Association Between Inflammatory Bowel Disease in Women and the Fertility Marker Anti-Müllerian Hormone

Inflammatory Bowel Disease (IBD) is an immune-mediated disorder characterized by chronic intestinal inflammation. IBD, along with its associated treatments, may have systemic effects including potential implications for female fertility. Anti-Müllerian hormone (AMH) levels are commonly used as a biomarker of ovarian reserve and fertility potential. However, the impact of IBD and its therapies on AMH levels remains unclear. This study aims to evaluate the association between IBD, AMH levels, and fertility.

This retrospective study analyzed electronic medical records from a multicenter academic institution from January 2017 to September 2024. Female patients with recorded AMH levels and a diagnosis of IBD were identified and compared to a control group without an IBD diagnosis. Baseline characteristics were compared between the two groups. Fisher's exact test was used for statistical analysis.

A total of 146 patients were included in the study, with 67 patients diagnosed with IBD and 79 control patients. Among patients with IBD, 7.5% (5/67) exhibited low AMH levels, whereas 12.7% (10/79) of non-IBD patients had low AMH levels (p=0.41). In multivariable logistic regression adjusting for age, ethnicity, body mass index, nicotine use, and hormonal therapy, IBD was not significantly associated with low AMH levels (OR 0.67, 95% CI 0.21-2.18, p=0.505). In age-stratified analyses using Fisher's exact test, IBD status was not significantly associated with low AMH levels in women under 35 (p=0.055) or those aged 35 and older (p=0.733). Additionally, we did not identify a significant association between low AMH levels and IBD subtype; p=1.00. No significant association was observed between low AMH levels and disease activity.

Our study did not identify a statistically significant association between IBD and low AMH levels. These findings should be interpreted cautiously due to the modest sample size, differences in hormonal therapy use, and a cohort in which most patients had mild or inactive disease. Future studies with larger sample sizes evaluating the impact of disease activity and treatment exposure on fertility outcomes in IBD patients are needed to provide additional guidance on early referral of these patients for fertility evaluation.