Abstract
Anti-müllerian hormone (AMH) is the preferred biomarker for ovarian reserve testing based on its stability across the menstrual cycle. Despite its increased use, there have been very few studies that have followed AMH levels over time in young, healthy populations. The few existing studies are in women of European descent. The objective of this study was to determine factors that affect AMH levels with the ultimate goal of identifying and providing better counseling to women who are at the highest risk for a rapid decline in ovarian reserve. In this study, African-American women (AAW) aged 23-34 years (yr) at their first visit, were recruited from the Detroit, Michigan metropolitan area, as part of the Study of the Environment, Lifestyle and Fibroids. Anthropometric measurements, health information and blood samples were collected from participants at three time points over 3 years. Serum AMH levels were measured using the Ansh picoAMH assay. Summary statistics were derived for the variables of interest and linear mixed-effect models were used to estimate the effects of a range of exposures on AMH levels (Stata/SE 15.1). A total of 1,646 women with up to three visits were included in the analysis. The mean time between the first and third visit was 38±2.4 months. The median AMH values for the three visits were 4.1, 3.6, and 3.2 ng/mL, respectively. The mean age was 28.7 yr at the first visit, 30.4 yo at the second visit, and 32.1 yo at the third visit. There was a non-linear relationship between age and AMH, with highest levels at age 23 and a rapid decline after age 35. The majority of women were found to be obese at the three visits (60%, 63%, and 64%, respectively), with 45% of women being obese at all three visits. For approximately 1/3 (29%) of visits, there was hormonal contraception use by the participant. In models controlling for age and age(2), body mass index and hormonal contraception use were inversely associated with AMH. This large cohort study of 1,646 women with 4,455 measures provides important information on factors affecting AMH concentrations in reproductive aged AAW, a population that is largely underrepresented in the ovarian reserve literature. Further data collection in this cohort will allow us to examine patterns of AMH trajectories. Knowledge of AMH trajectories from diverse populations may lead to development of personalized reproductive-lifespan-estimates which would empower women to make informed and well-timed reproductive choices.