Correlation of serum anti-Mullerian hormone with hormonal and environmental parameters in Brazilian climacteric women

Evaluation of Anti-Müllerian Hormone (AMH) Serum Levels in Patients with Polycystic Ovary Syndrome (PCOS) Depending on Body Mass Index (BMI)

The relationship between anti-Müllerian hormone (AMH) levels and body weight, expressed through body mass index (BMI), in women with PCOS has been a topic of discussion for a long time, yet the literature continues to present conflicting data. The latest guidelines emphasize the growing role of AMH in the diagnosis of polycystic ovary syndrome and suggest that it should become one of the diagnostic criteria for identifying this condition. Objectives: The aim of this study was to determine the relationship between AMH levels and BMI in reproductive-age patients. The bioethics committee approved the conduct of the study. Methods: A total of 193 patients diagnosed with polycystic ovary syndrome (PCOS) based on the Rotterdam criteria were included in the study group. The control group consisted of 196 patients who did not meet the diagnostic criteria for PCOS. Blood samples (5 mL of venous blood) were collected from all participants to determine AMH levels. Additionally, body weight and height were measured, and BMI was calculated. Results: The mean AMH level for women with PCOS was 7.187 ng/mL (median: 6.400 ng/mL) and was more than twice as high as women without PCOS (mean: 3.399 ng/mL, median: 2.835 ng/mL). The decline in the average AMH level occurs at an older age (35-39 years) in women with PCOS compared to women without PCOS (25-29 years). A significant negative correlation between AMH levels and BMI was observed only in women with PCOS in the 25-29 age group. In women in the 20-24 age group, this correlation takes the form of a statistical tendency. Conclusions: Obesity is a modifiable factor influencing AMH levels. The demonstrated relationship between AMH and BMI may contribute to the development of therapeutic protocols tailored to the patient's clinical condition.

A systematic review of the association between modifiable lifestyle factors and circulating anti-Müllerian hormone

BACKGROUND

Levels of anti-Müllerian hormone (AMH) are known to be associated with lifestyle determinants such as smoking and oral contraception (OC) use. When measuring AMH in clinical practice, it is essential to know which factors may influence circulating levels or ovarian reserve in general.

OBJECTIVE AND RATIONALE

To date, there is no systematic review or summarizing consensus of the nature and magnitude of the relation between AMH and modifiable lifestyle factors. The purpose of this review was to systematically assess the evidence on association of lifestyle behaviors with circulating AMH levels.

SEARCH METHODS

We performed a pre-registered systematic review of publications in Embase and PubMed on the lifestyle factors BMI, smoking, OC use, alcohol consumption, caffeine consumption, physical activity, and waist-hip ratio (WHR) in relation to circulating AMH levels up to 1 November 2023. The search strategy included terms such as 'Anti-Mullerian hormone', 'lifestyle', and 'women'. Studies were considered eligible if the association between at least one of the lifestyle factors of interest and AMH was assessed in adult women. The quality of included studies was assessed using the Study Quality Assessment Tools of the National Heart, Lung, and Blood Institute. The results were presented as ranges of the most frequently used association measure for studies that found a significant association in the same direction.

OUTCOMES

A total of 15 072 records were identified, of which 65 studies were eligible for inclusion, and 66.2% of the studies used a cross-sectional design. The majority of studies investigating BMI, smoking, OC use, and physical activity reported significant inverse associations with AMH levels. For WHR, alcohol, and caffeine use, the majority of studies did not find an association with AMH. For all determinants, the effect measures of the reported associations were heterogeneous. The mean difference in AMH levels per unit increase in BMI ranged from -0.015 to -0.2 ng/ml in studies that found a significant inverse association. The mean difference in AMH levels for current smokers versus non-smokers ranged from -0.4 to -1.1 ng/ml, and -4% to -44%, respectively. For current OC use, results included a range in relative mean differences in AMH levels of -17% to -31.1%, in addition to a decrease of 11 age-standardized percentiles, and an average decrease of 1.97 ng/ml after 9 weeks of OC use. Exercise interventions led to a decrease in AMH levels of 2.8 pmol/l to 13.2 pmol/l after 12 weeks in women with polycystic ovary syndrome or a sedentary lifestyle.

WIDER IMPLICATIONS

Lifestyle factors are associated with differences in AMH levels and thus should be taken into account when interpreting individual AMH measurements. Furthermore, AMH levels can be influenced by the alteration of lifestyle behaviors. While this can be a helpful tool for clinical and lifestyle counseling, the nature of the relation between the observed differences in AMH and the true ovarian reserve remains to be assessed.

REGISTRATION NUMBER

PROSPERO registration ID: CRD42022322575.