Endogenous and exogenous factors influencing anti-Müllerian hormone levels in women of reproductive age
DOI:
https://doi.org/10.15584/ejcem.2025.2.23Keywords:
anti-Müllerian hormone, fertility, ovarian reserve, reproductionAbstract
Introduction and aim. Anti-Müllerian hormone (AMH) is a key marker of ovarian reserve (OR), which declines with advancing reproductive age. Certain pathological conditions can reduce OR or lower AMH levels independently of age, potentially impair ing fertility. This study aims to review the scientific literature on factors influencing AMH levels and the causes of diminished OR, including lifestyle, diet, supplementation, pathogenic factors, environmental influences, and genetic predispositions.
Material and methods. This review was conducted using electronic databases, including PubMed and Google Scholar. A comprehensive search was carried out across these databases, covering the period from 2007 to 2024. The inclusion criteria encom pass studies on AMH and factors influencing ovarian reserve, that present either quantitative or qualitative data.
Analysis of the literature. The most important factor determining the level of AMH is age. In addition, factors that may influ ence hormone levels include genetic background, autoimmune diseases, polycystic ovary syndrome (PCOS), environmental toxins, diet, supplementation, oral contraception, physical activity, and smoking.
Conclusion. The causes of reduced OR and abnormal AMH levels remain unclear in many cases. Recommendations for the pre vention of pathologically reduced OR include lifestyle modifications, a diet rich in antioxidants, avoiding toxins, refraining from smoking, appropriate supplementation, genetic testing, and regular blood tests.
Downloads
References
Moslehi N, Mirmiran P, Azizi F, Tehrani FR. Do dietary intakes influence the rate of decline in anti-Mullerian hormone among eumenorrheic women? A population-based prospective investigation. Nutr J. 2019;18(1):83. doi: 10.1186/s12937-019-0508-5
di Clemente N, Racine C, Pierre A, Taieb J. Anti-Müllerian Hormone in Female Reproduction. Endocr Rev. 2021;42(6):753-782. doi: 10.1210/endrev/bnab012
Krawczyńska M, Słowińska-Srzednicka J. The utilization of anti-müllerian hormone (AMH) plasma level measurements in diagnosis of endocrine diseases. Borgis Postępy Nauk Medycznych. 2016;12:921-928.
Iwase A, Hasegawa Y, Tsukui Y, et al. Anti-Müllerian hormone beyond an ovarian reserve marker: the relationship with the physiology and pathology in the life-long follicle development. Front Endocrinol (Lausanne). 2023;14:1273966. doi: 10.3389/fendo.2023.1273966
Ramezani Tehrani F, Bidhendi Yarandi R, Solaymani-Dodaran M, Tohidi M, Firouzi F, Azizi F. Improving Prediction of Age at Menopause Using Multiple Anti-Müllerian Hormone Measurements: the Tehran Lipid-Glucose Study. J Clin Endocrinol Metab. 2020;105(5):dgaa083. Doi: 10.1210/clinem/dgaa083
Nelson SM, Davis SR, Kalantaridou S, Lumsden MA, Panay N, Anderson RA. Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review. Hum Reprod Update. 2023;29(3):327-346. doi: 10.1093/humupd/dmac045
Moridi I, Chen A, Tal O, Tal R. The Association between Vitamin D and Anti-Müllerian Hormone: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(6):1567. doi: 10.3390/nu12061567
Ziaei R, Ghasemi-Tehrani H, Movahedi M, et al. The association between Diet Quality Index-International score and risk of diminished ovarian reserve: a case-control study. Front Nutr. 2023;10:1277311. doi: 10.3389/fnut.2023.1277311
Zhu Q, Li Y, Ma J, Ma H, Liang X. Potential factors result in diminished ovarian reserve: a comprehensive review. J Ovarian Res. 2023;16(1):208. doi: 10.1186/s13048-023-01296-x
Man L, Lustgarten Guahmich N, Vyas N, et al. Ovarian Reserve Disorders, Can We Prevent Them? A Review. Int J Mol Sci. 2022;23(23):15426. Published 2022 Dec 6. doi: 10.3390/ijms232315426
Sinha S, Sharan A, Sinha S. Anti-Mullerian Hormone as a Marker of Ovarian Reserve and Function. Cureus. 2022;14(9):e29214. doi: 10.7759/cureus.29214
Safiyeh FD, Mojgan M, Parviz S, Sakineh MA, Behnaz SO. The effect of selenium and vitamin E supplementation on anti-Mullerian hormone and antral follicle count in infertile women with occult premature ovarian insufficiency: A randomized controlled clinical trial. Complement Ther Med. 2021;56:102533. doi: 10.1016/j.ctim.2020.102533
European Society for Human Reproduction and Embryology (ESHRE) Guideline Group on POI, Webber L, Davies M, et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod. 2016;31(5):926-937. doi: 10.1093/humrep/dew027
Prieto-Huecas L, Piera-Jordán CÁ, Serrano De La Cruz-Delgado V, et al. Assessment of Nutritional Status and Its Influence on Ovarian Reserve: A Systematic Review. Nutrients. 2023;15(10):2280. doi: 10.3390/nu15102280
Pelosi E, Simonsick E, Forabosco A, Garcia-Ortiz JE, Schlessinger D. Dynamics of the ovarian reserve and impact of genetic and epidemiological factors on age of menopause. Biol Reprod. 2015;92(5):130. doi: 10.1095/biolreprod.114.127381
Éliás M, Kónya M, Kekk Z, et al. Platelet-rich plasma (PRP) treatment of the ovaries significantly improves fertility parameters and reproductive outcomes in diminished ovarian reserve patients: a systematic review and meta-analysis. J Ovarian Res. 2024;17(1):104. doi: 10.1186/s13048-024-01423-2
Hardy TM, McCarthy DO, Fourie NH, Henderson WA. Anti-Müllerian Hormone Levels and Urinary Cortisol in Women With Chronic Abdominal Pain. J Obstet Gynecol Neonatal Nurs. 2016;45(6):772-780. doi: 10.1016/j.jogn.2016.06.012
Dong YZ, Zhou FJ, Sun YP. Psychological stress is related to a decrease of serum anti-müllerian hormone level in infertile women. Reprod Biol Endocrinol. 2017;15(1):51. doi: 10.1186/s12958-017-0271-4
Mínguez-Alarcón L, Souter I, Williams PL, et al. Occupational factors and markers of ovarian reserve and response among women at a fertility centre. Occup Environ Med. 2017;74(6):426-431. doi: 10.1136/oemed-2016-103953
Walentowicz P, Sadlecki P, Krintus M, et al. Serum anti-müllerian hormone levels in patients with epithelial ovarian cancer. Int J Endocrinol. 2013;2013:517239. doi: 10.1155/2013/517239
Czarnywojtek A, Borowska M, Dyrka K, et al. The influence of various endocrine disruptors on the reproductive system. Endokrynol Pol. 2023;74(3):221-233. doi: 10.5603/EP.a2023.0034
Repouskou A, Panagiotidou E, Panagopoulou L, et al. Gestational exposure to an epidemiologically defined mixture of phthalates leads to gonadal dysfunction in mouse offspring of both sexes. Sci Rep. 2019;9(1):6424. doi: 10.1038/s41598-019-42377-6
Özcan P, Fıçıcıoğlu C, Kizilkale O, et al. Can Coenzyme Q10 supplementation protect the ovarian reserve against oxidative damage?. J Assist Reprod Genet. 2016;33(9):1223-1230. doi: 10.1007/s10815-016-0751-z
Kabodmehri R, Javaheri FSH, Alami F, et al. Female infertility and dietary antioxidant index (DAI); a case-control study. BMC Womens Health. 2023;23(1):608. doi: 10.1186/s12905-023-02747-9
Hu H, Zhang J, Xin X, et al. Efficacy of natural products on premature ovarian failure: a systematic review and meta-analysis of preclinical studies. J Ovarian Res. 2024;17(1):46. doi: 10.1186/s13048-024-01369-5
Banerjee K, Thind A, Bhatnagar N, et al. Effect of Reproductive and Lifestyle Factors on Anti-Mullerian Hormone Levels in Women of Indian Origin. J Hum Reprod Sci. 2022;15(3):259-271. doi: 10.4103/jhrs.jhrs_79_22
KaboodMehri R, Sorouri ZZ, Sharami SH, Bagheri SE, Yazdipaz S, Doaei S. The association between the levels of anti-Müllerian hormone (AMH) and dietary intake in Iranian women. Arch Gynecol Obstet. 2021;304(3):687-694. doi: 10.1007/s00404-021-06098-4
Hohos NM, Cho KJ, Swindle DC, Allshouse AA, Rudolph MC, Skaznik-Wikiel ME. Fat-1 Transgene Is Associated With Improved Reproductive Outcomes. Endocrinology. 2018;159(12):3981-3992. doi: 10.1210/en.2018-00723
Xu Y, Nisenblat V, Lu C, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol. 2018;16(1):29. doi: 10.1186/s12958-018-0343-0
Aramesh S, Alifarja T, Jannesar R, Ghaffari P, Vanda R, Bazarganipour F. Does vitamin D supplementation improve ovarian reserve in women with diminished ovarian reserve and vitamin D deficiency: a before-and-after intervention study. BMC Endocr Disord. 2021;21(1):126. doi: 10.1186/s12902-021-00786-7
Dennis NA, Houghton LA, Pankhurst MW, Harper MJ, McLennan IS. Acute Supplementation with High Dose Vitamin D3 Increases Serum Anti-Müllerian Hormone in Young Women. Nutrients. 2017;9(7):719. doi: 10.3390/nu9070719
Delkhorrami M, Farshbaf-Khalili A, Mirghafourvand M, Hamdi K, Oskouei BS. Low Serum Selenium Levels in Iranian Women with Idiopathic Primary Ovarian Insufficiency: A Case–Control Study. J Biochem Tech. 2020;1:71-78.
Jankowska K, Maksym R, Zgliczyński W. Dehydroepiandrosterone can restore the function of the ovaries: a series of 5 cases and a review of the literature. J Obstet Gynecol Investig. 2019;2(1):11-18. doi: 10.5114/jogi.2019.86745.
Neves AR, Montoya-Botero P, Polyzos NP. The Role of Androgen Supplementation in Women With Diminished Ovarian Reserve: Time to Randomize, Not Meta-Analyze. Front Endocrinol (Lausanne). 2021;12:653857. doi: 10.3389/fendo.2021.653857
Yilmaz N, Uygur D, Inal H, Gorkem U, Cicek N, Mollamahmutoglu L. Dehydroepiandrosterone supplementation improves predictive markers for diminished ovarian reserve: serum AMH, inhibin B and antral follicle count. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):257-260. doi: 10.1016/j.ejogrb.2013.04.003
Hassa H, Aydin Y, Ozatik O, Erol K, Ozatik Y. Effects of dehydroepiandrosterone (DHEA) on follicular dynamics in a diminished ovarian reserve in vivo model. Syst Biol Reprod Med. 2015;61(3):117-121. doi: 10.3109/19396368.2015.1011353
Singh N, Zangmo R, Kumar S, et al. A prospective study on role of dehydroepiandrosterone (DHEA) on improving the ovarian reserve markers in infertile patients with poor ovarian reserve. Gynecol Endocrinol. 2013;29(11):989-992. doi: 10.3109/09513590.2013.824957
Bentzen JG, Forman JL, Pinborg A, et al. Ovarian reserve parameters: a comparison between users and non-users of hormonal contraception. Reprod Biomed Online. 2012;25(6):612-619. doi: 10.1016/j.rbmo.2012.09.001
Peigné M, Decanter C. Serum AMH level as a marker of acute and long-term effects of chemotherapy on the ovarian follicular content: a systematic review. Reprod Biol Endocrinol. 2014;12:26. doi: 10.1186/1477-7827-12-26
Gracia CR, Sammel MD, Freeman E, et al. Impact of cancer therapies on ovarian reserve. Fertil Steril. 2012;97(1):134-40.e1. doi: 10.1016/j.fertnstert.2011.10.040
Sammaritano LR. Menopause in patients with autoimmune diseases. Autoimmun Rev. 2012;11(6-7):A430-A436. doi: 10.1016/j.autrev.2011.11.006
Dólleman M, Verschuren WM, Eijkemans MJ, et al. Reproductive and lifestyle determinants of anti-Müllerian hormone in a large population-based study. J Clin Endocrinol Metab. 2013;98(5):2106-2115. doi: 10.1210/jc.20123995
Barriere P, Freour T, Masson D, Mirallie S, Jean M. Deleterious effect of tobacco on IVF outcome and ovarian reserve as reflected by serum anti‑Mullerian hormone (AMH). Fertil Steril 2007;88:S30. doi: 10.1016/j.fertnstert.2007.07.113
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
