Anti-müllerian hormone and obesity

Obesity continues to be an epidemic in the United States, negatively impacting overall morbidity and mortality, as well as reproductive outcomes. Although the effect of obesity on fertility is likely multi-faceted, obese patients exhibit an altered ovarian follicular environment that impairs steroidogenic action, folliculogenesis and metabolism, and is associated with inflammation, which may contribute to these poor outcomes. Anti-Müllerian hormone (AMH), produced by the granulosa cells of preantral and antral follicles, has been demonstrated to be a useful marker of ovarian reserve; AMH is the earliest marker to change with aging and has minimal inter- and intra-cycle variability. The relation between obesity and serum AMH levels is complex. Age, presence or absence of PCOS, the status of glucose metabolism like insulin resistance states, and potentially race may affect this interaction. The effect of weight loss on serum AMH levels is less clear. It is dependent on the above-mentioned factors, as well as the type of intervention like caloric restriction, physical activity, medical or surgical treatment. Consequently, despite the abundance of publications that study the relationship between obesity and AMH levels, the results are conflicting with lack of a consensus. Elucidation of the mechanisms of the effects of obesity states on serum AMH levels will improve our understanding of these complex interactions, potentially leading to discovery of therapies that may improve reproductive function.