Anti-Mullerian hormone in the diagnosis of polycystic ovary syndrome: can morphologic description be replaced?

STUDY QUESTION: Can anti-Müllerian hormone (AMH) level replace the morphologic description in the diagnosis of polycystic ovary syndrome (PCOS) and what is the relationship between AMH and different diagnostic criteria of PCOS? SUMMARY ANSWER: AMH may be a good substitute for polycystic ovarian morphology (PCOM) in diagnosing PCOS. WHAT IS KNOWN ALREADY: AMH has been suggested as an alternative to antral follicle count (AFC) in diagnosing PCOS. Cut-off values for AMH studied so far show an acceptable specificity but a rather poor sensitivity, leaving up to one-third of PCOS women undiagnosed. STUDY DESIGN, SIZE, DURATION: We used data from a cross-sectional, case-control study on women with prior preterm birth and their controls, i.e. women with prior full-term birth. Among 262 women, 56 met the Rotterdam criteria (PCOS-R) and 44 the Androgen Excess-PCOS Society (PCOS-AES) criteria of PCOS. PARTICIPANTS/MATERIALS, SETTING, METHODS: Fasting blood samples were collected, a transvaginal ultrasound investigation and a clinical examination were performed. PCOS-R and PCOS-AES were re-diagnosed by replacing PCOM with AMH. Main outcome measures were the prevalence of PCOS, PCOM, hirsutism, oligoamenorrhoea and serum levels of AMH and androgens. MAIN RESULTS AND THE ROLE OF CHANCE: When replacing PCOM with AMH, the specificity and sensitivity for identifying PCOS were 97.1 and 94.6% according to the PCOS-R criteria and 97.2 and 95.5% according to the PCOS-AES criteria, respectively, at an AMH cut-off value of 20 pmol/l. LIMITATIONS, REASONS FOR CAUTION: The results need to be confirmed when international standards and methods for AMH measurements are established. WIDER IMPLICATIONS OF THE FINDINGS: AMH may be a good substitute for PCOM in diagnosing PCOS. STUDY FUNDING/COMPETING INTEREST(S): This study was financed by the Cooperative of Central Norway Regional Health Authority and Norwegian University of Science and Technology. The authors have no interests to disclose. TRIAL REGISTRATION NUMBER: This study is registered at www.clinicaltrials.gov as NCT01355536.

Does AMH Reflect Follicle Number Similarly in Women with and without PCOS?

CONTEXT: Increased Anti-Mullerian Hormone in polycystic ovary syndrome, may be due to overactive follicles rather than reflect antral follicle count. OBJECTIVE: Does Anti-Mullerian Hormone reflect antral follicle count similarly in women with or without polycystic ovary syndrome or polycystic ovarian morphology? DESIGN: Cross-sectional, case-control. SETTING: Women who delivered preterm in 1999-2006. For each index woman, a woman with a term delivery was identified. PATIENTS: Participation rate was 69%. Between 2006-2008, 262 women were included, and diagnosed to have polycystic ovary syndrome, polycystic ovarian morphology or to be normal controls. INTERVENTION(S): Blood tests, a clinical examination and vaginal ultrasound. MAIN OUTCOME MEASURE(S): Anti-Mullerian Hormone/antral follicle count-ratio, SHBG, androstenedione and insulin, to test potential influence on the Anti-Mullerian Hormone/antral follicle count -ratio. RESULTS: Mean Anti-Mullerian Hormone/antral follicle count ratio in women with polycystic ovary syndrome or polycystic ovarian morphology was similar to that of the controls (polycystic ovary syndrome: 1,2 p = 0,10 polycystic ovarian morphology: 1,2, p = 0,27 Controls 1,3). Anti-Mullerian Hormone showed a positive linear correlation to antral follicle count in all groups. Multivariate analysis did not change the results. CONCLUSIONS: We confirmed the positive correlation between AMH and follicle count. Anti-Mullerian Hormone seems to be a reliable predictor of antral follicle count, independent of polycystic ovary syndrome diagnosis or ovarian morphology.