Air pollution and anti-Müllerian hormone: the Doetinchem Cohort Study

Emerging epidemiologic studies have investigated the relationship between exposure to air pollutants and anti-Müllerian hormone (AMH), a biomarker for ovarian reserve. However, findings remain inconclusive, and there is a lack of longitudinal studies with repeated AMH measurements, which could better characterize the impact of air pollutants on ovarian reserve across the lifespan. In 2574 women with a mean baseline age of 37.6 years from a prospective population-based cohort in the Netherlands, we used linear mixed models to investigate the associations between long-term exposure to four regulated air pollutants (NO₂, O₃, PM₁₀, and PM_2.5) and longitudinal serum AMH levels. Annual average concentrations of air pollutants were estimated at baseline residential addresses using an enhanced European hybrid land-use regression model. Serum AMH was measured up to five times over a period exceeding 20 years using the highly sensitive picoAMH assay. Results showed that, despite marginal AMH differences after age 60, there were no associations between the air pollutant exposures and AMH levels across the reproductive lifespan in single-pollutant models, and the observed differences were further attenuated in two-pollutant models. In addition, none of the air pollutants were related to age at menopause. To summarize, we did not find clinically relevant associations between long-term air pollutant exposure and longitudinal AMH levels. Further studies are needed to confirm these findings in diverse populations and higher exposure scenarios, as well as to explore vulnerable periods of exposure during early life.