Factors influencing the rate of anti-Müllerian hormone decline: a retrospective study of 4245 infertile women.

RESEARCH QUESTION: What factors influence the rate of decline in anti-Müllerian hormone (AMH) concentrations among infertile women?

DESIGN

In this retrospective cohort, women who underwent repeated AMH measurements between January 2012 and December 2021 were enrolled. Participants were stratified into tertiles based on their annual AMH decline rate. Multivariable linear regression model was used to identify statistically significant predictors of AMH decline rates, adjusting for several potential confounders.

RESULTS

In infertile women, key factors associated with an accelerated decline in AMH concentrations included more than three ovarian stimulation cycles (P = 0.030), tubal lesions (P < 0.001) and advanced baseline age (P < 0.001). Polycystic ovary syndrome (PCOS) was inversely associated with the rate of AMH decline (P < 0.001). No statistically significant associations were observed between AMH decline rates and ovulation induction, gynaecological surgery (ovarian or tubal), age at menarche, baseline AMH concentrations, baseline body mass index, education concentration or employment status in infertile women.

CONCLUSIONS

In infertile women, treatment for more than three ovarian stimulation cycles in assisted reproductive technology, tubal lesions and advanced age were factors associated with an accelerated rate of AMH decline, whereas PCOS was associated with a reduced rate of AMH decline. Medical intervention targeting these influencing factors may mitigate the rate of ovarian reserve loss and delay ovarian aging. The results specifically highlight the need for caution regarding the potential impairment of ovarian reserve due to repeated cycles of ovarian stimulation.