This study investigated associated factors on AMH levels such as reproductive measures, lifestyle, and socio-demographic status among poor-responder women in Iran. The study found AMH levels in poor-responder women are associated with demographic, lifestyle, and reproductive factors [5, 6]. The AMH level is increasingly assessed among female patients and various populations while poor-responder women have been poorly investigated.
Among lifestyle variables, never/seldom or less than 2-items vegetable intake per day was associated with a lower level of AMH in poor-responders in the final analysis. Overall, findings indicated that AMH levels are influenced by lifestyle [11, 12]. In agreement our study, F. Foroozanfard et al. have been found a beneficial effects of dietary pattern on AMH levels [13].
In the current study, there was an association between fast food consumption and lower levels of AMH in the unilabiate analysis. Consistent with our study, in a study conducted by KaboodMehri et al. in Iran [14], the intake of fast foods and saturated fats was negatively associated with AMH levels. However, in contrast to our study, there was no significant association between fruit and vegetable intake and AMH level. This discrepancy may be due to differences in the study's target population (poor-responders in the current study), sample size, and racial differences. In agreement with our study, dairy products consumption was not associated with AMH levels. In contrast, no correlations were found between dietary patterns and AMH in Banerjee et al. study [15].
Smoking is one of the important predictors of AMH levels. We found that AMH level was associated with passive smoking while no significant association was reported for women smoking since in the Iranian culture, especially in Azerbaijan Province women smoking is a rare event and only 2 poor-responder women were smoking. Therefore, due to the low frequency of female smokers, this relationship was not found. However, due to the high frequency of smoking in Iranian men is high, exposure to second-hand smoke (passive smoking) was common in our study and a significant relationship was also found. Several studies from around the world have reported a negative association between smoking and AMH levels [16, 17].
In this study, low physical activity was associated with lower levels of AMH while with no significant relation. In line with our study, in the study conducted by M. Dólleman[18] et al. no significant relationship was found for physical activity in the final analysis. The same results were also reported in KaboodMehri et al. study[14].
Among the demographic indicators; in most studies, an inverse relationship between advanced age and AMH levels has been reported. In the present study, an inverse and significant correlation was found between age and AMH levels. Other socio-economic variables such as occupation, education and place of residence were not related to AMH levels in the present study. This finding has been repeated in most previous studies. Although, some studies have found a weak relationship between the AMH level and the socioeconomic level, which deserves future investigations using methodological studies through accurate and valid localized instruments to assess the socioeconomic level and by adjusting the effects of confounding variables.
Regarding reproductive factors; OCP consumption is one of the associated factors for AMH in the previous studies [15, 18–20]. However, in this study, we have not found a significant relation for OCP. Considering that the study population of these studies was poor-responder women and OCP use was rare among them, finding a relationship between OCP and AMH levels in terms of statistics and the number of OCP used cannot be indicative of previous studies.
Age at menarche, irregular cycle, menopause age and pregnancy loss are other reproductive factors associated with AMH levels in previous studies but not for all [21]. Given that poor-responder women of the present study to find out no significant association between these variables and AMH levels are reasonable.