The relation between serum anti-Mullerian hormone levels and follicle count in polycystic ovary syndrome

Year 2018, Volume: 4 Issue: 1, 32 - 37, 04.01.2018

Nefise Tanrıdan Okcu Hakan Nazik Ayşe Topcu Akduman Gürkan Uncu

https://doi.org/10.18621/eurj.332118

Abstract

Objective. Polycystic ovary syndrome (PCOS) is one of the most
common endocrine disorders, affecting up to 10% of reproductive-age women. Anti-Mullerian
hormone (AMH) is a member of the transforming growth factor β family and has an
inhibitory effect on primordial follicle recruitment in the ovary. The study
aimed to investigate the importance of serum AMH levels in the different
phenotypes of PCOS and find the optimal cut-off level of AMH in PCOS
patients. Methods. This was a
prospective clinical trial in which diagnoses of 50 PCOS patients based on
Rotterdam revised criteria were compared to 50 normo-ovulatory cases. Additionally,
the PCOS group was divided into 2 subgroups based on 2 or 3 Rotterdam criteria
and compared to 50 normo-ovulatory cases. Results. When compared with the control group, the AMH levels
of the PCOS group were significantly higher than those of the control group (6.81
± 2.8 ng/ml vs. 3.22 ± 2.2 ng/ml, p
< 0.001). In the subgroup analysis, the AMH levels of Group 1 and Group 2
were significantly higher than those of the control group (p < 0.001). The AMH cut-off value of 4.1 ng/ml was found to
distinguish healthy women from PCOS patients, with 84% sensitivity and 80%
specificity. Conclusions. Subgroup
analyses showed higher levels of AMH in the severe PCOS group, but the
difference was not statistically significant. More studies are suggested for
researching the different PCOS subgroups to detect optimal AMH thresholds.

Keywords

anti-Mullerian hormone, ovarian follicles, polycystic ovary syndrome, ultrasonography

References

• [1] Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet 2007;370:685-97.
• [2] Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745-49.
• [3] Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif AGJ, Haseltine F. eds., Polycystic Ovary Syndrome. Blackwell Scientific 1992, pp. 377-84.
• [4] Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41-7.
• [5] Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Positions statement: criteria for defining polycystic ovary syndromeas a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006;91:4237-45.
• [6] Webber LJ, Stubbs S, Stark J, Trew GH, Margara R, Hardy K, et al. Formation and early development of follicles in the polycystic ovary. Lancet 2003;362:1017-21.
• [7] Stubbs SA, Hardy K, da Silva-Buttkus P, Stark J, Webber LJ, Flanagan AM, et al. Anti-mullerian hormone protein expression is reduced during the initial stages of follicle development in human polycystic ovaries. J Clin Endocrinol Metab 2005;90:5536-43.
• [8] 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 2006;91:941-5.
• [9] Jayaprakasan K, Deb S, Batcha M, Hopkisson J, Johnson I, Campbell B, et al. The cohort of antral follicles measuring 2-6 mm reflects the quantitative status of ovarian reserve as assessed by serum levels of anti-mullerian hormone and response to controlled ovarian stimulation. Fertil Steril 2010;94:1775-81.
• [10] La Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS; ESHRE Special Interest Group for Reproductive Endocrinology--AMH Round Table. Anti-mullerian hormone (AMH): what do we still need to know? Hum Reprod 2009;24:2264-75.
• [11] Jonard S, Dewailly D. The follicular excess in polycystic ovaries, due to intraovarianhyperandrogenism, may be the main culprit for the follicular arrest. Hum Reprod Update 2004; 10: 107-17.
• [12] 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 2009;296:238-43.
• [13] Dewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, et al. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod 2011;26:3123-9.
• [14] Dewailly D, Pigny P, Soudan B, Catteau-Jonard S, Decanter C, Poncelet E, et al. Reconciling the definitions of polycystic ovary syndrome: the ovarian follicle number and serum anti-mullerian hormone concentrations aggregate with the markers of hyperandrogenism. J Clin Endocrinol Metab 2010;95:4399-405.
• [15] Johnstone EB, Rosen MP, Neril R, Trevithick D, Sternfeld B, Murphy R, et al. The polycystic ovary post-Rotterdam: a common, age-dependent finding in ovulatory women without metabolic significance. J Clin Endocrinol Metab 2010;95:4965-72.
• [16] Pepe M, Longton G, Janes H. Estimation and comparison of receiver operating characteristic curves. Stata J 2009;9:1.
• [17] Wetzka B, Textor W, Ochsner A, Geisthövel F. Anti-Mullerian hormone confirms the novel classification of female functional androgenization including polycystic ovary syndrome. Eur J Endocrinol 2011;165:323-30.
• [18] Li Y, Ma Y, Chen X, Wang W, Li Y, Zhang Q et, al. Different diagnostic power of anti-Mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet 2012;29:1147-51.
• [19 ] Köninger A, Koch L, Edimiris P, Enekwe A, Nagarajah J, Kasimir-Bauer S, et al. Anti-Mullerian hormone: an indicator for the severity of polycystic ovarian syndrome. Arch Gynecol Obstet 2014;290:1023-30.
• [20] Dewailly D, Catteau-Jonard S, Reyss AC, Leroy M, Pigny P. Oligoanovulation with polycystic ovaries but not overt hyperandrogenism. J Clin Endocrinol Metab 2006;91:3922-7.
• [21] Jonard S, Robert Y, Cortet-Rudelli C, Pigny P, Decanter C, Dewailly D. Ultrasound examination of polycystic ovaries: is it worth counting the follicles? Hum Reprod 2003;18:598-603.
• [22] Modi D, Bhartiya D, Puri C. Developmental expression and cellular distribution of Mullerian inhibiting substance in the primate ovary. Reproduction 2006;132:443-53.
• [23] Fleming R, Kelsey TW, Anderson RA, Wallace WH, Nelson SM. Interpreting human follicular recruitment and antimüllerian hormone concentrations throughout life. Fertil Steril 2012;98:1097-102.
• [24] Grossman MP, Nakajima ST, Fallat ME, Siow Y. Müllerian-inhibiting substance inhibits cytochrome P450 aromatase activity in human granulosa lutein cell culture. Fertil Steril 2008;89:1364-70.
• [25] Broekmans FJ, Visser JA, Laven JS, Broer SL, Themmen AP, Fauser BC. Anti-Müllerian hormone and ovarian dysfunction. Trends Endocrinol Metab 2008;19:340-7.
• [26] Pigny P, Jonard S, Dewailly D. Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91:941-5.
• [27] Fanchin R, Schonäuer LM, Righini C, Guibourdenche J, Frydman R, Taieb J. Serum Anti-Müllerian hormone is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3. Hum Reprod 2003;18:323-7.
• [28] de Vet A, Laven JS, de Jong FH, Themmen AP, Fauser BC. Antimüllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril 2002;77:357-62.
• [29] Piltonen T, Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A, Tapanainen JS. Serum anti-Mullerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome. Hum Reprod 2005;20:1820-6.