Salivary and serum androgens with anti-M\xfcllerian hormone measurement for the diagnosis of polycystic ovary syndrome

Thozhukat Sathyapalan,Brian Keevil,Soha R Dargham,Eric S Kilpatrick,Ahmed Al-Qaissi,Stephen L Atkin

doi:10.1038/s41598-018-22176-1

Abstract

To determine the predictive value of a raised androgen level with an elevated anti-Müllerian hormone (AMH) for the diagnosis or exclusion of polycystic ovary syndrome (PCOS), a prospective cross-sectional study of 170 women (105 with PCOS type A and 65 normal) was undertaken. AMH was combined with one of, total serum testosterone (T); calculated free androgen index; salivary testosterone (salT); serum androstenedione (A); salivary androstenedione (salA). The diagnostic sensitivity and specificity of AMH (>35 pmol/l) alone for PCOS were 55% and 79% respectively. The diagnostic sensitivity and specificity of AMH (>35 pmol/l) with either an elevated T or raised FAI level for PCOS showed 100% specificity and a 100% positive predictive value. Conversely, diagnostic exclusion of PCOS was shown by an AMH <35 pmol/l with a normal T or FAI salivary testosterone giving 100% specificity and 100% positive predictive value. AMH with an elevated A or elevated salA level gave specificities of 87% and 94%, and positive predictive values 80% and 94%, respectively. Therefore, the combination of an AMH with a cut off of 35 pmol/l combined with a raised T and/or a FAI will confirm PCOS whilst a normal AMH with a normal T and/or FAI will exclude PCOS, thus addressing diagnostic uncertainty.

Highlights

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age and its prevalence varies according to the criteria used between 6% (NIH criteria) and 10% (Androgen Excess Society or Rotterdam society guidelines)[1]; it still remains a diagnosis only after the exclusion of other conditions[2,3]
The combination of a raised anti-Müllerian hormone (AMH) with either a raised serum T or raised free androgen index (FAI) was 100% specific for a diagnosis of polycystic ovary syndrome (PCOS) in this population with a positive predictive value of 100%; this was less robust for the salivary testosterone (salT) with a specificity of 94% and a positive predictive value of 91%
This study shows an AMH above a conservative threshold of 35 pmol/l with either a raised T or a raised FAI identified 100% of PCOS women with type A phenotype with a 100% positive predictive value, though sensitivity was low

Summary

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age and its prevalence varies according to the criteria used between 6% (NIH criteria) and 10% (Androgen Excess Society or Rotterdam society guidelines)[1]; it still remains a diagnosis only after the exclusion of other conditions[2,3]. The antral follicle count is increased in PCOS and PCOS is associated with higher serum AMH values[4]; higher AMH levels are associated with PCOS patients fulfilling all three diagnostic criteria[5]. We have recently reported that the combination of a raised FAI with a raised salT identified 100% of PCOS patients in a biobank cohort, thought this was not found with serum A or salA7, though others have suggested that serum A reflects androgen excess in PCOS8 and has diagnostic value[9]. The aim of this study was to look if AMH would be complementary for the diagnosis of PCOS in combination with an elevated androgen levels (T or FAI or salT or A or salA) within this well-defined cohort of PCOS patients from the general population that fulfilled all 3 of the Rotterdam criteria

Objectives

Methods

Results

Conclusion