Links between age at menarche, antral follicle count, and body mass index in African American and European American women

Earlier age of menarche is associated with both higher BMI and higher antral follicle counts in adulthood in both African American and European American women.

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Volume 111, Issue 1, Pages 122–131


Sonya M. Schuh, Ph.D., Julia Kadie, Mitchell P. Rosen, M.D., Barbara Sternfeld, Ph.D., Renee A. Reijo Pera, Ph.D., Marcelle I. Cedars, M.D.



To examine the relationships between age at menarche, antral follicle count (AFC), and body mass index (BMI) in a multi-ethnic population of women.


Community-based, cross-sectional study.


Academic setting.


A total of 245 African American women and 273 European American women, aged 25–45 years, with regular menstrual cycles and no reproductive disorders. The ethnicity of these women was self-reported and genetically validated.


The AFCs were measured by transvaginal ultrasound during the early follicular phase. Anthropometric measurements were taken, and age at menarche was gathered by questionnaire.

Main Outcome Measure(s)

Determination of the associations between age of menarche and adult AFC and BMI.


Earlier age of menarche was associated with both higher BMIs and higher AFCs in adulthood, with control for female age. The antral follicle difference between early (<12 years) vs. late (≥15 years) initiation of menarche in both white and black women was +3.81 and +3.34 follicles, respectively, which is equivalent to an approximately 20% difference in AFC.


This study provides the first evidence that timing of menarche may influence AFC. Because of limited studies on African American women, this work provides additional needed data and may enhance our ability to prospectively screen and better treat various diseases associated with the female reproductive lifespan.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.