Abstract
BackgroundNo data regarding metformin effects on follicular fluid anti-Müllerian hormone (AMH) levels were to date available in literature. The aim of the present study was to evaluate in patients with polycystic ovary syndrome (PCOS) whether metformin administration affects serum and follicular AMH levels, and whether this is related to ovarian response to the treatment.MethodsTwenty young patients with PCOS who had received metformin were enrolled. Ten patients were anovulatory (Met-anov group), whereas the other 10 were ovulatory (Met-ov group) but had failed to conceive. Further untreated PCOS (PCOS controls, n. 10) and healthy controls (non-PCOS controls, n. 10) who were scheduled for laparoscopic surgery were enrolled. In each subjects, clinical and biochemical evaluations were performed. AMH concentrations in blood and antral follicular fluid were assayed.ResultsIn both Met-anov and Met-ov groups, and without difference between them, serum androgens and AMH, and indices of insulin resistance were significantly (p < 0.05) improved after treatment. On the other hand, significant differences (p < 0.05) between the two groups were detected with respect to the same biochemical parameters in antral follicular fluid. In the Met-anov group, no significant correlation was observed between AMH concentrations in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes; whereas in Met-ov group significant correlations were detected between AMH levels in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes.ConclusionsMetformin administration in patients with PCOS exerts a differential action on the ovarian AMH levels on the basis of ovulatory response. Changes in AMH levels in antral follicular fluid during metformin treatment could be involved in the local mechanisms mediating the ovulatory restoration.
Highlights
No data regarding metformin effects on follicular fluid anti-Müllerian hormone (AMH) levels were to date available in literature
Is still unknown if the AMH excess in polycystic ovary syndrome (PCOS) is secondary to the increase in pre-antral follicles number, or if an intrinsic increased AMH production by the granulosa cells is the cause of follicular arrest in PCOS
A significant difference (p < 0.05) between Met-anov and Met-ov groups was observed at baseline and after metformin with regards to the serum levels of sex-hormone binding globulin (SHBG), fasting insulin, GIR, homeostasis model analysis (HOMA), and AMH before treatment (Table 1)
Summary
No data regarding metformin effects on follicular fluid anti-Müllerian hormone (AMH) levels were to date available in literature. The aim of the present study was to evaluate in patients with polycystic ovary syndrome (PCOS) whether metformin administration affects serum and follicular AMH levels, and whether this is related to ovarian response to the treatment. Since AMH is secreted exclusively in the gonads, its Polycystic ovary syndrome (PCOS), one of the most common endocrine disorders in women of childbearing age [4,5,6], is characterized by a marked increase in preantral follicles number [7]. Controversial data are available regarding the relationship between the high serum AMH levels and the pre-antral follicles number in PCOS patients [8,9,10,11,12]. Is still unknown if the AMH excess in PCOS is secondary to the increase in pre-antral follicles number, or if an intrinsic increased AMH production by the granulosa cells is the cause of follicular arrest in PCOS
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