Polycystic ovary syndrome (PCOS) is a common reproductive disorder characterized by elevated androgens and anti-Mullerian hormone (AMH). These hormones remain elevated throughout pregnancy, and potential effects of hormone exposure on offspring from women with PCOS remain largely unexplored. Expanding on recent reports of prenatal AMH exposure in mice, we have fully characterized the reproductive consequences of prenatal AMH (pAMH) exposure throughout the lifespan of first- and second-generation offspring of both sexes. We also sought to elucidate mechanisms underlying pAMH-induced reproductive effects. There is a known reciprocal relationship between AMH and androgens, and in PCOS and PCOS-like animal models, androgen feedback is dysregulated at the level the hypothalamus. Kisspeptin neurons express androgen receptors and play a critical role in sexual development and function. We therefore hypothesized that pAMH-induced reproductive phenotypes would be mediated by androgen signaling at the level of kisspeptin cells. We tested the pAMH model in kisspeptin-specific androgen receptor knockout (KARKO) mice and found that virtually all pAMH-induced phenotypes assayed are eliminated in KARKO offspring compared to littermate controls. By demonstrating the necessity of androgen receptor in kisspeptin cells to induce pAMH phenotypes, we have advanced understanding of the interactions between AMH and androgens in the context of prenatal exposure, which could have significant implications for children of women with PCOS.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility, classically presenting with disrupted ovulation, polycystic ovaries, and androgen excess, as well as many non-reproductive comorbidities. For instance, PCOS patients exhibit increased stress reactivity and higher rates of depression and anxiety compared to the general population. The prenatal anti-Mullerian hormone (pAMH)-induced model of PCOS was recently shown to recapitulate reproductive phenotypes in female mice, however little remains known about the consequences of pAMH exposure. We first aimed to expand upon this model by investigating pAMH-induced effects on offspring of both sexes. Pregnant dams on a C57Bl/6 background received daily i.p. injections of either AMH (0.12 mg/kg/d) or VEH late in gestation. Offspring were born into 4 groups (pAMH vs. VEH females, pAMH vs. VEH males) and assessed starting at weaning for changes in body weight, anogenital distance, pubertal onset, estrous cyclicity, fertility, and reproductive senescence. Statistical differences were determined by t-test or 2-way ANOVA when applicable, and significance set at p<0.05. As expected, pAMH increased anogenital distance in females but not males. Pubertal onset was delayed not only in females as previously reported, but also in males. Additionally, pAMH adult females showed significant disruptions in estrous cycling at P60 (increased time spent in diestrus, decreased number of cycles, increased cycle length), only mild disruptions by P90, then robust disruptions at 8 mo, 10 mo, and 12 mo of age that were distinct from reproductive senescence. When paired with wildtype untreated mates for a fertility assay starting at 3 mo of age, pAMH females had smaller and fewer number of litters, while pAMH males showed only delayed plugging behavior. Although pAMH males showed no difference in testis weight, pAMH females also had significantly reduced ovarian and uterine weights in diestrus. Interestingly, during the fertility assay, we found increased fetal death from both the pAMH females and males, even though pAMH males were paired with wildtype untreated females. We hypothesized that the increased fetal death could be the result of an pAMH-induced stress phenotype in both sexes. Using a simple stress response test measuring defecation and urination during exposure to a novel environment, we found that pAMH robustly increased stress response in both sexes at multiple timepoints. We also assessed glucocorticoid response to a restraint stress paradigm in adult females. While we observed no differences in baseline serum corticosterone levels, the pAMH group showed increased peak levels followed by a prolonged elevation levels after 2 hr. Together, these results enhance existing knowledge of the effects of pAMH exposure by demonstrating alterations in both male and female mice on both reproductive and non-reproductive measures.