Evidence of Profound Ovarian Suppression on Combined Hormonal Contraception Resulting in Dramatically Different Ovarian Reserve Testing and Oocyte Retrieval Outcomes: Case Report and Review of the Literature

OBJECTIVE:To describe a case report and demonstrate that degree of ovarian suppression with continuous combined hormonal contraception (CHC) may be more profound than previously described and may present similarly as decreased ovarian reserve.DESIGN:Case report and review of the literature.SETTING:Private practice in vitro fertilization center.PATIENTS:A 36-year-old single gravida 0 presenting for oocyte cryopreservation on CHC.INTERVENTIONS:Discontinuation of vaginal ring combined hormonal contraceptive for 6 months.MAIN OUTCOME MEASURES:Antral follicle count, antimüllerian hormone, day 3 follicle-stimulating hormone, total oocytes, and mature oocytes retrieved before and after discontinuation of CHC.RESULTS:After a 6-month break from CHC, our patient's antimüllerian hormone level increased from undetectable levels to 3.45 ng/mL, day 3 follicle-stimulating hormone level decreased from 14.9 IU/mL-6.17 IU/mL, and antral follicle count improved from 0-28. In addition, the number of oocytes retrieved after a 4-month CHC break and 6-month break increased from 8 to 29, respectively.CONCLUSIONS:In patients on long-term combined continuous hormonal contraception, profound ovarian suppression can result in a clinical picture of diminished ovarian reserve and extremely poor response to high-dose stimulation, which may be reversed by more time off from suppression.