Characteristics of studies included in the meta-analysis 1

(1)

Supplemental Digital Content 1 - Characteristics of studies included in the meta-analysis

¹

Author, year Country Design Sample size Age BMI (kg/m²)

Obesity definition (BMI, kg/m²)

Ovarian reserve markers

Findings Correlation Coefficients

Studies on AMH (ng/ml or otherwise stated)

Pigny et al.,

2003 France Case-control

104 (59 PCOS + 45 infertile controls)

PCOS: 27.4 Control: 28.3

PCOS: 26.7 (18.7-37.7)² Control: 23.1 (19.2-31.2)²

>25

PCOS: 47.1 (24.4- 85)² Control: 20.8 (3.6- 37.2) pmol/l

AMH was lower in obese than in non-obese controls (15.2 ± 9.3 vs. 22 ± 12.7 pmol/l; p= 0.07).

AMH was significantly correlated with BMI in controls (p=0.048).

PCOS: -0.061³ Control: -0.280³

Nardo et al.,

2007 UK Cross-

sectional

136 infertile

women 33 24 ( 29-35)⁴ - 2 ( 1.1-3.5) ⁴

No significant correlation between AMH and BMI (p=0.88)

-0.01³

Chen et al.,

2008 Taiwan Cross-

sectional

99 women

with PCOS 26 23.1 ( 27.6-

37.1) ⁵ -

94.7 (34.5- 237.6) ⁵ pmol/l

Negative correlation between BMI and AMH (p=0.035).

-0.213

Piouka et al.,

2009 Greece Case-control

200 Women with PCOS (100 obese) +50 healthy women (25 obese)

25

PCOS NW:

22.1 ± 1.8 PCOS obese : 30.75 ± 4.6 Control NW:

22.4 ± 1.5 Control obese:

30.4 ± 4.6

≥25

PCOS NW:

6.53± 4.7 PCOS obese : 4.48 ± 2.92 Control NW:

2.4 ± 0.3

AMH was significantly lower in obese compared with NW women (p<0.001).

AMH and BMI were negatively correlated (p<0.001).

-0.310 ³

Steiner et al.,

2010 USA Exploratory 20 women (10

obese) 29

NW: 21.9 ± 1.6 Obese: 37.3 ± 6

>30

NW: 4.4 ± 1.8 Obese: 2.9

±2.1

AMH was significantly lower in obese than in NW women (p<0.05).

-

Dafopoulos et

al., 2010 Greece Cross-

sectional 137 women 31.7 22.6 ± 2.45 - 2.07 ± 1.14

AMH and BMI were negatively correlated (p<0.05)

-0.345 Park et al.,

2010 Korea Cross-

sectional 120 women 37.2 22.1 ± 2.87 - 1.38 ± 0.98 AMH and BMI were not

correlated (not significant) -0.087 Halawaty et

al., 2010 Egypt Cross- sectional

100 women (50 obese)

Non-obese:

46.1 Obese: 46.2

Non-obese:

25.6 ± 1.36 Obese: 32.9 ± 1.32

≥30

Non-obese:

3.39 ± 0.24 Obese: 2.55 ± 0.81

No significant different was observed between the two groups.

- Lambert-

Messerlian, 2011

USA Cross-

sectional

322 women (86.3% regular menstruatio)

29.4 33.6 ± 8.2 - 2.1 ± 2 AMH and BMI were

negatively correlated. -0.18³

(2)

Buyuk et al.,

2011 USA Cross-

sectional

290 women with infertility (138 NOR)

NOR: 37.1 NOR: 27.3 ±

5.9 ≥25 2 ± 2

Obese NOR women had similar mean AMH compared to NW women (2 ± 2.4 vs. 1.8 ± 1.5).

No significant correlation between BMI and AMH in NOR women was observe.

-0.15³

Sahmay et al.,

2011 Turkey Cross-

sectional

332 women (107 women with PCOS (51 obese) + 225 non- PCOS infertile women (121 obese))

Non-obese PCOS: 28.7 PCOS obese:

29.5 Non-PCOS non-obese:

32.3 Non-PCOS obese : 33.4

- ≥25

Non-obese PCOS: 6.85 ± 2.95 Obese PCOS:

6.66 ± 3.18 Non-PCOS non-obese:

2.27 ± 1.12 Non-PCOS obese: 2.28 ± 1.49

AMH was not significantly different between two groups of BMI in both with and without PCOS women.

BMI and AMH were not significantly correlated in total participants (n=322).

-0.0084

Shaw et al.,

2011 USA Cross-

sectional

135 women ( 82 with BMI < 25, 32 with BMI: 25- 30, and 21 with BMI ≥ 30)

41 25 ± 5.15 ≥25

NW: 4.36 (3.5, 5.21)⁵ OW: 4.14 ( 1.21, 7.07) Obese: 4.57 ( 3.43, 5.64) pmol/l

AMH was similar between

BMI groups. -

Lin et al.,

2011 Taiwan Prospective

290 infertile women ( 126 with PCOS and 164 without PCOS)

27.7 25.3 ± 6.6 - 7.9 ± 5.3

AMH and BMI were negatively correlated (p=0.004).

-0.166

Li et al., 2012 China Case-control

131 women with PCOS (62 HA+ and 69 HA-) and 61 infertile women

HA+: 29.9 HA- : 29.22 Control: 30.1

HA+: 20.1 ± 5.76

HA- : 23.35 ± 5.22

Control: 20.52

± 1.58

-

HA+: 8.4 ± 4.57 HA- : 5.81 ± 3.85 Control: 3.74

± 2.25

In HA -, AMH and BMI positively correlated (p<0.05).

0.26

La Marca et

al., 2012 Italy Cross-

sectional 416 women 34 NS - 3.45 (1.64-

5.64)⁴

AMH and BMI was negatively correlated (p=

0.03).

-0.1

Caglar et al.,

2013 Turkey Prospective

55 normal weight women ( 34

26 PCOS:

22.1±1.9 - PCOS: 4.7

(1.9-26.1)⁶

AMH and BMI were not

correlated (p=0.235). PCOS: -0.163

(3)

PCOS and 21 non-PCOS )

Non-PCOS:

22 ± 1.1

Non-PCOS:

3.4(1.4-7)

Cui et al., 2014 China Retrospective

1896 infertile and 304 women with PCOS

Infertile: 38.2 PCOS: 28.75

Infertile:22.68

± 3.19 PCOS: 24 ± 3.95

-

Infertile:2.67

± 2.52 PCOS: 5.44 ± 4.1

AMH and BMI were negatively correlated in both groups of women infertile: p=0.006, PCOS:

P=0.01) .

infertile : -0.064 PCOS: -0.148

Tehrani et al.,

2014 Iran Cross-

sectional 1015 36.7 27 ± 4.6 - -

AMH and BMI were negatively correlated (p<0.001)

-0.15³

Moy et al.,

2015 USA Cross-

sectional

350 infertile women ( 99 AA, 159 C, 58 H, and 34 A)

16-46 yr

AA: 30.7 ± 6.8 C: 25.9 ± 6 H: 28.1± 5.9 A: 22.9 ± 4.4

-

AA: 1.9 (1.3- 2.4)⁷ C: 2.4 (1.8-3) H: 1.5 (1.1-2) A: 3.2 (0.9- 5.4)

AMH and BMI were negatively correlated in group C (P=0.002).

C: -0.24

Bakas et al.,

2015 Greece Retrospective 195 infertile

women 35.6 23.67 ± 3.74 - 2.24 ± 1.54

AMH was not significantly correlated with BMI (P=0.82).

0.01 ³

Yang et al.,

2015 Taiwan Cross-

sectional

156 women with PCOS (50 obese) + 30 healthy non-obese

Non-obese PCOS: 24 obese PCOS:

25

Healthy non- obese: 26

Non-obese PCOS:

21.6(19.7- 23.4)⁴ obese PCOS:

31 ( 29.3-35.1) 50

Healthy non- obese: 20.1 (18.6-21.3)

≥27

Non-obese PCOS: 64 (43-83)⁴ obese PCOS:

37 (19-56) 50 Health non- obese: 20 (14- 26)pmol/l

AMH was significantly lower in obese PCOS women compared to non- obese PCOS

(p<0.0001).

AMH and BMI were negatively correlated in PCOS women (p<0.0001).

PCOS :-0.392 ³

Olszanecka- Glinianowicz et al., 2015

Poland Cross- sectional

87 women with PCOS (48 obese) 67 healthy non-PCOS ( 36 obese)

NW PCOS:

23.7

Obese PCOS:

27.9 NW non- PCOS: 23.8 Obese non- PCOS: 27.3

NW PCOS:

21.3±2.2 Obese PCOS:

36.1±6.3 NW non- PCOS: 22.2±2 Obese non- PCOS:

33.4±5.4

≥30

NW PCOS:

7±4 NW non- PCOS:

5.1±2.4 Obese non- PCOS:

3.9±2.3

AMH were significantly higher in both PCOS and non-PCOS obese than in NW groups (p<0.05).

AMH and BMI were negatively correlated in all study groups (p=0.001).

r: -0.30

Kriseman et

al., 2015 USA Cross-

sectional

489 infertile women (104 PCOS)

PCOS: 31 Non-PCOS:

35.2

PCOS: 29.9 ± 8.4

Non-PCOS:

25.9 ± 5.5

≥25

PCOS: 7.6 ± 9.5 Non-PCOS:

1.7 ± 2.3

In the PCOS women, AMH was significantly higher in the group of BMI

≤ 25 (10.9 ± 13.4 ng/ml) compared with BMI

Total: -0.04³ PCOS: -0.29 ³

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categories of 25-29.9 (6.4

± 3.8), 30-34 (5.2 ± 5.7), and BMI ≥ 35 (5.9 ± 7.5).

No significant correlation was observed between AMH and BMI in all study participants.

AMH was negatively correlated with BMI in PCOS women (P=0.002).

Lambert- Messerlian et al., 2016

Island Prospective 45 women (22

obese) 33.7 24.6 ± 2.9 ≥25

Total: 1.69 (0.29-12.7)⁸ BMI<25: 2.24 (0.4-5.1) BMI ≥ 25:

1.69 (0.29- 12.7)

AMH was not significantly different between the two BMI groups.

-

Al_Safi et al.,

2016 Colorado Interventional 12 NW and 15 obese

NW: 28.4 Obese: 34.8

NW: 21.8 ± 1.73 Obese: 37.8±

5.81

≥30

NW: 5.3 ± 3.12 Obese: 4.2 ± 2.71

AMH was not significantly different between the two BMI groups.

-

Cui et al., 2016 China Cross- sectional

5240 Chinese women with infertility

(21-64 yrs) - - - AMH and BMI negatively

correlated (p<0.01). -0.18

Studies on FSH (mIU/ml or otherwise stated)

Kiddy et al.,

1990 UK Cross-

sectional

263 women with PCOS (91 obese)

NS

Obese:

30.3±4.2 Non-obese:

21±1.8

>25

Obese:

4.4±1.9 Non-obese:

4.2±1.9

FSH was not significantly different between obese and non-obese groups.

-

Dale et al.,

1992 Norway Case-control

49 women with PCOS ( 30 obese) +14 control ( 7 obese)

PCOS-obese:

29 PCOS non- obese: 29 Control: 31

PCOS-obese:

30.5 ± 0.7 PCOS non- obese:

21.4±0.5 Control-obese:

28 ± 0.8 Control-non- obese: 22±0.9

>25

PCOS-obese:

4.6 ± 1.1 PCOS non- obese:

5.2±1.74 Control- obese: 6.4 ± 1.06 Control-non- obese:

6.7±3.17

FSH was not significantly different according to BMI in both groups of PCOS and control.

-

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De Pergola et

al., 1992 Italy Case-control

10 obese and 10 NW women

Obese: 33.4 NW: 31.8

Obese:

41.4±11.4 NW: 23±2.35

≥30

Obese: 5.9 ± 1.86 NW: 5.14 ± 0.81 ng/ml

FSH was not significantly different between obese and NW women (p=0.254).

BMI and FSH was not correlated significantly in obese women.

obese:-0.136

Turcato et al.,

1997 Italy Interventional 26

premenopausa l women

33.7 38.3±6.4 - 6.2±3.8 ng/ml No significant correlation

between BMI and FSH -0.26

Pigny et al.,

2000 France Prospective

41 women with PCOS (20 had BMI≤27) and 24 healthy

PCOS: 25 Control:17

PCOS with BMI ≤27:

22±2.5 PCOS with BMI >27:

31±2.3 Control:

21±2.5

≥27

PCOS with BMI ≤27:

5.7±1.5 PCOS with BMI >27:

5.4±1.5 Control:

6.8±3.6

FSH was not significantly different according to BMI in PCOS group.

-

Ng et al., 2005 Hong

Kong Case-control

107 fertile control and 32 PCOS (11 obese)

Control:36 PCOS: 31

Control: 21.95 (16.34-36.84)⁸ PCOS non- obese: 21 (18.52-24.30) PCOS-obese:

32 (28-37)

≥25

Control: 6.2 (1-13.7)⁸ PCOS-obese:

5.2 (3.3-8.1) PCOS-non- obese: 5.1 (1- 9) IU/l

FSH was not significantly different according to BMI in PCOS women.

No significant correlation was observed between BMI and AFC in PCOS women.

PCOS=-0.072

Balen et al., 2006

Belgium, Denmark, Sweden, and UK

Cross- sectional

335 women with infertility (177 with BMI <25; 93 with BMI 25.1-30

29

BMI<25:

21.6±2 BMI 25.1-30:

27.6±1.5 BMI >30:

32.3±1.9

≥25

BMI<25:

5.6±2.4 BMI 25.1-30:

5.2±2.4 BMI >30:

4.8±1.92 IU/l

FSH was not significantly different between the BMI groups.

-

Piouka et al.,

200 Women with PCOS (100 obese) + 50 healthy women (25 obese)

23.9-27.3

PCOS NW:

30.4 ± 4.6

≥25

PCOS NW:

6.15± 1.73 PCOS obese : 5.52 ± 1.62 Control NW:

6.6 ± 2.7 mIU/ml

FSH was significantly lower in obese/overweight compared with NW women.

-

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Dafopoulos et

al., 2010 Greece Cross- sectional

137 women (43% were smoker)

31.7 22.6 ± 2.45 - 8.67±6.88

IU/l

BMI had no significant

correlation with FSH. -0.127

Halawaty et

Non-obese:

46.1 Obese: 46.2

Non-obese:

25.6 ± 1.36 Obese: 32.9 ± 1.32

≥30

Non-obese:

13.1 ± 2.1 Obese: 12.2 ± 4.8 IU/L

No significant difference was observed between the two groups.

-

Zhang et al.,

2010 China Retrospective

2628 infertile women with PCOS ( NW:222, OW: 379, obese: 27)

NW: 31.5 OW: 32.6 Obese: 30.9

NW: 22.03

±1.3 OW:

26.56±1.23 Obese:

31.21±1.33

≥25

NW: 6.7±2.65 OW:

6.54±2.04 Obese:

6.37±1.60 IU/l

No significant differences were observed in FSH between the three groups.

-

Gorar et al.,

2010 Turkey Case-control

24 women with PCOS (9 obese) +13 control with BMI<25

PCOS:20 Control:26

Non-obese PCOS :20.9 (2.5)⁴ Obese PCOS:

30.9 (5.75) Control: 21.30 (2.5)

≥25

Non-obese PCOS:

5.55±1.59 Control:

6.09±2.40

FSH was not significantly different between the two BMI groups of PCOS.

-

Sahmay et al.,

2011 Turkey Cross-

sectional

332 women (107 women with PCOS (51 obese) + 225 non- PCOS infertile women(121 obese )

Non-obese PCOS: 28.7 Obese PCOS:

29.5 Non-obese non-PCOS:

32.3 Obese Non- PCOS: 33.4

- ≥25

Non-obese PCOS: 5.36 ± 1.27 Obese PCOS:

5.07 ± 1.55 Non-obese non-PCOS:

6.47± 2.33 Obese Non- PCOS BMI:

6.55 ± 2.2

FSH was not significantly different between two groups of BMI in both with and without PCOS women.

BMI and FSH was not significantly correlated in total participants (n=322).

0.193

Su et al., 2011 Taiwan Case-control

266 women with PCOS (113 overweight/ob ese) +107 controls (21 OW/obese)

PCOS: 26.2

Control: 29.5 - ≥25

Obese PCOS with BMI ≥ 25: 5.96±1.73 Non-obese PCOS:

6.15±1.72 Obese Control:

6.54±1.85 Non-obese control:

6.94±2.29 mIU/ml

FSH was not significantly different according to the BMI in both PCOS and control groups.

BMI was not significantly correlated with FSH in PCOS and control.

PCOS: -0.061³ control: -0.16³

(7)

Katsikis et al.,

2011 Greece Controlled

clinical study

936 PCOS (729 classic + 207 new) + 204 healthy controls

Classic: 23.3 New:25.1 Controls:31

Classic:

26.7±6.8 New:

26.3±6.9 Controls:

25.7±6.6

≥25

Classic:

5.7±1.7 New:

6.1±1.9 Controls:

7.1±2.4 IU/l

In newer PCOS women, FSH was significantly lower in OW/obese women than in NW (5.6±1.7 vs. 6.5±2;

p≤0.0016).

In classic PCOS women and controls, FSH were not between obese and non-obese women.

-

Tsai et al.,

2013 Taiwan Case-control

45 women PCOS (24 with BMI ≥22 and 21 with BMI<22) and 161 infertile control ( 49 with BMI ≥22 and 112 with BMI <22)

25-43

PCOS women with BMI ≥22:

26±4 PCOS women with BMI <22:

19.6±1.2 Non-PCOS with BMI ≥22:

24.4±3.1 Non-PCOS with BMI <22:

19.9±1.3

-

PCOS women with BMI

≥22: 6.7±1.9 PCOS women with BMI

<22: 6.9±1.7 Non-PCOS with BMI

≥22: 6.9±1.9 Non-PCOS with BMI

<22: 7.8±2.8 mIU/ml

Mean FSH was

significantly lower in non- PCOS with BMI ≥ 22 than in non-PCOS with BMI

<22 (P<0.05).

FSH was significantly correlated with BMI in non-PCOS group (P<0.01).

PCOS= -0.03 Infertile= -0.21

Malhotra et al.,

2013 India Prospective

183 infertile ( 93 with BMI:18.5- 24.9, 69 with BMI 25-29.9, and 21 BMI≥30)

32.13 25.35±3.92 ≥25

NW: 5.9±1.85 OW: 6.3±2.48 Obese:

6.4±2.01

No significant differences were observed between the groups.

-

Bakas et al.,

2015 Greece Retrospective 195 infertile

women 35.6 23.67 ± 3.74 - 7.06 ± 1.84

IU/L

FSH was not significantly correlated with BMI (p=0.48).

0.05³

Yang et al.,

2015 Taiwan Cross-

sectional

156 women with PCOS (106 non- obese and 50 obese) + 30 healthy non- obese

Non-obese PCOS: 24 obese PCOS:

50 Health non- obese: 26

Non-obese PCOS:

21.6(19.7- 23.4)5 obese PCOS:

31 ( 29.3-35.1) 50

Health non- obese: 20.1 (18.6-21.3)

≥27

Non-obese PCOS: 6.57 (5.55-7.55)⁵ obese PCOS:

5.65 ( 5.05- 6.11) 50 Health non- obese: 7.15 (6.10-8.10)

FSH was significantly lower in obese PCOS women than in non-obese PCOS (P<0.0001)

-

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Olszanecka- Glinianowicz et al., 2015

Poland Cross- sectional

87 women with PCOS (48 obese)+

67 healthy non-PCOS ( 36 obese)

NW PCOS:

23.7

Obese PCOS:

27.9 NW non- PCOS: 23.8 Obese non- PCOS: 27.3

NW PCOS:

33.4±5.4

≥30

NW PCOS:

8.6±11.3 mIU/ml

FSH was not significantly different according to the BMI in both PCOS and

non-PCOS. -

Chen et al.,

2015 China Case-control

785 PCOS + 297 age-matched non-PCOS

20-35

PCOS with BMI≥23:27.46

±4.39 PCOS with 18.5<BMI<23:

20.79±1.24 PCOS with BMI<18.5:

17.54±0.87 Non-PCOS with

BMI≥23:25.86

±2.66 PCOS with 18.5<BMI<23:

20.73±1.23 PCOS with BMI<18.5:

17.67±0.95

≥23

PCOS with BMI≥23:5.74

±2.8 PCOS with 18.5<BMI<23 : 6.19±2.79 PCOS with BMI<18.5:

6.4±4.29 Non-PCOS with BMI≥23:6.4±

2.47 Non-PCOS with

18.5<BMI<23 : 6.44±2.06 Non-PCOS with BMI<18.5:

6.5±1.46

Mean FSH was significantly lower in PCOS women with BMI≥23 than in PCOS women with

18.5<BMI<23.

-

Aladashvili- Chikvaidze et al., 2015

Tbilisi

Prospective cross- sectional

103 women with different reproductive problems (48 with BMI

<18.5 and 55 with BMI≥25)

Underweight:

20.1 OW/obese:

20.9

- -

In all study population, BMI and FSH were correlated negatively (p=0.009).

-0.3

Nambiar et al.,

2016 India Case-control

282 women with PCOS ( 162 obese) + 200 control (60 obese)

PCOS: 28.64 Control:

31.11

Lean PCOS:

22.15± 1.64 Obese PCOS:

27.32 ± 1.64 Lean control:

21.83 ± 1.77

>25

Lean PCOS:

6.26± 2.59 Obese PCOS:

6.11 ±2.17 Lean control:

6.31 ± 1.75

FSH was not different between lean and obese women in both groups of PCOS and control.

-

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Obese control:

27.36±1.55

Obese control:

6.33±1.74

Al_Safi et al.,

NW: 28.4 Obese: 34.8

NW: 21.8 ± 1.73 Obese: 37.8±

5.81

≥30

NW: 4.8 ± 1.04 Obese: 4.4 ± 1.55

FSH was not significantly different between the two BMI groups.

-

Kumar et al.,

2016 Indian Cross-

sectional

80 PCOS + 80 control

PCOS: 25.6 PCOS: 27

- PCOS:

4.2±1.6

FSH was negatively correlated with BMI in PCOS women (p=0.01)

-0.207

Studies on AFC

Ng et al., 2005 Hong

Kong Case-control

107 fertile control and 32 PCOS

Control:36 PCOS: 31

Control: 21.95(

16.3-36.8)⁸ PCOS: 23 (18.52-36.14)

≥25

Control: 12(2- 20)^8,9 PCOS:

38.5(18-75)

AFC was not significantly different according to BMI status (non-obese (n=21):

43.5 (22-75)⁹ vs. obese (n=11): 36 (18-72)⁹; p=0.412) in PCOS women.

No significant correlation was observed between BMI and AFC in PCOS women.

PCOS=-0.08

Balen et al., 2006

Belgium, Denmark, Sweden, and UK

Cross- sectional

335 women with PCOS (93 OW, and 65 obese)

29

NW: 21.6 ± 2 OW: 27.6 ± 1.5 Obese: 32.3 ± 1.9

≥25

NW: 18.7 ± 15.8⁹ OW: 19.2 ± 14

Obese: 24.3

±16.6

AFC was significantly higher in obese and overweight women compared to NW.

-

Nardo et al.,

2007 UK Cross-

sectional

136 infertile

women 33 24 ( 29-35)⁴ - 10 (7-15) ^4,9

No significant correlation between AFC and BMI (p=0.48)

-0.06 ³ Chen et al.,

2008 Taiwan Cross-

sectional

99 women

with PCOS 26 23.05 ( 27.6-

37.11) ⁵ - 24.5 ( 12-

47.5) ⁵

No significant correlation

between BMI and AFC 0.123

Piouka et al.,

200 Women with PCOS (100 obese and

overweight)+

50 healthy women (25 obese and overweight)

Mean age range : 23.9- 27.3

PCOS NW:

30.4 ± 4.6

≥25

PCOS NW:

23.7± 8.68⁹ PCOS obese : 23.7 ± 6.96¹⁰ Control NW:

13.9 ± 3.9

- -

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Halawaty et

Non-obese:

46.1 Obese: 46.2

Non-obese:

25.6 ± 1.36 Obese: 32.9 ± 1.32

≥30

Non-obese:

5 ± 0.31 Obese: 4.36 ± 0.11

No significant difference was observed between the two groups.

-

Katsikis et al.,

2011 Greece controlled

clinical study

936 PCOS (729 classic + 207 new) and 204 healthy controls

Classic: 23.3 New: 25.1 Control: 31.3

NW classic:

21.6 ± 2 OW/obese classic:

32.3±5.8 NW new: 21.9

± 1.9 OW/obese new: 32.3 ± 6.5 NW control:

21.8 ± 2 OW/obese:

31.7 ± 6.6

≥25

NW classic:

21.5 ± 9.3⁹ OW/obese classic:

22.6±10.1 NW new: 24.7

± 8.8 OW/obese new: 24 ± 8.4 NW control:

12.4 ± 3.7 OW/obese:

13.1 ± 3.7

No significant differences were observed in AFC between groups of BMI.

-

Malhotra et al.,

183 infertile ( 93 with BMI:18.5- 24.9, 69 with BMI 25-29.9, and 21 BMI≥30)

32.13 25.35±3.92 ≥25

NW AFC right ovary: 7

± 2.64 OW AFC right ovary:

6±2.46 Obese AFC right: 5±2.66 NW AFC left ovary: 6 ± 2.37 OW AFC right ovary:

6±2.45 Obese AFC right: 5±2.36

OW and obese women had significantly higher AFC on the right ovary but no significant differences were observed in mean AFC when AFC on both sides were taken together.

-

Ngala et al.,

2015 Ghana Cross-

sectional

104 infertile

women 36.3 27± 3.37 - 13.63± 8.46

AFC and BMI was positively correlated (p<0.0001).

0.50

Yang et al.,

2015 Taiwan Cross-

sectional

75 women with PCOS (21 obese) +12 healthy non-obese

- - ≥27

Non-obese PCOS: 54 (37-67)^4,9 obese PCOS:

51 ( 30-60) Health non-

obese: 10 (8- 15)

AFC was not significantly different between the two groups of PCOS.

AFC and BMI were negatively correlated in PCOS women.

PCOS :-0.177 ³

(11)

Studies on Inhibin β (pg/ml)

Pigny et al.,

2000 France Prospective

41 women with PCOS (20 had BMI≤27) + 24 healthy

PCOS: 25 Control:17

PCOS= 27.3±5 Control:

21±2.5

≥27

PCOS=110.5±

51.5 Control = 108±47.5

PCOS women with BMI

>27 had significantly lower Inhibin B than those PCOS women with BMI

≤27 (92±40.2 vs. 144±53.5 pg/ml; p<0.01).

BMI had negative correlation with Inhibin B in PCOS women (p<0.01)

PCOS= -0.47 ³

Tinkanen et al.,

2001 Finland Cross-

sectional

74 infertile

women 32 22.9 ±4.2 - 97.8 ± 46

BMI and Inhibin B were negatively correlated (p=0.02).

-0.264³

Malhotra et al.,

183 infertile (69 with BMI 25-29.9, and 21 BMI≥30)

32.13 25.35±3.92 ≥25

NW:

36.2(2.45-99)⁸ OW: 31.4(5.2- 91.3) Obese:

20.8(10.3- 46.3)

OW and obese women had significantly lower Inhibin B compared to NW (p<0.0259).

-

Al-Safi et al.,

NW: 28.4 Obese: 34.8

NW: 21.8 ± 1.73 Obese: 37.8±

5.81

≥30

NW: 61.3 ± 18.59 Obese: 78.6 ± 24.94

Inhibin B was significantly lower in obese than in normal weight women (p=0.0495)

-

1 Data are mean/median ± SDs or otherwise stated.²Mean (90%CI).³ Spearman r. ⁴Median (Interquartile range).⁵ Median (95%CI).⁶Median (min, max). ⁷Mean (95% CI).

8 Median (range).⁹Total antral follicular count.

A, Afro-Caribbean; AFC, Antral Follicular Count; E, European; HA, Hyperandrogenism; NOR, normal ovarian reserve; ME, Middle Eastern ; NW, Normal weight; OW, overweight ; PCOS, Polycystic ovary syndrome; SA, South Asia; SEA, South East Asia.