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The Role of Anti-Müllerian Hormone in the Characterization of the Different Polycystic Ovary Syndrome Phenotypes

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Abstract

Rotterdam criteria identified 4 polycystic ovary syndrome (PCOS) phenotypes based on the combination of anovulation (ANOV), hyperandrogenism (HA), and polycystic ovaries (PCOs): phenotype 1 (ANOV + HA + PCO), phenotype 2 (ANOV + HA), phenotype 3 (HA + PCO), and phenotype 4 (ANOV + PCO). Anti-Müllerian hormone (AMH) was suggested to play a pathophysiologic and diagnostic role in this syndrome. The aim of this study was to compare AMH levels among the different phenotypes in relation to clinical, endocrine, and metabolic features. We enrolled 117 women with PCOS (body mass index: 25.89 ± 6.20 kg/m2, age range: 18–37 years) and 24 controls. Anthropometric characteristics, hirsutism score, ultrasound ovarian features, and hormonal parameters, including AMH, were evaluated. Each participant also underwent an oral glucose tolerance test and an euglycemic–hyperinsulinemic clamp. The prevalence of phenotypes 1 to 4 was 62.4%, 8.6%, 11.1%, and 17.9%, respectively. Body mass index and insulin resistance indexes were similar among the groups. Phenotype 1 showed the highest luteinizing hormone, androgens levels, ovarian volume, and AMH concentrations (9.27 ± 8.17 ng/mL, P < .05) versus phenotype 2 and controls. Phenotype 2 women were hirsute, showed an intermediate free androgen index value, low ovarian volume, and low AMH levels (4.05 ± 4.12 ng/mL). Phenotype 3 showed an intermediate state of HA and slightly augmented AMH levels (5.87 ± 4.35 ng/mL). The clinical and endocrine characteristics of phenotype 4 resembled those of controls, except for higher ovarian volume and AMH levels (7.62 ± 3.85 ng/mL; P < .05). Our results highlight the heterogeneity of the association between increased AMH levels, menstrual dysfunction, and HA in the different PCOS phenotypes, thus offering a key to an understanding of the current controversy on the value of AMH measurement in PCOS.

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References

  1. Franks S. Polycystic ovary syndrome. N Engl J Med. 1995;333: 853–861.

    CAS  PubMed  Google Scholar 

  2. Pasquali R, Stener-Victorin E, Yildiz BO, et al. PCOS forum: research in polycystic ovary syndrome today and tomorrow. Clin Endocrinol (Oxf). 2011;74(4):424–433.

    Google Scholar 

  3. Zawadski JK, Dunaif A. Diagnostic Criteria for Polycystic Ovary Syndrome: Towards A Rational Approach. Polycystic Ovary Syndrome 2011. Boston, MA: Blackwell Scientific; 2011:377–384.

    Google Scholar 

  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. Fertil Steril. 2004;81(1):19–25.

    Google Scholar 

  5. Belosi C, Selvaggi L, Apa R, et al. Is the PCOS diagnosis solved by ESHRE/ASRM 2003 consensus or could it include ultrasound examination of the ovarian stroma? Hum Reprod. 2006;21(12): 3108–3115.

    CAS  PubMed  Google Scholar 

  6. Broekmans FJ, Knauff EA, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BC. PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG. 2006;113(10):1210–1217.

    CAS  PubMed  Google Scholar 

  7. Geisthövel F, Rabe T. The ESHRE/ASRM consensus on polycystic ovary syndrome (PCOS)—an extended critical analysis. Reprod Biomed Online. 2007;14(4):522–535.

    PubMed  Google Scholar 

  8. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25(2):544–551.

    PubMed  Google Scholar 

  9. Carlsson IB, Scott JE, Visser JA, Ritvos O, Themmen AP, Hovatta O. Anti-Mullerian hormone inhibits initiation of growth of human primordial ovarian follicles in vitro. Hum Reprod. 2006;21(9):2223–2227.

    CAS  PubMed  Google Scholar 

  10. Nardo LG, Yates AP, Roberts SA, Pemberton P, Laing I. The relationships between AMH, androgens, insulin resistance and basal ovarian follicular status in non-obese subfertile women with and without polycystic ovary syndrome. 2009;24(11):2917–2923.

    CAS  Google Scholar 

  11. Pigny P, Merlen E, Robert Y, et al. Elevated serum level of anti-Mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab. 2003;88(12):5957–5962.

    CAS  PubMed  Google Scholar 

  12. Pellatt L, Rice S, Mason HD. Anti-Müllerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction. 2010;139(5):825–833.

    CAS  PubMed  Google Scholar 

  13. New MI, Lorenzen F, Lerner AJ, et al. Genotyping steroid 21-hydroxylase deficiency: hormonal reference data. J Clin Endocrinol Metab. 1983;57(2):320–326.

    CAS  PubMed  Google Scholar 

  14. Treloar AE, Boynton RE, Behn BG, et al. Variation of the human menstrual cycle through reproductive life. Int J Fertil. 1967;12(1 pt 2):77–126.

    CAS  PubMed  Google Scholar 

  15. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21:1440–1447.

    CAS  PubMed  Google Scholar 

  16. Ciampelli M, Fulghesu AM, Cucinelli F, et al. Impact of insulin and body mass index on metabolic and endocrine variables in polycystic ovary syndrome. Metabolism. 1999;48(2):167–172.

    CAS  PubMed  Google Scholar 

  17. De Simone M, Verrotti A, Iughetti L, et al. Increased visceral adipose tissue is associated with increased circulating insulin and decreased sex hormone binding globulin levels in massively obese adolescent girls. J Endocrinol Invest. 2001;24(6):438–444.

    PubMed  Google Scholar 

  18. Peterkin BB. Dietary guidelines for Americans. J Am Diet Assoc. 1990;90(12): 1725–1727.

    CAS  PubMed  Google Scholar 

  19. Fulghesu AM, Ciampelli M, Belosi C, et al. A new ultrasound criterion for the diagnosis of polycystic ovary syndrome: the ovarian stroma/total area ratio. Fertil Steril. 2001;76(2):326–323.

    CAS  PubMed  Google Scholar 

  20. Orsini LF, Venturoli S, Lorusso R, et al. Ultrasonic findings in polycystic ovarian disease. Fertil Steril. 1985;43(5):709–714.

    CAS  PubMed  Google Scholar 

  21. Ciampelli M, Leoni F, Cucinelli F, et al. Assessment of insulin sensitivity from measurements in the fasting state and during an oral glucose tolerance test in polycystic ovary syndrome and menopausal patients. J Clin Endocrinol Metab. 2005;90(3):1398–1406.

    CAS  PubMed  Google Scholar 

  22. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979;237(3):E214–E223.

    Google Scholar 

  23. Broekmans FJ, Fauser BC. Diagnostic criteria for polycystic ovarian syndrome. Endocrine. 2006;30(1):3–11.

    CAS  PubMed  Google Scholar 

  24. Welt CK, Gudmundsson JA, Arason G, et al. Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: the impact of weight on phenotype and metabolic features. J Clin Endocrinol Metab. 2006;91(12):4842–4848.

    CAS  PubMed  Google Scholar 

  25. Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91(2):456–488.

    PubMed  Google Scholar 

  26. Dewailly D, Catteau-Jonard S, Reyss AC, et al. Oligoanovulation with polycystic ovaries but not overt hyperandrogenism. J Clin Endocrinol Metab. 2006;91(10):3922–3927.

    CAS  PubMed  Google Scholar 

  27. Guastella E, Longo RA, Carmina E. Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes. Fertil Steril. 2010;94(6):2197–2201.

    CAS  PubMed  Google Scholar 

  28. Panidis D, Tziomalos K, Misichronis G, et al. Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod. 2012; 27(2):541–549.

    CAS  PubMed  Google Scholar 

  29. 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(2):E238–E243.

    CAS  PubMed  Google Scholar 

  30. Dilbaz B, Ozkaya E, Cinar M, Cakir E, Dilbaz S. Cardiovascular disease risk characteristics of the main polycystic ovary syndrome phenotypes. Endocrine. 2011;39(3):272–277.

    CAS  PubMed  Google Scholar 

  31. Yilmaz M, Isaoglu U, Delibas IB, Kadanali S. Anthropometric, clinical and laboratory comparison of four phenotypes of polycystic ovary syndrome based on Rotterdam criteria. J Obstet Gynaecol Res. 2011;37(8): 1020–1026.

    PubMed  Google Scholar 

  32. Katsikis I, Karkanaki A, Misichronis G, Delkos D, Kandaraki EA, Panidis D. Phenotypic expression, body mass index and insulin resistance in relation to LH levels in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2011;156(2): 181–185.

    CAS  PubMed  Google Scholar 

  33. Desforges-Bullet V, Gallo C, Lefebvre C, Pigny P, Dewailly D, Catteau-Jonard S. Increased anti-Mullerian hormone and decreased FSH levels in follicular fluid obtained in women with polycystic ovaries at the time of follicle puncture for in vitro fertilisation. Fertil Steril. 2010;94(1): 198–204.

    CAS  PubMed  Google Scholar 

  34. Kauffman RP, Baker TE, Baker VM, DiMarino P, Castracane VD. Endocrine and metabolic differences among phenotypic expressions of polycystic ovary syndrome according to the 2003 Rotterdam consensus criteria. Am J Obstet Gynecol. 2008; 198(6):670.e1–e7; discussion 670. e7–e10.

    PubMed  Google Scholar 

  35. Blank SK, McCartney CR, Marshall JC. The origins and sequelae of abnormal neuroendocrine function in polycystic ovary syndrome. Hum Reprod Update. 2006;12(4):351–361.

    CAS  PubMed  Google Scholar 

  36. Sahmay S, Atakul N, Oncul M, Tuten A, Aydogan B, Seyisoglu H. Serum anti-Mullerian hormone levels in the main phenotypes of polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):157–161.

    CAS  PubMed  Google Scholar 

  37. Dewailly D, Gronier H, Poncelet E, 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(11):3123–3129.

    CAS  PubMed  Google Scholar 

  38. 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):941–945.

    PubMed  Google Scholar 

  39. Li Y, Ma Y, Chen X, et al. Different diagnostic power of anti-Mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet. 2012;9(10):1147–1151.

    Google Scholar 

  40. Dewailly D, Pigny P, Soudan B, et al. Reconciling the definitions of polycystic ovary syndrome: the ovarian follicle number and serum anti-Müllerian hormone concentrations aggregate with the markers of hyperandrogenism. J Clin Endocrinol Metab. 2010; 95(9):4399–4405.

    CAS  PubMed  Google Scholar 

  41. Rosenfield RL, Wroblewski K, Padmanabhan V, et al. Antimüllerian hormone levels are independently related to ovarian hyperandrogenism and polycystic ovaries. Fertil Steril. 2012;98(1): 242–249.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Pellatt L, Hanna L, Brincat M, et al. Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2006;92(1):240–245.

    PubMed  Google Scholar 

  43. Dewailly D, Andersen CY, Balen A, et al. The physiology and clinical utility of anti-Mullerian hormone in women. Hum Reprod Update. 2014;20(3):370–385.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Roma, Italia

    Daniela Romualdi PhD, MD, C. Di Florio MD, V. Tagliaferri MD, S. De Cicco MD, D. Gagliano MD, V. Immediata MD, A. Lanzone MD & M. Guido PhD, MD

  2. OASI Institute for Research, Troina, Italia

    A. Lanzone MD

  3. Ospedale Generale Regionale “F. Miulli,” Acquaviva delle Fonti, Italia

    M. Guido PhD, MD

Authors
  1. Daniela Romualdi PhD, MD
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  2. C. Di Florio MD
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  3. V. Tagliaferri MD
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  4. S. De Cicco MD
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  5. D. Gagliano MD
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  6. V. Immediata MD
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  7. A. Lanzone MD
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Correspondence to Daniela Romualdi PhD, MD.

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Romualdi, D., Di Florio, C., Tagliaferri, V. et al. The Role of Anti-Müllerian Hormone in the Characterization of the Different Polycystic Ovary Syndrome Phenotypes. Reprod. Sci. 23, 655–661 (2016). https://doi.org/10.1177/1933719115611751

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