#109 : Differential Effects of Age and Lifestyle on Anti-Mullerian Hormone Levels and Ovarian Reserve in Asian Women with and Without Polycystic Ovarian Syndrome (PCOS)

Background and Aims: Polycystic ovarian syndrome (PCOS) afflicts 4-20% of all women at reproductive age and is a common cause of infertility. Elevated anti-Mullerian hormone levels (AMH), a clinical marker for ovarian reserve, are routinely associated with PCOS, however, an exact cut-off value has remained elusive. Interestingly, observational studies reported that women with PCOS have purported higher ovarian reserves, implied from higher AMH levels, and later age of menopause delayed by 2 years when compared to women without PCOS. Our study focuses on the Asian population, a demographic frequently under-represented in cohort studies. We posit that our results will bridge the gap in the collective understanding of PCOS and how age and lifestyle effects on ovarian reserves in Asian women.

Method: A large retrospective study was conducted at a tertiary-care hospital in Singapore from 2016-2020. AMH and clinical demographics from 3,739 Asian women aged 21-53 years were collected. Wilcoxon Rank Sum was used to analyze the data and significance was established if p<0.05. Logistic regression and ROC were generated in R.

Results: AMH (aOR=1.07), age (aOR=0.89) and BMI (aOR=1.12) were significantly associated with PCOS(p<0.001) in Asian women. AMH declined with age but the decline in the PCOS group was less severe, with 80% AMH retained in women in their 40s, as compared to controls which retained only 40% AMH(Fig. 1). BMI>25 and smoking status affected AMH levels with higher BMI and smoking associated with lower AMH. An ethnic stratification revealed that average AMH levels of Malay women with PCOS were lower than Chinese and Indian women in each age group (Fig. 2). The constructed model incorporating all variables had an ROC AUC=0.89.

Conclusion: This study highlights the importance of improving the resolution of PCOS diagnosis through AMH profiling, especially in Asian populations. The results from this study suggest potential beneficial effects of lifestyle modifications such as maintaining a healthy BMI and stopping smoking, especially in Asian women with PCOS.