The role of anti-müllerian hormone in the classification of anovulation

Abstract

ObjectiveTo investigate 1) whether anti Müllerian hormone (AMH) can replace gonadotropin and estradiol levels, which are currently used in the classification of anovulatory infertility and 2) whether increased serum AMH levels can be used to diagnose polycystic ovary syndrome (PCOS).DesignObservational cohort study.Materials and MethodsPatients with oligomenorrhea or secondary amenorrhea were included. Gonadotropins, estradiol, AMH, testosteron and androstenedion levels were measured and antral follicle count was performed with transvaginal ultrasound. PCOS was defined according to the Rotterdam consensus criteria.Cut off values of high AMH levels were defined as AMH higher than the 95th percentile and low AMH levels were lower than the 5th percentile of AMH in an age-matched cohort of normo-ovulatory women.ResultsIn total, 1.316 anovulatory women were included. The median age was 28.8 years. Forty-three women (3%) were classified as hypogonadotropic, hypoestrogenic anovulatory, 1.102 (84%) as normogonadotropic, normoestrogenic and 171 (13%) had hypergonadotropic, hypoestrogenic anovulatory infertility.In a cohort of 389 healthy regularly cycling women with a median age of 29.3 years, the 95th percentile of normal AMH levels was 19.3 and the 5th percentile was 0.7 μg/L.Serum AMH levels were within normal ranges in women with WHO I anovulation. Women with WHO II anovulatory infertility had higher serum AMH levels than age matched controls, although the majority of WHO II women had AMH levels within the normal range. Low serum AMH levels were predictive of ovarian aging and high serum AMH levels were predictive of PCOS.ConclusionIn the classification of anovulation, the role of serum AMH levels seems to be limited to the prediction of ovarian aging. High serum AMH levels were predictive of PCOS, although that the majority of our normogonadotropic PCOS women had AMH levels within normal ranges, indicating that serum AMH levels cannot replace the Rotterdam consensus criteria. ObjectiveTo investigate 1) whether anti Müllerian hormone (AMH) can replace gonadotropin and estradiol levels, which are currently used in the classification of anovulatory infertility and 2) whether increased serum AMH levels can be used to diagnose polycystic ovary syndrome (PCOS). To investigate 1) whether anti Müllerian hormone (AMH) can replace gonadotropin and estradiol levels, which are currently used in the classification of anovulatory infertility and 2) whether increased serum AMH levels can be used to diagnose polycystic ovary syndrome (PCOS). DesignObservational cohort study. Observational cohort study. Materials and MethodsPatients with oligomenorrhea or secondary amenorrhea were included. Gonadotropins, estradiol, AMH, testosteron and androstenedion levels were measured and antral follicle count was performed with transvaginal ultrasound. PCOS was defined according to the Rotterdam consensus criteria.Cut off values of high AMH levels were defined as AMH higher than the 95th percentile and low AMH levels were lower than the 5th percentile of AMH in an age-matched cohort of normo-ovulatory women. Patients with oligomenorrhea or secondary amenorrhea were included. Gonadotropins, estradiol, AMH, testosteron and androstenedion levels were measured and antral follicle count was performed with transvaginal ultrasound. PCOS was defined according to the Rotterdam consensus criteria. Cut off values of high AMH levels were defined as AMH higher than the 95th percentile and low AMH levels were lower than the 5th percentile of AMH in an age-matched cohort of normo-ovulatory women. ResultsIn total, 1.316 anovulatory women were included. The median age was 28.8 years. Forty-three women (3%) were classified as hypogonadotropic, hypoestrogenic anovulatory, 1.102 (84%) as normogonadotropic, normoestrogenic and 171 (13%) had hypergonadotropic, hypoestrogenic anovulatory infertility.In a cohort of 389 healthy regularly cycling women with a median age of 29.3 years, the 95th percentile of normal AMH levels was 19.3 and the 5th percentile was 0.7 μg/L.Serum AMH levels were within normal ranges in women with WHO I anovulation. Women with WHO II anovulatory infertility had higher serum AMH levels than age matched controls, although the majority of WHO II women had AMH levels within the normal range. Low serum AMH levels were predictive of ovarian aging and high serum AMH levels were predictive of PCOS. In total, 1.316 anovulatory women were included. The median age was 28.8 years. Forty-three women (3%) were classified as hypogonadotropic, hypoestrogenic anovulatory, 1.102 (84%) as normogonadotropic, normoestrogenic and 171 (13%) had hypergonadotropic, hypoestrogenic anovulatory infertility. In a cohort of 389 healthy regularly cycling women with a median age of 29.3 years, the 95th percentile of normal AMH levels was 19.3 and the 5th percentile was 0.7 μg/L. Serum AMH levels were within normal ranges in women with WHO I anovulation. Women with WHO II anovulatory infertility had higher serum AMH levels than age matched controls, although the majority of WHO II women had AMH levels within the normal range. Low serum AMH levels were predictive of ovarian aging and high serum AMH levels were predictive of PCOS. ConclusionIn the classification of anovulation, the role of serum AMH levels seems to be limited to the prediction of ovarian aging. High serum AMH levels were predictive of PCOS, although that the majority of our normogonadotropic PCOS women had AMH levels within normal ranges, indicating that serum AMH levels cannot replace the Rotterdam consensus criteria. In the classification of anovulation, the role of serum AMH levels seems to be limited to the prediction of ovarian aging. High serum AMH levels were predictive of PCOS, although that the majority of our normogonadotropic PCOS women had AMH levels within normal ranges, indicating that serum AMH levels cannot replace the Rotterdam consensus criteria.