The Diagnostic Performance of Antimullerian Hormone for Polycystic Ovarian Syndrome and Polycystic Ovarian Morphology

Overview

Journal Arch Gynecol Obstet

Specialty Gynecology & Obstetrics

Date 2022 Dec 24

PMID 36565362

Authors

Fisun Vural

Birol Vural

Eyupcan Kardas

Ayse Deniz Erturk Coskun

Irem Yildirim

Affiliations

Soon will be listed here.

Abstract

Purpose: The diagnosis of polycystic ovary syndrome (PCOS) remains a challenge to clinicians due to heterogeneous clinical presentation and diagnostic criteria. This study investigated the utilization of Anti-Müllerian hormone (AMH) alone or replacing polycystic ovarian morphology (PCOM) in the PCOS diagnostic criteria.

Methods: A total of 401 women were categorised as PCOS (n:154), nonPCOS with polycystic ovarian morphology (PCOM) (n:105), and nonPCOS with normal ovarian morphology (NOM) (n:142). First, the diagnostic performance of AMH for PCOS diagnosis in Rotterdam, Androgen Excess Society, and National Institutes of Health (NIH) criteria was analyzed. Second, AMH was used instead of PCOM in Rotterdam criteria and we searched diagnostic performance for PCOS phenotypes.

Results: AMH levels were positively correlated with LH, testosterone, hirsutism score, menstrual cycle length, and antral follicle count (p < 0.05). AMH alone had specificity and sensitivity for PCOS diagnosis were 84.9% and 72.4% in Rotterdam (AUC: 0.866); 84.4% and 72% in Androgen Excess Society (AUC: 0.857); 83.3% and 66.4% in National Institute of Health criteria (AUC: 0.825). AMH alone had satisfactory diagnostic potential for phenotype A, but not other phenotypes. The replacement of PCOM with AMH in Rotterdam criteria had a high diagnostic potential for PCOS (AUC: 0.934, sensitivity:97.4%, specificity: 90.67%). Phenotype A and phenotype D were diagnosed with 100% sensitivity and 94.5% specificity. Phenotype C was recognised with 96.15% sensitivity and 94.5% specificity.

Conclusion: AMH may be used with high diagnostic accuracy instead of PCOM in the Rotterdam PCOS criteria.

Citing Articles

Evaluation of Biochemical Serum Markers for the Diagnosis of Polycystic Ovary Syndrome (PCOS) in Obese Women in Kazakhstan: Is Anti-Müllerian Hormone a Potential Marker?.

Madikyzy M, Durmanova A, Trofimov A, Akbay B, Tokay T Biomedicines. 2024; 12(10).

PMID: 39457645 PMC: 11504444. DOI: 10.3390/biomedicines12102333.

Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis.

Fahs D, Salloum D, Nasrallah M, Ghazeeri G Diagnostics (Basel). 2023; 13(9).

PMID: 37174950 PMC: 10177792. DOI: 10.3390/diagnostics13091559.

References

Moran L, Misso M, Wild R, Norman R . Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2010; 16(4):347-63. DOI: 10.1093/humupd/dmq001. View

Azziz R, Adashi E . Stein and Leventhal: 80 years on. Am J Obstet Gynecol. 2015; 214(2):247.e1-247.e11. DOI: 10.1016/j.ajog.2015.12.013. View

Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale H, Futterweit W . The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2008; 91(2):456-88. DOI: 10.1016/j.fertnstert.2008.06.035. View

Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R . Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016; 106(1):6-15. DOI: 10.1016/j.fertnstert.2016.05.003. View

Saxena U, Ramani M, Singh P . Role of AMH as Diagnostic Tool for Polycystic Ovarian Syndrome. J Obstet Gynaecol India. 2018; 68(2):117-122. PMC: 5895547. DOI: 10.1007/s13224-017-1066-4. View

Sahmay S, Atakul N, Aydogan B, Aydin Y, Imamoglu M, Seyisoglu H . Elevated serum levels of anti-Müllerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2013; 92(12):1369-74. DOI: 10.1111/aogs.12247. View

Kristensen S, Ramlau-Hansen C, Ernst E, Olsen S, Bonde J, Vested A . A very large proportion of young Danish women have polycystic ovaries: is a revision of the Rotterdam criteria needed?. Hum Reprod. 2010; 25(12):3117-22. DOI: 10.1093/humrep/deq273. View

Dewailly D, Lujan M, Carmina E, Cedars M, Laven J, Norman R . Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2013; 20(3):334-52. DOI: 10.1093/humupd/dmt061. View

Sahmay S, Aydin Y, Oncul M, Senturk L . Diagnosis of Polycystic Ovary Syndrome: AMH in combination with clinical symptoms. J Assist Reprod Genet. 2013; 31(2):213-20. PMC: 3933601. DOI: 10.1007/s10815-013-0149-0. View

10.

Dumont A, Robin G, Catteau-Jonard S, Dewailly D . Role of Anti-Müllerian Hormone in pathophysiology, diagnosis and treatment of Polycystic Ovary Syndrome: a review. Reprod Biol Endocrinol. 2015; 13:137. PMC: 4687350. DOI: 10.1186/s12958-015-0134-9. View

11.

Iliodromiti S, Kelsey T, Anderson R, Nelson S . Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab. 2013; 98(8):3332-40. DOI: 10.1210/jc.2013-1393. View

12.

Pigny P, Jonard S, Robert Y, Dewailly D . Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metab. 2005; 91(3):941-5. DOI: 10.1210/jc.2005-2076. View

13.

Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D . Anti-Mullerian hormone levels reflect severity of PCOS but are negatively influenced by obesity: relationship with increased luteinizing hormone levels. Am J Physiol Endocrinol Metab. 2008; 296(2):E238-43. DOI: 10.1152/ajpendo.90684.2008. View

14.

Laven J, Mulders A, Visser J, Themmen A, de Jong F, Fauser B . Anti-Müllerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab. 2004; 89(1):318-23. DOI: 10.1210/jc.2003-030932. View

15.

Fraissinet A, Robin G, Pigny P, Lefebvre T, Catteau-Jonard S, Dewailly D . Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome. Hum Reprod. 2017; 32(8):1716-1722. DOI: 10.1093/humrep/dex239. View

16.

Singh A, Singh R . Can anti-Mullerian hormone replace ultrasonographic evaluation in polycystic ovary syndrome? A review of current progress. Indian J Endocrinol Metab. 2015; 19(6):731-43. PMC: 4673800. DOI: 10.4103/2230-8210.167548. View

17.

Pellatt L, Hanna L, Brincat M, Galea R, Brain H, Whitehead S . Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2006; 92(1):240-5. DOI: 10.1210/jc.2006-1582. View

18.

Abbara A, Eng P, Phylactou M, Clarke S, Hunjan T, Roberts R . Anti-Müllerian hormone (AMH) in the Diagnosis of Menstrual Disturbance Due to Polycystic Ovarian Syndrome. Front Endocrinol (Lausanne). 2019; 10:656. PMC: 6775233. DOI: 10.3389/fendo.2019.00656. View

19.

Hart R, Doherty D, Norman R, Franks S, Dickinson J, Hickey M . Serum antimullerian hormone (AMH) levels are elevated in adolescent girls with polycystic ovaries and the polycystic ovarian syndrome (PCOS). Fertil Steril. 2010; 94(3):1118-21. DOI: 10.1016/j.fertnstert.2009.11.002. View

20.

Woo H, Kim K, Rhee E, Park H, Lee M . Differences of the association of anti-Müllerian hormone with clinical or biochemical characteristics between women with and without polycystic ovary syndrome. Endocr J. 2012; 59(9):781-90. DOI: 10.1507/endocrj.ej12-0055. View