A systematic review of the association between modifiable lifestyle factors and circulating anti-Müllerian hormone.
Level 2 - randomized trial
Systematic review of predominantly cross-sectional and observational studies rather than randomized trials.
PubMed 38402486 · doi:10.1093/humupd/dmae004
What was done
A pre-registered systematic review (PROSPERO CRD42022322575) searched PubMed and Embase through November 1, 2023, to assess associations between circulating anti-Müllerian hormone (AMH) levels and modifiable lifestyle factors (BMI, smoking, oral contraceptive [OC] use, alcohol, caffeine, physical activity, and waist-hip ratio [WHR]) in adult women. Study quality was evaluated using NHLBI assessment tools.
What was found
Across 65 included studies (66.2% cross-sectional): - BMI: Most studies reported significant inverse associations, with mean AMH decreases ranging from -0.015 to -0.2 ng/ml per unit BMI increase. - Smoking: Most studies found significant inverse associations; current smokers had lower AMH than non-smokers (reductions ranged from -0.4 to -1.1 ng/ml, or -4% to -44%). - Oral Contraceptives: Most studies found significant inverse associations, with relative mean reductions of -17% to -31.1%, an 11 age-standardized percentile decrease, and an average decrease of 1.97 ng/ml after 9 weeks of use. - Physical Activity: Exercise interventions in women with PCOS or sedentary lifestyles decreased AMH by 2.8 to 13.2 pmol/l after 12 weeks. - WHR, Alcohol, and Caffeine: The majority of studies found no significant association.
Why it matters
Circulating AMH is widely used to assess ovarian reserve and guide fertility care, but levels are substantially lower in women with higher BMI, current smoking habits, or oral contraceptive use. Clinicians should account for these modifiable lifestyle factors to avoid misinterpreting ovarian reserve.
Limits
Most included studies were cross-sectional (66.2%), limiting causal inference. Reported effect sizes were heterogeneous across studies. It remains unproven whether lifestyle-associated differences in AMH reflect actual changes in true ovarian reserve or transient shifts in circulating hormone concentrations.
Cited by
- supports Prolonged periods of anovulation, such as from hormonal birth control, pregnancy, or the postpartum state, suppress circulating anti-Müllerian hormone (AMH) levels.