Research Article| Volume 92, P115-122, October 2016

Smoking, alcohol and caffeine in relation to two hormonal indicators of ovarian age during the reproductive years

  • J. Kline
    Corresponding author at: Department of Epidemiology, 722 West 168th Street, Room 1607, New York, NY 10032, USA.
    Department of Social Psychiatry and Imprints Center, New York State Psychiatric Institute, New York, NY 10032, USA

    Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA

    Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA
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  • A. Tang
    New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA
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  • B. Levin
    Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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      • Smoking is associated with increased follicle stimulating hormone (FSH) and unrelated to anti-Müllerian hormone (AMH).
      • This observation suggests that current smoking either impairs the development of antral follicles or dysregulates the hypothalamic–pituitary–ovarian axis.
      • The absence of an association with anti-Müllerian hormone argues against mechanisms related to accelerated follicle atresia.



      To examine whether or not cigarette smoking, alcohol and caffeine intake are related to two indicators of ovarian age–anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH).

      Study design

      Cross-sectional study of 477 women with a recent index spontaneous abortion (SA) (105 trisomic, 93 non-trisomic) or livebirth (LB) (279) with hormones measured on days 2–4 of an apparently normal menstrual cycle after the index pregnancy.


      Current smoking is associated with about a 15% increase in median FSH (β for ln(FSH) = 0.14, 95% CI 0.03,0.25). It is not significantly related to AMH (β for ln(AMH) = −0.25, 95% CI −0.56,0.06). Neither alcohol 2–7 days per week nor caffeine 122–<553 mg per day is independently related to AMH or FSH.


      The observation that current smoking is associated with FSH, but not with AMH, suggests that current smoking either impairs the development of antral follicles or dysregulates the hypothalamic–pituitary–ovarian axis. The absence of an association with AMH argues against mechanisms related to accelerated follicle atresia.


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