Effects of environmental, social and surgical factors on ovarian reserve: Implications for age-relative female fertility

Objective To investigate new risk factors for female fertility by analyzing the effects of environmental, social, and surgical factors on antral follicle counts (AFC) and anti-Mullerian hormone (AMH) levels. Methods A total of 1513 women aged 20-47 years who underwent in vitro fertilization/intracytoplasmic injection treatment in Southwest Hospital from December 2017 to December 2019 were included. Women were assessed for AFC and AMH levels, and completed a questionnaire. Ordinal logistic regression analyses with generalized linear mixed models were used to calculate the adjusted odds ratio (OR) for diminished ovarian reserve. Results Adnexal surgery was the only risk factor associated with low AFC in women aged 20-30 years. Younger age at menarche, alcohol drinking, and adnexal surgery are three independent risk factors for AMH decline in women aged 20-30 years. Intense exercise, sleep quality, and adnexal surgery are three independent risk factors for a low AFC in women aged 31-36 years. Alcohol drinking and adnexal surgery are two independent risk factors for AMH decline in women aged 31-36 years. Conclusion With age, female fertility becomes sensitive to high-intensity exercise and poor sleep quality. Adnexal surgery and alcohol drinking are two important risk factors for female fertility in women under age 37 years.