title: The impact of smoking on antimüllerian hormone levels in women aged 38 to 50 years.
abstract: OBJECTIVE
  Smoking is associated with increased follicle-stimulating hormone levels and early menopause. Smoking may directly accelerate ovarian follicular depletion or may act indirectly by increasing the pituitary production of follicle-stimulating hormone. Antimüllerian hormone (AMH), produced by ovarian follicles, is a more direct measure of ovarian reserve. The objective of our study was to determine the extent to which smoking influences ovarian reserve, as measured by AMH levels.
  
  
  METHODS
  A community sample of 284 women aged 38 to 50 years completed a self-administered questionnaire including a detailed smoking history. Serum AMH levels were measured on day 2, 3, or 4 of the menstrual cycle. The association between AMH and smoking was analyzed using linear regression, adjusting for age and body mass index.
  
  
  RESULTS
  Participants aged 38 to 42, 43 to 45, and 46 to 50 years had geometric mean AMH values of 6.7 pM (95% CI, 5.2-8.7 pM), 2.7 pM (95% CI, 1.9-3.8 pM), and 1.3 pM (95% CI, 1.0-1.7 pM), respectively. Current smokers, but not past smokers, had 44% lower AMH values than did the reference group (participants with neither active nor former or passive smoke exposure; P = 0.04). Passive smoking had no effect on AMH values when compared with the reference group (P = 0.55). The impact of smoking on AMH values was not dose dependent based on cigarettes per day (P = 0.08) or pack-years (P = 0.22). Finally, prenatal exposure to smoking (either maternal or paternal) had no impact on AMH levels (P = 0.47 and P = 0.89, respectively).
  
  
  CONCLUSIONS
  Active smoking, but not former smoking, is associated with decreased AMH values in late-reproductive-age and perimenopausal women, suggesting a possible direct effect of smoking on the depletion of the antral but not primordial follicles. The direct impact of active smoking on AMH levels in younger women requires further investigation.
authors.affiliation: Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA. bethplante@gmail.com
authors.forename: Beth J
authors.initials: BJ
authors.lastname: Plante
authors.forename: Glinda S
authors.initials: GS
authors.lastname: Cooper
authors.forename: Donna D
authors.initials: DD
authors.lastname: Baird
authors.forename: Anne Z
authors.initials: AZ
authors.lastname: Steiner
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008593:Menopause / Q000378:metabolism*; D008875:Middle Aged; D006080:Ovarian Follicle / Q000378:metabolism*; D012016:Reference Values; D012907:Smoking / Q000378:metabolism*
chemical_list: D054304:Anti-Mullerian Hormone