Alcohol, cigarette smoking, and ovarian reserve in reproductive-age African-American women


      Although alcohol consumption and cigarette smoking are common behaviors in reproductive-age women, little is known about the impact of consumption patterns on ovarian reserve. Even less is known about the effects of smoking and alcohol use in reproductive-age African-American women.


      The objective of the study was to examine the impact of the patterns of alcohol intake and cigarette smoking on anti-Müllerian hormone levels as a marker of ovarian reserve in African-American women.

      Study Design

      This was a cross-sectional analysis from the baseline clinical visit and data collection of the Study of Environment, Lifestyle, and Fibroids performed by the National Institute of Environmental Health Sciences. A total of 1654 volunteers, aged 23–34 years, recruited from the Detroit, Michigan community completed questionnaires on alcohol intake and cigarette smoking and provided serum for anti-Müllerian hormone measurement. Multivariable linear and logistic regressions were used as appropriate to estimate the effect of a range of exposure patterns on anti-Müllerian hormone levels while adjusting for potential confounders including age, body mass index, and hormonal contraception.


      Most participants were alcohol drinkers (74%). Of those, the majority (74%) engaged in binge drinking at least once in the last year. Women who reported binge drinking twice weekly or more had 26% lower anti-Müllerian hormone levels compared with current drinkers who never binged (95% confidence interval, –44, –2, P < .04). Other alcohol consumption patterns (both past and current) were unrelated to anti-Müllerian hormone. The minority of participants currently (19%) or formerly (7%) smoked, and only 4% of current smokers used a pack a day or more. Neither smoking status nor second-hand smoke exposure in utero, childhood, or adulthood was associated with anti-Müllerian hormone levels.


      Results suggest that current, frequent binge drinking may have an adverse impact on ovarian reserve. Other drinking and smoking exposures were not associated with anti-Müllerian hormone in this cohort of healthy, young, African-American women. A longitudinal study of how these common lifestyle behaviors have an impact on the variability in age-adjusted anti-Müllerian hormone levels is merited.

      Key words

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        • La Marca A.
        • Sighinolfi G.
        • Radi D.
        • et al.
        Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART).
        Hum Reprod Update. 2010; 16: 113-130
        • Broer S.L.
        • Eijkemans M.J.
        • Scheffer G.J.
        • et al.
        Anti-mullerian hormone predicts menopause: a long-term follow-up study in normoovulatory women.
        J Clin Endocrinol Metab. 2011; 96: 2532-2539
        • Steiner A.Z.
        • Herring A.H.
        • Kesner J.S.
        • et al.
        Antimullerian hormone as a predictor of natural fecundability in women aged 30–42 years.
        Obstet Gynecol. 2011; 117: 798-804
        • Baird D.D.
        • Steiner A.Z.
        Anti-Mullerian hormone: a potential new tool in epidemiologic studies of female fecundability.
        Am J Epidemiol. 2012; 175: 245-249
        • Nelson S.M.
        • Messow M.C.
        • Wallace A.M.
        • et al.
        Nomogram for the decline in serum antimullerian hormone: a population study of 9,601 infertility patients.
        Fertil Steril. 2011; 95: 736-741.e1-3
        • Shaw C.M.
        • Stanczyk F.Z.
        • Egleston B.L.
        • et al.
        Serum antimullerian hormone in healthy premenopausal women.
        Fertil Steril. 2011; 95: 2718-2721
        • Substance Abuse and Mental Health Services Administration
        2013 national survey on drug use and health (National Survey on Drug Use and Health). Table 2.41B: alcohol use in lifetime, past year, and past month among persons aged 18 or older, by demographic characteristics: percentages, 2012 and 2013.
        Substance Abuse and Mental Health Services Administration, Washington (DC)2013
        • Dwyer-Lindgren L.
        • Flaxman A.D.
        • Ng M.
        • et al.
        Drinking Patterns in US Counties From 2002 to 2012.
        Am J Public Health. 2015; 105: 1120-1127
        • Gormack A.A.
        • Peek J.C.
        • Derraik J.G.
        • et al.
        Many women undergoing fertility treatment make poor lifestyle choices that may affect treatment outcome.
        Hum Reprod. 2015; 30: 1617-1624
        • Rossi B.V.
        • Berry K.F.
        • Hornstein M.D.
        • et al.
        Effect of alcohol consumption on in vitro fertilization.
        Obstet Gynecol. 2011; 117: 136-142
        • Augood C.
        • Duckitt K.
        • Templeton A.A.
        Smoking and female infertility: a systematic review and meta-analysis.
        Hum Reprod. 1998; 13: 1532-1539
        • Kee K.
        • Flores M.
        • Cedars M.I.
        • et al.
        Human primordial germ cell formation is diminished by exposure to environmental toxicants acting through the AHR signaling pathway.
        Toxicol Sci. 2010; 117: 218-224
        • Soldin O.P.
        • Makambi K.H.
        • Soldin S.J.
        • et al.
        Steroid hormone levels associated with passive and active smoking.
        Steroids. 2011; 76: 653-659
        • Jamal A.
        • Agaku I.T.
        • O’Connor E.
        • et al.
        Current cigarette smoking among adults—United States, 2005–2013.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 1108-1112
        • Dolleman M.
        • Verschuren W.M.
        • Eijkemans M.J.
        • et al.
        Reproductive and lifestyle determinants of anti-Mullerian hormone in a large population-based study.
        J Clin Endocrinol Metab. 2013; 98: 2106-2115
        • Nardo L.G.
        • Christodoulou D.
        • Gould D.
        • et al.
        Anti-Mullerian hormone levels and antral follicle count in women enrolled in in vitro fertilization cycles: relationship to lifestyle factors, chronological age and reproductive history.
        Gynecol Endocrinol. 2007; 23: 486-493
        • Whitworth K.W.
        • Baird D.D.
        • Steiner A.Z.
        • et al.
        Anti-Mullerian hormone and lifestyle, reproductive, and environmental factors among women in rural South Africa.
        Epidemiology. 2015; 26: 429-435
        • Li N.
        • Fu S.
        • Zhu F.
        • et al.
        Alcohol intake induces diminished ovarian reserve in childbearing age women.
        J Obstet Gynaecol Res. 2013; 39: 516-521
        • Gleicher N.
        • Kim A.
        • Weghofer A.
        • et al.
        Differences in ovarian aging patterns between races are associated with ovarian genotypes and sub-genotypes of the FMR1 gene.
        Reprod Biol Endocrinol. 2012; 10: 77
        • VanderWeele T.J.
        • Chen Y.
        • Ahsan H.
        Inference for causal interactions for continuous exposures under dichotomization.
        Biometrics. 2011; 67: 1414-1421
        • Plante B.J.
        • Cooper G.S.
        • Baird D.D.
        • et al.
        The impact of smoking on antimullerian hormone levels in women aged 38 to 50 years.
        Menopause. 2010; 17: 571-576
        • Schuh-Huerta S.M.
        • Johnson N.A.
        • Rosen M.P.
        • et al.
        Genetic variants and environmental factors associated with hormonal markers of ovarian reserve in Caucasian and African American women.
        Hum Reprod. 2012; 27: 594-608
        • Dafopoulos A.
        • Dafopoulos K.
        • Georgoulias P.
        • et al.
        Smoking and AMH levels in women with normal reproductive history.
        Arch Gynecol Obstet. 2010; 282: 215-219
        • La Marca A.
        • Giulini S.
        • Tirelli A.
        • et al.
        Anti-Mullerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology.
        Hum Reprod. 2007; 22: 766-771
        • Moore K.R.
        • Cole S.R.
        • Dittmer D.P.
        • Schoenbach V.J.
        • Smith J.S.
        • Baird D.D.
        Self-reported reproductive tract infections and ultrasound diagnosed uterine fibroids in African-American women.
        J Womens Health. 2015; 24: 489-495
        • Baird D.D.
        • Harmon Q.E.
        • Upson K.
        • et al.
        A prospective, ultrasound-based study to evaluate risk factors for uterine fibroid incidence and growth: methods and results of recruitment.
        J Womens Health (Larchmt). 2015; 24: 907-915
      1. National Institute on Alcohol Abuse and Alcoholism. Alcohol facts and statistics. Available at: Accessed June 22, 2015.

        • Hornung R.W.
        Estimation of average concentration in the presence of nondetectable values.
        Appl Occup Environ Hygiene. 1990; 5: 46-51
        • Marsh E.E.
        • Bernardi L.A.
        • Steinberg M.L.
        • et al.
        Novel correlates between antimullerian hormone and menstrual cycle characteristics in African-American women (23–35 years-old).
        Fertil Steril. 2016; 106: 443-450.e2
        • Dewailly D.
        • Andersen C.Y.
        • Balen A.
        • et al.
        The physiology and clinical utility of anti-Mullerian hormone in women.
        Hum Reprod Update. 2014; 20: 370-385
        • Lie Fong S.
        • Visser J.A.
        • Welt C.K.
        • et al.
        Serum anti-mullerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood.
        J Clin Endocrinol Metab. 2012; 97: 4650-4655
        • Thune I.
        • Brenn T.
        • Lund E.
        • et al.
        Physical activity and the risk of breast cancer.
        N Engl J Med. 1997; 336: 1269-1275
        • Fuchs C.S.
        • Stampfer M.J.
        • Colditz G.A.
        • et al.
        Alcohol consumption and mortality among women.
        N Engl J Med. 1995; 332: 1245-1250
        • Greenland S.
        Modeling and variable selection in epidemiologic analysis.
        Am J Public Health. 1989; 79: 340-349
        • American College of Obstetricians and Gynecologists. AJOG Committee on Gynecologic Practice
        Ovarian reserve testing. Committee opinion no. 618.
        Obstet Gynecol. 2015; 125: 268-273
        • Thun M.J.
        • Peto R.
        • Lopez A.D.
        • et al.
        Alcohol consumption and mortality among middle-aged and elderly US adults.
        N Engl J Med. 1997; 337: 1705-1714
        • Mendelson J.H.
        • Lukas S.E.
        • Mello N.K.
        • et al.
        Acute alcohol effects on plasma estradiol levels in women.
        Psychopharmacology. 1988; 94: 464-467
        • Ben-Rafael Z.
        • Levy T.
        • Schoemaker J.
        Pharmacokinetics of follicle-stimulating hormone: clinical significance.
        Fertil Steril. 1995; 63: 689-700
        • McKenzie P.P.
        • McClaran J.D.
        • Caudle M.R.
        • et al.
        Alcohol inhibits epidermal growth factor-stimulated progesterone secretion from human granulosa cells.
        Alcohol Clin Exp Res. 1995; 19: 1382-1388
        • Thilagam A.
        Mathematical modelling of decline in follicle pool during female reproductive ageing.
        Math Med Biol. 2016; 33: 107-121
        • Gold E.B.
        • Bromberger J.
        • Crawford S.
        • et al.
        Factors associated with age at natural menopause in a multiethnic sample of midlife women.
        Am J Epidemiol. 2001; 153: 865-874
        • Klonoff-Cohen H.
        Female and male lifestyle habits and IVF: what is known and unknown.
        Hum Reprod Update. 2005; 11: 179-203
        • Stillman R.J.
        • Rosenberg M.J.
        • Sachs B.P.
        Smoking and reproduction.
        Fertil Steril. 1986; 46: 545-566
        • Mattison D.R.
        • Thorgeirsson S.S.
        Smoking and industrial pollution, and their effects on menopause and ovarian cancer.
        Lancet. 1978; 1: 187-188
        • Broer S.L.
        • Mol B.W.
        • Hendriks D.
        • et al.
        The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count.
        Fertil Steril. 2009; 91: 705-714
        • Metzger
        • Metzger D.S.
        • Koblin B.
        • et al.
        Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies.
        Am J Epidemiol. 2000; 152: 99-106
        • Sterling T.D.
        • Weinkam J.J.
        Comparison of smoking-related risk factors among black and white males.
        Am J Ind Med. 1989; 15: 319-333
        • Caraballo R.S.
        • Giovino G.A.
        • Pechacek T.F.
        • Mowery P.D.
        Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older.
        Am J Epidemiol. 2001; 153: 807-814
        • Block G.
        • Hartman A.M.
        • Dresser C.M.
        • Carroll M.D.
        • Gannon J.
        • Gardner L.
        A data-based approach to diet questionnaire design and testing.
        Am J Epidemiol. 1986; 124: 453-469