DISCUSSION

Another ovarian reserve marker, serum Anti mullerian hormone concentration was not accounted in this study. However, the reductions in Antral follicle count and ovarian volume, which are probably temporary, should be taken into account when counselling women on their reproductive lifespan as these parameters might improve after termination of oral contraception use. DISCUSSION

ADVANTAGES OF SONOGRAPHIC OVARIAN RESERVE ASSESSMENT Sonographic ovarian reserve assessment is an - Safe, - Readily available, - Noninvasive technique, - Rapid diagnosis, - Cheaper and cost effective than Anti mullerian hormone (AMH) studies.

CONCLUSION This study indicates that sonographic ovarian reserve markers i.e. AFC and ovarian volume, are negatively affected by oral contraception, and are lower in women using oral contraceptive pills and suggests that reproductive life span may be temporarily affected in users of oral contraceptives. Sonographic ovarian reserve still retains its efficacy as it is safer and cheaper than hormonal studies

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