Anti-Müllerian hormone (AMH) in the Diagnosis of Menstrual Disturbance Due to Polycystic Ovarian Syndrome.

Ali Abbara,Tom Kelsey,Sophie A Clarke,Artsiom Hramyka,Maria Phylactou,Sunitha Vimalesvaran,Lisa Owens,Geoffrey H Trew,Alexander N Comninos,Waljit S Dhillo,Rehan Salim,Tia Hunjan,Kate Purugganan,Rachel Roberts,George Christopoulos,Rumana Islam,Pei Chia Eng

doi:10.3389/fendo.2019.00656

Abstract

Introduction: Polycystic ovarian syndrome (PCOS) is a leading cause of female subfertility worldwide, however due to the heterogeneity of the disorder, the criteria for diagnosis remains subject to conjecture. In the present study, we evaluate the utility of serum Anti-Müllerian hormone (AMH) in the diagnosis of menstrual disturbance due to PCOS.Method: Menstrual cycle length, serum AMH, gonadotropin and sex-hormone levels, total antral follicle count (AFC), body mass index (BMI) and ovarian morphology on ultrasound were analyzed in a cohort of 187 non-obese women, aged 18–35 years, screened for participation in a clinical trial of fertility treatment between 2013 and 2016 at a tertiary reproductive endocrine center.Results: Serum AMH was higher in women with menstrual disturbance when compared to those with regular cycles (65.6 vs. 34.8 pmol/L; P < 0.0001). The odds of menstrual disturbance was increased 28.5-fold (95% CI 3.6–227.3) in women with serum AMH >60 pmol/L, in comparison to those with an AMH < 15 pmol/L. AMH better discriminated women with menstrual disturbance (area under ROC 0.77) from those with regular menstrual cycles than AFC (area under ROC 0.67), however the combination of the two markers increased discrimination than either measure alone (0.83; 95% CI 0.77–0.89). Serum AMH was higher in women with all three cardinal features of PCOS (menstrual disturbance, hyperandrogenism, polycystic ovarian morphology) when compared to women with none of these features (65.6 vs. 14.6 pmol/L; P < 0.0001). The odds of menstrual disturbance were increased by 10.7-fold (95% CI 2.4–47.1) in women with bilateral polycystic morphology ovaries than those with normal ovarian morphology. BMI was a stronger predictor of free androgen index (FAI) than either AMH or AFC.Conclusion: Serum AMH could serve as a useful biomarker to indicate the risk of menstrual disturbance due to PCOS. Women with higher AMH levels had increased rates of menstrual disturbance and an increased number of features of PCOS.

Highlights

Polycystic ovarian syndrome (PCOS) is a leading cause of female subfertility worldwide, due to the heterogeneity of the disorder, the criteria for diagnosis remains subject to conjecture
In addition to classification by follicle number per ovary (FNPO), morphological appearance was classified as being polycystic ovarian (PCO) morphology if follicles were peripherally distributed around a central stroma or multicystic ovarian (MCO) morphology if ovaries had an increased number of follicles that were uniformly distributed
Oligo/amenorrhea was present in one third of women; women with oligo/amenorrhea had higher body mass index (BMI) (25.0 vs. 23.3 kg/m2), Anti-Müllerian hormone (AMH) (65.6 vs. 34.8 pmol/L), antral follicle count (AFC) (38 vs. 29), and free androgen index (FAI) (3.0 vs. 2.1%) (Table 1)

Summary

Introduction

Polycystic ovarian syndrome (PCOS) is a leading cause of female subfertility worldwide, due to the heterogeneity of the disorder, the criteria for diagnosis remains subject to conjecture. The Rotterdam criteria is most widely-used for the diagnosis of PCOS, requiring the presence of two or more of the following features: oligo/amenorrhea, clinical or biochemical hyperandrogenism, and PCO morphology on ultrasound [6]. International guidelines have updated the criteria for diagnosis of PCOS [2]. The Rotterdam criteria defined PCO morphology by the presence of at least 12 FNPO, due to advances in ultrasound resolution these criteria have been revised to be at least 20 FNPO in the updated guidelines [2]

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Results

Conclusion