Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;34(2):196-202.
doi: 10.1016/j.jpag.2020.11.021. Epub 2020 Dec 3.

Is Ovarian Reserve Impacted in Anorexia Nervosa?

Sarah Pitts  1 , Suzanne E Dahlberg  2 , Jenny Sadler Gallagher  2 , Catherine M Gordon  3 , Amy D DiVasta  2
Affiliations

Is Ovarian Reserve Impacted in Anorexia Nervosa?

Sarah Pitts et al. J Pediatr Adolesc Gynecol. 2021 Apr.

Abstract

Study objectives: Hypothalamic amenorrhea is common in adolescents and young adults (AYAs) with anorexia nervosa (AN), and ovarian reserve is not routinely assessed. AN increases rates of fertility problems, but how or when AN negatively influences future fertility is unclear. We sought to determine whether biomarkers of ovarian reserve were impacted in AYA with AN.

Design: Cross-sectional study.

Setting: Tertiary care center.

Participants: Females with AN and amenorrhea (n = 97) at the pre-intervention visit of a clinical trial, n = 19 females without an eating disorder or menstrual dysfunction.

Main outcome measures: Serum anti-Müllerian hormone (AMH) concentrations.

Results: AMH levels were higher in AYA with AN than unaffected adolescents (4.7 vs. 3.2 ng/mL; P = .03). Neither FSH nor inhibin B differed between groups. In 19.6% of participants with AN, AMH levels were elevated above the normal range (>6.78 ng/mL). These subjects had a longer disease duration than those with normal AMH levels (9 vs. 3 mos; P = .03); age or degree of malnutrition did not differ between AN subjects with normal or elevated AMH.

Conclusions: AMH levels appear to be normal or elevated in AYA with AN. Low AMH in a patient with AN should raise clinical concern regarding ovarian reserve, and should not be attributed to degree of malnutrition alone. Currently, AMH is not regularly assessed during routine AN clinical care. However, our findings suggest some clinical utility in identifying those patients with reduced ovarian reserve. Potential links between the hypothalamic amenorrhea suffered by patients with AN and PCOS should be explored.

Keywords: Adolescents; Anorexia nervosa; Anti-Müllerian hormone; Fertility; Malnutrition; Ovarian reserve.

PubMed Disclaimer

Conflict of interest statement

Disclosures: Drs. Pitts and DiVasta have received investigator-initiated research funding from Merck Pharmaceuticals for a quality improvement project. The other authors report no disclosures or conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Pathway to study entry for (A) 97 adolescents with anorexia nervosa and (B) 19 healthy comparison subjects.
Fig. 1.
Fig. 1.
Pathway to study entry for (A) 97 adolescents with anorexia nervosa and (B) 19 healthy comparison subjects.
Fig. 2.
Fig. 2.
Box and whisker plots comparing serum hormone concentrations between adolescents and young adults (AYA) with anorexia nervosa (AN) and comparison subjects. (A) Anti-Müllerian hormone; (B) estradiol; (C) inhibin B; and (D) follicle-stimulating hormone (FSH). Data presented include the median (dark black horizontal bar), values at the 25th and 75th percentiles (bottom and top edges of the colored box), and the minimum/maximum values (horizontal lines at the end of the whiskers).
Fig. 2.
Fig. 2.
Box and whisker plots comparing serum hormone concentrations between adolescents and young adults (AYA) with anorexia nervosa (AN) and comparison subjects. (A) Anti-Müllerian hormone; (B) estradiol; (C) inhibin B; and (D) follicle-stimulating hormone (FSH). Data presented include the median (dark black horizontal bar), values at the 25th and 75th percentiles (bottom and top edges of the colored box), and the minimum/maximum values (horizontal lines at the end of the whiskers).
Fig. 2.
Fig. 2.
Box and whisker plots comparing serum hormone concentrations between adolescents and young adults (AYA) with anorexia nervosa (AN) and comparison subjects. (A) Anti-Müllerian hormone; (B) estradiol; (C) inhibin B; and (D) follicle-stimulating hormone (FSH). Data presented include the median (dark black horizontal bar), values at the 25th and 75th percentiles (bottom and top edges of the colored box), and the minimum/maximum values (horizontal lines at the end of the whiskers).
Fig. 2.
Fig. 2.
Box and whisker plots comparing serum hormone concentrations between adolescents and young adults (AYA) with anorexia nervosa (AN) and comparison subjects. (A) Anti-Müllerian hormone; (B) estradiol; (C) inhibin B; and (D) follicle-stimulating hormone (FSH). Data presented include the median (dark black horizontal bar), values at the 25th and 75th percentiles (bottom and top edges of the colored box), and the minimum/maximum values (horizontal lines at the end of the whiskers).
Fig. 3.
Fig. 3.
Box and whisker plots comparing serum hormone concentrations between MA with a prolonged duration of amenorrhea (no menses for > 3 months) versus those with shorter duration of amenorrhea (no menses for ≤3 months). (A) Anti-Müllerian hormone; (B) estradiol; (C) inhibin B; and (D) cortisol. Data presented include the median (dark black horizontal bar), values at the 25th and 75th percentiles (bottom and top edges of the colored box), and the minimum/maximum values (horizontal lines at the end of the whiskers).
Fig. 3.
Fig. 3.
Box and whisker plots comparing serum hormone concentrations between MA with a prolonged duration of amenorrhea (no menses for > 3 months) versus those with shorter duration of amenorrhea (no menses for ≤3 months). (A) Anti-Müllerian hormone; (B) estradiol; (C) inhibin B; and (D) cortisol. Data presented include the median (dark black horizontal bar), values at the 25th and 75th percentiles (bottom and top edges of the colored box), and the minimum/maximum values (horizontal lines at the end of the whiskers).
Fig. 3.
Fig. 3.
Box and whisker plots comparing serum hormone concentrations between MA with a prolonged duration of amenorrhea (no menses for > 3 months) versus those with shorter duration of amenorrhea (no menses for ≤3 months). (A) Anti-Müllerian hormone; (B) estradiol; (C) inhibin B; and (D) cortisol. Data presented include the median (dark black horizontal bar), values at the 25th and 75th percentiles (bottom and top edges of the colored box), and the minimum/maximum values (horizontal lines at the end of the whiskers).
Fig. 3.
Fig. 3.
Box and whisker plots comparing serum hormone concentrations between MA with a prolonged duration of amenorrhea (no menses for > 3 months) versus those with shorter duration of amenorrhea (no menses for ≤3 months). (A) Anti-Müllerian hormone; (B) estradiol; (C) inhibin B; and (D) cortisol. Data presented include the median (dark black horizontal bar), values at the 25th and 75th percentiles (bottom and top edges of the colored box), and the minimum/maximum values (horizontal lines at the end of the whiskers).
See this image and copyright information in PMC

References

    1. Smink FRE, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr. Psychiatry Rep 2012;14(4):406–414. - PMC - PubMed
    1. Yager J, Andersen AE. Clinical practice. Anorexia nervosa. N. Engl. J. Med 2005;353(14):1481–1488. - PubMed
    1. Kimmel MC, Ferguson EH, Zerwas S, Bulik CM, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int. J. Eat. Disord 2016;49(3):260–275. - PMC - PubMed
    1. Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Reproductive health outcomes in eating disorders. Int. J. Eat. Disord 2013;46(8):826–833. - PubMed
    1. Parry JP, Koch CA. Ovarian Reserve Testing; 2000.

Substances