Endocrine Abstracts (2019) 63 P311 | DOI: 10.1530/endoabs.63.P311

Ovarian reserve and exposure to environmental pollutants (ORExPo study)

Daniele Santi1, Antonio La Marca2, Marco Michelangeli3, Andrea Casonati3, Roberto Grassi3, Enrica Baraldi4 & Manuela Simoni1


1Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 2Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy; 3Hopenly, S.r.l. Reggio Emilia, Reggio Emilia, Italy; 4Department of Laboratory Medicine and Pathology Azienda USL of Modena, Modena, Italy.


Background: Many chemicals present within the environment, as well as natural and artificial components of our diet, have the potential to interfere with the physiological role of hormones, interfering with hormone biosynthesis, signalling or metabolism. In the last years AMH, a protein secreted by granulosa cells, has emerged as a reliable marker of ovarian reserve. It is largely accepted the influence of age and smoking on AMH serum levels, although a clear effect of environment has not been demonstrated.

Purpose: To assess the association existing between environmental pollutants and anti-Mullerian hormone (AMH), a well know marker of ovarian reserve. The hypothesis is that high exposure to pollutants may be associated to an age-independent decrease in AMH, suggesting decreased ovarian reserve.

Methods: A longitudinal, observational, retrospective, real-world big data trial was performed. All laboratory AMH measurements of women living in the area surrounding the city of Modena performed from January 2007 to October 2017 at the Central Laboratory of Modena Hospital were extracted and collected in a large database. AMH serum levels were measured with commercial assay (Beckman Coulter). A computing data warehouse was created, in which AMH data were connected to patients’ age and residential address. The database was completed, including environmental data and considering the city where each patient lived for geo-localization. The environmental exposure considered daily particulate matter (PM) and NO2 values.

Results: 1,463 AMH measurements were collected for 1,318 women (mean 1.94 ng/ml, and median of 0.90 ng/ml). AMH was inversely related to patients’ age (Rho=−0.437, P<0.001), although not related to age in patients younger than 25 years (Adjusted R-squared 0.068 P=0.055). On the contrary, AMH was inversely related to age after 25 years of age (Adjusted R-squared 0.120, P<0.001). AMH was inversely related to environmental pollutants, such as PM10 (Rho=−0.088, P=0.001), PM2.5 (Rho=−0.062, P=0.021) and NO2 (Rho=−0.111, P<0.001). This association was age–independent. No relationships were found between AMH and environmental temperatures.

Conclusion: This is the first big-data approach designed to evaluate the influence of environment on AMH serum levels. Increasing air pollution affects AMH serum levels. It is very well known that there is a large genetic component in the ovarian reserve at birth, but other factors may influence the extent of the follicular pool such as environmental factors. Results of this study strongly suggest that environmental factors may also modify the downward dynamics of AMH and ovarian reserve during adulthood.

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