Anti-Müllerian hormone and lifestyle, reproductive, and environmental factors among women in rural South Africa.

Anti-Mullerian hormone is a peptide growth factor that was first recognized for its effects on sex differentiation in the male fetus.1 In adult women, antiMullerian hormone is produced by granulosa cells and is a marker of ovarian reserve.2 Animal studies indicate that antiMullerian hormone inhibits the recruitment of new follicles from the primordial follicle pool and is involved in regulating the number of growing follicles, and selecting follicles for ovulation.3 Data suggest that women have a fixed ovarian reserve, starting with approximately 1–2 million follicles at birth, after which oocyte numbers decline.4 By menopause, fewer than 1,000 follicles remain.5 This decline in oocytes mirrors a decline in antiMullerian hormone concentration, which peaks sometime during late adolescence or early adulthood, thereafter decreasing until antiMullerian hormone is undetectable among post-menopausal women.6, 7 Anti-Mullerian hormone has been extensively studied among infertile women, and its utility in predicting ovarian response in assisted reproductive technology among this population has been well established.6, 8, 9 Attention has now focused on studying the distribution and determinants of antiMullerian hormone concentrations in the general population. Although there have been recent appeals to investigators to consider the assessment of antiMullerian hormone as a primary outcome measure when examining effects of exposures that may target the ovary,8 few such investigations exist. The aim of the present study was to investigate environmental factors affecting antiMullerian hormone concentrations in reproductive-age women in rural South Africa. Environmental effects on anti-Mullerian hormone are plausible; for example, chemotherapy, radiation, and smoking are known to decrease its concentration.10–14 We were especially interested in the environmental exposure of cooking over open wood fires, due to shared toxic contaminants of cigarette smoke and combustion by-products of biomass fuel burning, and we hypothesized that women who cooked over open wood fires would have lower anti-Mullerian hormone concentrations. Indoor residual spraying for malaria control (using either dichlorodiphenyltrichloroethane [DDT] or pyrethroids) also occurred in some of the study villages. Given the animal studies showing their adverse effects on the ovary,15–18 we hypothesized that exposure to these pesticides would be associated with decreased antiMullerian hormone concentrations. In addition, given the paucity of data on antiMullerian hormone in women other than those seeking treatment at fertility clinics, we also aimed to describe the associations between demographic, lifestyle, and reproductive factors and antiMullerian hormone concentrations in this South African sample.