Association between body mass index and anti-Müllerian hormone in women with ovarian endometrioma and dermoid cyst.

BACKGROUND

Adiposity influences reproductive function via endocrine and immune pathways. The association between body mass index (BMI) and anti-Müllerian hormone (AMH) in endometriosis is uncertain, and BMI may not fully capture adiposity-related biology relevant to ovarian reserve. We assessed whether BMI is associated with AMH in untreated ovarian endometrioma and whether this differs from dermoid cysts.

METHODS

Retrospective single-center cohort of 951 newly diagnosed, reproductive-age women from January 1, 2020 to December 31, 2023 (717 endometrioma; 234 dermoid). AMH was measured on one platform; imaging included transvaginal ultrasonography with MRI or contrast-enhanced abdominopelvic CT as needed. Multivariable linear regression modeled log-AMH versus BMI, adjusting for age, diagnosis, cyst size and laterality, parity, smoking, alcohol use, cycle regularity, and cycle length. Nonlinearity was screened with restricted cubic splines; piecewise models explored age breakpoints. An interaction term tested whether the BMI effect differed by diagnosis. Effects are reported as percent change in AMH per 1 kg/m².

RESULTS

Women with endometrioma were older (31.9 vs 29.9 years; P<.001) and had lower BMI (21.1 vs 22.4 kg/m²; P<.001) than those with dermoid. Median AMH was 2.52 vs 2.70 ng/mL; age-adjusted geometric means did not differ (P = .245). Piecewise modeling identified earlier age breakpoints in endometrioma (35.7 years) than dermoid (40.4 years). In fully adjusted models, each 1 kg/m² higher BMI was associated with 2.3% lower AMH (P = .003). Group-specific estimates were -1.9% per kg/m² in endometrioma (P = .060) and -2.8% per kg/m² in dermoid (P = .009); the BMI×diagnosis interaction was not significant (P = .538). Model fit was modest (adjusted R²=0.22), and BMI explained 1% of AMH variance (partial R²=0.01). Sensitivity analyses restricting the BMI range yielded consistent directions of effect with attenuation at lower BMI.

CONCLUSIONS

Across endometrioma and dermoid cysts, BMI shows a weak inverse association with AMH without evidence of between-group differences. Given BMI's minimal explanatory value, local ovarian factors may more strongly determine ovarian reserve in endometrioma. Limited numbers of obese participants constrain inference at higher BMI; studies with broader BMI distributions and integrated metabolic profiling are warranted.