Independent impact of increasing body mass index on antimullerian hormone levels

ObjectiveObesity is a significant risk factor for infertility. Prior studies have shown that there may be an inverse association of antimullerian hormone (AMH) values and obesity when comparing normal weight vs. obese women. Alternatively, polycystic ovarian syndrome is associated with both obesity and increased AMH. The goal of this study was to determine the specific impact of the level of obesity on AMH levels.DesignCross sectional study.Materials and MethodsMedical records of 220 consecutive overweight and obese women < age 40 undergoing evaluation including AMH testing at a reproductive endocrinology and infertility clinic were studied. Women with primary ovarian insufficiency were excluded. World Health Organization body mass index (BMI) classifications were used: Class I (BMI 30-34.9), Class II (BMI 35-39.9), Class III (BMI > 40).ResultsUnivariate statistical evaluation showed a trend toward decreased AMH with increasing BMI. Among the 220 obese women, multivariate logistic regression was used to adjust for the inverse relationship between age and AMH. The adjusted odds ratio for having AMH above 0.8 ng/mL tended to reduce as obesity class was more severe after adjusting for age, polycystic ovary syndrome (PCOS) and tobacco use, but the results were not statistically significant. The independent risk for having an AMH over 5ng/mL is greater for women with Class I obesity (adj. OR 3.68, 95% CI 1.5-8.91, P=0.004) and Class II obesity (adj. OR 1.64, 95% CI 0.65-4.09, P=0.293) compared to those in Class 3.ConclusionWhile women with PCOS have increased AMH values, it appears likely that advancing obesity may be an independent risk factor for reduction of AMH level. ObjectiveObesity is a significant risk factor for infertility. Prior studies have shown that there may be an inverse association of antimullerian hormone (AMH) values and obesity when comparing normal weight vs. obese women. Alternatively, polycystic ovarian syndrome is associated with both obesity and increased AMH. The goal of this study was to determine the specific impact of the level of obesity on AMH levels. Obesity is a significant risk factor for infertility. Prior studies have shown that there may be an inverse association of antimullerian hormone (AMH) values and obesity when comparing normal weight vs. obese women. Alternatively, polycystic ovarian syndrome is associated with both obesity and increased AMH. The goal of this study was to determine the specific impact of the level of obesity on AMH levels. DesignCross sectional study. Cross sectional study. Materials and MethodsMedical records of 220 consecutive overweight and obese women < age 40 undergoing evaluation including AMH testing at a reproductive endocrinology and infertility clinic were studied. Women with primary ovarian insufficiency were excluded. World Health Organization body mass index (BMI) classifications were used: Class I (BMI 30-34.9), Class II (BMI 35-39.9), Class III (BMI > 40). Medical records of 220 consecutive overweight and obese women < age 40 undergoing evaluation including AMH testing at a reproductive endocrinology and infertility clinic were studied. Women with primary ovarian insufficiency were excluded. World Health Organization body mass index (BMI) classifications were used: Class I (BMI 30-34.9), Class II (BMI 35-39.9), Class III (BMI > 40). ResultsUnivariate statistical evaluation showed a trend toward decreased AMH with increasing BMI. Among the 220 obese women, multivariate logistic regression was used to adjust for the inverse relationship between age and AMH. The adjusted odds ratio for having AMH above 0.8 ng/mL tended to reduce as obesity class was more severe after adjusting for age, polycystic ovary syndrome (PCOS) and tobacco use, but the results were not statistically significant. The independent risk for having an AMH over 5ng/mL is greater for women with Class I obesity (adj. OR 3.68, 95% CI 1.5-8.91, P=0.004) and Class II obesity (adj. OR 1.64, 95% CI 0.65-4.09, P=0.293) compared to those in Class 3. Univariate statistical evaluation showed a trend toward decreased AMH with increasing BMI. Among the 220 obese women, multivariate logistic regression was used to adjust for the inverse relationship between age and AMH. The adjusted odds ratio for having AMH above 0.8 ng/mL tended to reduce as obesity class was more severe after adjusting for age, polycystic ovary syndrome (PCOS) and tobacco use, but the results were not statistically significant. The independent risk for having an AMH over 5ng/mL is greater for women with Class I obesity (adj. OR 3.68, 95% CI 1.5-8.91, P=0.004) and Class II obesity (adj. OR 1.64, 95% CI 0.65-4.09, P=0.293) compared to those in Class 3. ConclusionWhile women with PCOS have increased AMH values, it appears likely that advancing obesity may be an independent risk factor for reduction of AMH level. While women with PCOS have increased AMH values, it appears likely that advancing obesity may be an independent risk factor for reduction of AMH level.