{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T14:43:11Z","timestamp":1773585791198,"version":"3.50.1"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged and repetitive exposure to stressors leads to detrimental effects on female reproductive health; this can consequently increase susceptibility to stress and elevate risk of adverse mental health outcomes. Since October 2019, Lebanon has been engulfed in a multipronged crisis, beginning with a severe economic collapse, which was further exacerbated by the COVID-19 pandemic, followed by the catastrophic Beirut Blast in August 2020. These compounding events caused considerable stress, resulting in a substantial mental health burden. We employed a retrospective approach to trace the trend in Anti-Mullerian Hormone levels (the most widely used measure of functional ovarian reserve) in a sample of reproductive-aged Lebanese women in a tertiary healthcare center in Beirut in light of the events described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective chart review was performed of women aged 18\u201340 with AMH levels tested between January 2018 and June 2023 [excluding the time period between February 2020 \u2013 December 2020] (n\u2009=\u2009563). Patients who had AMH levels between January 2018 \u2013 January 2020 were included in the \u2018pre-stressful events\u2019 group (n\u2009=\u2009254) while those tested between January 2021 \u2013 June 2023 were in the \u2018post-stressful events\u2019 group (n\u2009=\u2009283). Patient\u2019s age, BMI, obstetrical and gynecological history, AMH level, and other relevant lab values were collected. Results were compared using the independent t-test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, this study demonstrated a lower mean AMH level in the post-stressful events group as compared to the pre-stressful events group, but this difference was not statistically significant. Patients with PCOS had a significant decline in the mean AMH level, as did patients with primary infertility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women with pre-existing reproductive health disorders, such as PCOS and infertility, are more vulnerable to stress and are more likely to experience a decline in AMH level and, by extension, ovarian reserve following stressful experiences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336016","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T18:35:16Z","timestamp":1762454116000},"page":"e0336016","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The effect of environmental stressors on anti-mullerian hormone levels in Lebanese women: a retrospective study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6030-4564","authenticated-orcid":true,"given":"Sima Fatima","family":"Sharafeddin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6072-2299","authenticated-orcid":true,"given":"Zeina","family":"Chehade","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samya El","family":"Sayed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dima","family":"Salloum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara","family":"Nahouli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoine","family":"Hannoun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4902-6124","authenticated-orcid":true,"given":"Ghina","family":"Ghazeeri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"issue":"7","key":"pone.0336016.ref001","doi-asserted-by":"crossref","first-page":"527","DOI":"10.5603\/GP.2016.0038","article-title":"Psychosocial aspects of infertility and its treatment","volume":"87","author":"A Malina","year":"2016","journal-title":"Ginekol Pol"},{"key":"pone.0336016.ref002","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.clinbiochem.2018.03.012","article-title":"Fertility and infertility: Definition and epidemiology","volume":"62","author":"M Vander Borght","year":"2018","journal-title":"Clin Biochem"},{"issue":"11","key":"pone.0336016.ref003","doi-asserted-by":"crossref","first-page":"3361","DOI":"10.1210\/clinem\/dgaa513","article-title":"Anti-m\u00fcllerian hormone and ovarian reserve: Update on assessing ovarian function","volume":"105","author":"LME Moolhuijsen","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"pone.0336016.ref004","doi-asserted-by":"crossref","first-page":"95","DOI":"10.14310\/horm.2002.1299","article-title":"The clinical significance of anti-M\u00fcllerian hormone evaluation in gynecological endocrinology","volume":"10","author":"A Karkanaki","year":"2011","journal-title":"Hormones (Athens)"},{"issue":"1","key":"pone.0336016.ref005","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/s12905-022-01782-2","article-title":"Serum anti-M\u00fcllerian hormone as a predictor of polycystic ovarian syndrome among women of reproductive age","volume":"22","author":"MS Butt","year":"2022","journal-title":"BMC Womens Health"},{"issue":"6","key":"pone.0336016.ref006","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1038\/nrendo.2011.224","article-title":"Anti-M\u00fcllerian hormone: an ovarian reserve marker in primary ovarian insufficiency","volume":"8","author":"JA Visser","year":"2012","journal-title":"Nat Rev Endocrinol"},{"issue":"4","key":"pone.0336016.ref007","article-title":"ACOG Committee Opinion No. 773: The Use of Antim\u00fcllerian Hormone in Women Not Seeking Fertility Care","volume":"133","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"2","key":"pone.0336016.ref008","doi-asserted-by":"crossref","first-page":"50","DOI":"10.5653\/cerm.2019.46.2.50","article-title":"Clinical application of serum anti-M\u00fcllerian hormone in women","volume":"46","author":"SR Oh","year":"2019","journal-title":"Clin Exp Reprod Med"},{"key":"pone.0336016.ref009","unstructured":"World Bank Group. 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