Endocrinology Department, Insituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal.
Gynaecology, Obstetrics and Reproductive Medicine Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
Endocrine. 2018 Jul;61(1):144-148. doi: 10.1007/s12020-018-1555-y. Epub 2018 Feb 22.
Anti-Müllerian hormone (AMH) is a useful marker of ovarian reserve. Obesity/overweight are increasing and may affect the reproductive health. Previous studies regarding the effect of body mass index (BMI) on AMH levels are discordant. Our main goal was to evaluate the influence of BMI on AMH levels in women without polycystic ovarian syndrome.
Revision of medical records of 951 women who performed AMH determinations as part of their fertility workup, between 2011 and 2016.
Median AMH concentration was 1.75 [interquartile range (IQR) 2] ng/mL (12.9 pmol/mL) and median age at AMH determination was 35 (IQR 6) years. These women evidenced a median BMI of 23 (IQR 5) kg/m. Caucasian women were more represented [889(89.3%)]. Smoking habits (present/past) were present in 359(36.1%), and 147(14.8%) harboured a history of ovarian surgery. On univariable analysis AMH was not correlated with BMI (r = 0.048/p = 0.135); the only factors influencing AMH were age (p < 0.001), ethnicity (p = 0.004), and previous ovarian surgery (p < 0.001). On multivariable analysis, age was the only variable significantly associated with AMH, evidencing a reduction of 6.2% for each additional year (p < 0.0001). Furthermore, we verified a trend suggesting an AMH reduction of 22% (p = 0.08) in black patients comparing with the caucasian ones, when controlling for the other variables.
We report one of the largest series evaluating the influence of BMI on AMH levels and, consequently, on ovarian reserve. BMI does not seem to affect AMH levels. The reported concerns on infertility in overweight and obese women may be related to follicular development/oocyte maturation or endometrial disorders, rather than decreased ovarian reserve.
抗苗勒管激素（AMH）是卵巢储备的有用标志物。肥胖/超重的情况正在增加，可能会影响生殖健康。此前关于体重指数（BMI）对 AMH 水平影响的研究结果并不一致。我们的主要目标是评估 BMI 对无多囊卵巢综合征的女性 AMH 水平的影响。
对 2011 年至 2016 年间进行 AMH 测定的 951 名女性的病历进行回顾性分析。
AMH 浓度中位数为 1.75[四分位间距（IQR）2]ng/ml（12.9pmol/ml），AMH 测定时的中位年龄为 35（IQR6）岁。这些女性的 BMI 中位数为 23（IQR5）kg/m2。白种人占比更高[889（89.3%）]。吸烟习惯（现在/过去）存在于 359 名（36.1%）女性中，147 名（14.8%）女性有卵巢手术史。单变量分析显示 AMH 与 BMI 无关（r=0.048，p=0.135）；唯一影响 AMH 的因素是年龄（p<0.001）、种族（p=0.004）和卵巢手术史（p<0.001）。多变量分析显示，年龄是唯一与 AMH 显著相关的变量，每增加 1 岁 AMH 降低 6.2%（p<0.0001）。此外，我们还发现了一个趋势，即与白种人相比，黑人患者的 AMH 水平降低了 22%（p=0.08），这一结果在控制了其他变量后仍具有统计学意义。
我们报告了评估 BMI 对 AMH 水平进而对卵巢储备影响的最大系列研究之一。BMI 似乎不会影响 AMH 水平。超重和肥胖女性不孕的报道可能与卵泡发育/卵母细胞成熟或子宫内膜紊乱有关，而不是卵巢储备下降。
