Age-specific reference ranges of serum anti-müllerian hormone in healthy women and its application in diagnosis of polycystic ovary syndrome: a population study.

OBJECTIVE: To establish the age-specific centiles of serum anti-müllerian hormone (AMH) levels in Chinese women, and to explore the use of multiples of median (MoM) AMH levels for the diagnosis of polycystic ovary syndrome (PCOS). DESIGN: An observational study. SETTING: University-affiliated hospitals and community clinics. POPULATION: We included 3137 healthy women aged 20-44 years recruited prospectively or who had archived serum samples from previous research projects. Another validation cohort of 751 women with PCOS as well as ovulatory controls, which was a convenient sample of women attending for infertility or menstrual disorders, was also studied. METHODS: The serum samples were assayed for AMH by the automated Access AMH assay. MAIN OUTCOME MEASURES: Age-specific reference ranges were constructed on the primary cohort with the Lambda-Mu-Sigma method. The MoM AMH of each subject in the validation cohort was calculated. RESULTS: Centile curves of serum AMH level against age were established. MoM AMH was significantly higher in women with PCOS than in controls (P < 0.05). The area under the ROC curve was 0.852 (95% confidence interval [CI] 0.825-0.877) (P < 0.0001) for discriminating women with PCOS from ovulatory controls by MoM AMH. CONCLUSIONS: We established a set of year-by-year age-specific reference ranges of serum AMH levels in Chinese women. The MoM AMH derived from this set of reference ranges is a promising tool to replace antral follicle count in the diagnosis of PCOS. TWEETABLE ABSTRACT: A set of age-specific reference ranges of AMH levels was established in Chinese women. Multiples of median AMH may be used to diagnose PCOS.

Current controversies with oral emergency contraception.

Emergency contraception (EC) is a method to be used in the case of unprotected sexual intercourse, failure of a regular contraceptive method, or after rape to try to prevent an unintended pregnancy. Oral EC remains surrounded by controversy, much due to myths and misconceptions among the public, policy makers and healthcare providers. This has resulted in restrictions on its availability in many parts of the world and restrictions on women's access to it. The aim of this article is to provide an evidence-based view on some of these common controversial issues surrounding oral EC in clinical practice. TWEETABLE ABSTRACT: Controversy about emergency contraception restricts access for women.