Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
J Clin Endocrinol Metab. 2013 May;98(5):2106-15. doi: 10.1210/jc.2012-3995. Epub 2013 Mar 26.
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.
We aimed to address the role of reproductive and lifestyle determinants of AMH in a large population-based cohort of women.
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).
Women from the general community participating in the Doetinchem Cohort study were assessed.
Two thousand three hundred twenty premenopausal women were included.
The effect of female reproductive and lifestyle factors on shifts in age-specific AMH percentiles was studied.
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.
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.
抗缪勒管激素（AMH）是一种卵巢储备标志物，在临床实践中越来越多地被用作预测和诊断工具。尽管 AMH 在临床实践中的应用越来越广泛，但关于可能的决定因素对 AMH 水平影响的大规模研究仍然很少。
我们旨在研究生殖和生活方式决定因素对大量基于人群的女性 AMH 的作用。
在这项横断面研究中，使用 CG-LMS（Cole 和 Green，Lambda，Mu 和 Sigma 模型，一种用于计算儿童生长曲线的成熟方法）的广义线性模型计算特定年龄的 AMH 百分位数。
参加多廷赫姆队列研究的社区一般女性。
纳入了 2320 名绝经前妇女。
研究女性生殖和生活方式因素对特定年龄 AMH 百分位数变化的影响。
与月经周期规律的妇女相比，目前口服避孕药（OC）使用者、月经周期不规则的妇女和孕妇的特定年龄 AMH 百分位数明显较低（OC 使用时低 11 个百分位；周期不规则时低 11 个百分位；妊娠时低 17 个百分位[所有 P 值均<.0001]）。初潮年龄和初产年龄与特定年龄 AMH 百分位数无关。更高的产次与特定年龄 AMH 百分位数高 2 个百分位相关（P =.02）。在所研究的生活方式因素中，目前吸烟与特定年龄 AMH 百分位数低 4 个百分位相关（P =.02），而不论吸烟剂量如何。体重指数、腰围、饮酒、体力活动和社会经济地位与特定年龄 AMH 百分位数无显著相关性。
本研究表明，一些生殖和生活方式因素与特定年龄 AMH 水平相关。与 OC 使用和吸烟相关的较低 AMH 水平似乎是可逆的，因为这些影响仅限于当前使用 OC 或香烟。在临床环境中解释 AMH 并根据 AMH 进行患者管理时，需要仔细考虑这些决定因素的影响。
