Serum Anti-Mullerian Hormone (AMH) Levels are Effective in Predicting the Diagnosis of Four Polycystic Ovarian Syndrome (PCOS) Phenotypes

Abstract

Purpose: Women with PCOS have higher levels of AMH than matched controls; however, the feasibility of using elevated serum AMH value as a criterion, in the diagnosis of PCOS, is still debatable. The goal of this study was to examine a population of women with elevated AMH (>5.0 ng/mL) and evaluate whether high serum AMH value can be predictive of four different clinical PCOS phenotypes (phenotype A (AOM, amenorrhea/oligomenorrhea + HA, hyperandrogenism + PCO, polycystic ovaries); Phenotype B: AOM + HA; Phenotype C: HA + PCO; and phenotype D: AOM + PCO, as defined by the Rotterdam criteria. Methods: This retrospective study included 227 women with one or more diagnoses of PCOS (ICD-9 256.4, ICD-10 E28.2) and 103 women without PCOS. All serum AMH levels were measured using Beckman Access-2 automated chemiluminescence assay and the age, BMI and AMH levels were analyzed using univariate analysis of covariance. Received operator curves were used to determine the AMH thresholds for predicting PCOS features and phenotypes. Results: Mean serum AMH levels were 9.96, 6.84, 6.43, 6.03, and 1.98 ng/ml in women with PCOS phenotype A, B, C, D, and control respectively. 101 (44.5%) patients were oligo/amenorrheic PCOS, 98 (43.2%) were hyperandrogenic PCOS, and 103 (45.4%) were PCO. Women with all three PCOS features had a significantly higher mean serum AMH compared to those with less of these features. The area under the curve (AUC) estimates of AMH showed high value ranging from 0.76 (95% CI, 0.71-0.81) in AOM group to 0.82 (95% CI, 0.79-0.88) in the PCO group. Conclusion: This study confirms the diagnostic opportunity of AMH test for discriminating between patients with PCOS phenotype and controls. High AMH accurately predicted PCOS in 92% (209 out of 227) patients diagnosed with PCOS. AMH value can predict PCOS in 78% women with oligo/amenorrheic PCOS, 77% with hyperandrogenic PCOS, and 79% with PCO. In keeping with the view that women with PCOS have a variety of phenotypic presentation that can be challenging to diagnose, using AMH test in combination with oligo/ amenorrhea or hyperandrogenism offers a non-invasive objective tool to screen patients with clinical features of PCOS.