title: Reproductive and lifestyle determinants of anti-Müllerian hormone in a large population-based study.
abstract: BACKGROUND
  Anti-müllerian hormone (AMH) is an ovarian reserve marker that is increasingly applied in clinical practice as a prognostic and diagnostic tool. Despite increased use of AMH in clinical practice, large-scale studies addressing the influence of possible determinants on AMH levels are scarce.
  
  
  OBJECTIVE
  We aimed to address the role of reproductive and lifestyle determinants of AMH in a large population-based cohort of women.
  
  
  METHODS
  In this cross-sectional study, age-specific AMH percentiles were calculated using general linear modeling with CG-LMS (Cole and Green, Lambda, Mu, and Sigma model, an established method to calculate growth curves for children).
  
  
  METHODS
  Women from the general community participating in the Doetinchem Cohort study were assessed.
  
  
  METHODS
  Two thousand three hundred twenty premenopausal women were included.
  
  
  METHODS
  The effect of female reproductive and lifestyle factors on shifts in age-specific AMH percentiles was studied.
  
  
  RESULTS
  In comparison to women with a regular menstrual cycle, current oral contraceptive (OC) users, women with menstrual cycle irregularity, and pregnant women had significantly lower age-specific AMH percentiles (for OC use, 11 percentiles lower; for cycle irregularity, 11 percentiles lower; and for pregnancy, 17 percentiles lower [P value for all <.0001]). Age at menarche and age at first childbirth were not associated with the age-specific AMH percentile. Higher parity was associated with 2 percentiles higher age-specific AMH (P = .02). Of the lifestyle factors investigated, current smoking was associated with 4 percentiles lower age-specific AMH percentiles (P = .02), irrespective of the smoking dose. Body mass index, waist circumference, alcohol consumption, physical exercise, and socioeconomic status were not significantly associated with age-specific AMH percentiles.
  
  
  CONCLUSIONS
  This study demonstrates that several reproductive and lifestyle factors are associated with age-specific AMH levels. The lower AMH levels associated with OC use and smoking seem reversible, as effects were confined to current use of OC or cigarettes. It is important to give careful consideration to the effect of such determinants when interpreting AMH in a clinical setting and basing patient management on AMH.
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands. M.Dolleman-2@umcutrecht.nl
authors.forename: M
authors.initials: M
authors.lastname: Dólleman
authors.forename: W M M
authors.initials: WM
authors.lastname: Verschuren
authors.forename: M J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: M E T
authors.initials: ME
authors.lastname: Dollé
authors.forename: E H J M
authors.initials: EH
authors.lastname: Jansen
authors.forename: F J M
authors.initials: FJ
authors.lastname: Broekmans
authors.forename: Y T
authors.initials: YT
authors.lastname: van der Schouw
mesh_terms: D000328:Adult; D000367:Age Factors; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003276:Contraceptives, Oral / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008954:Models, Biological; D009426:Netherlands; D010298:Parity; D011446:Prospective Studies; D043762:Reproductive Behavior; D060728:Reproductive Health; D012907:Smoking / Q000009:adverse effects; D015854:Up-Regulation / Q000187:drug effects; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003276:Contraceptives, Oral; D054304:Anti-Mullerian Hormone