Archives of Gynecology and Obstetrics

, Volume 297, Issue 5, pp 1307–1316 | Cite as

Tight interplay in early pregnancy between follistatin and anti-mullerian hormone in women with polycystic ovarian syndrome (PCOS)

  • Angela Köninger
  • Antje Kampmeier
  • Pawel Mach
  • Boerge Schmidt
  • Thomas Strowitzki
  • Rainer Kimmig
  • Alexandra Gellhaus
Gynecologic Endocrinology and Reproductive Medicine



Follistatin levels increase during the course of pregnancy and may play a role in ovarian arrest, reflected by the simultaneous decrease of anti-mullerian-hormone (AMH) levels. The aim of the study was to investigate AMH and follistatin levels during the hormonal window at the beginning of pregnancy. Since both parameters are described as deregulated in polycystic ovarian syndrome (PCOS), subgroup analysis of PCOS patients may additionally elucidate their interplay and effects on ovarian activity.


Serum samples were retrospectively analyzed using the AMH Gen II ELISA and the Human Follistatin Quantikine ELISA Kit. Samples were collected longitudinally from 57 patients (32 with PCOS and 25 controls) before conception and during the first trimester. In 18 patients, measurements from the early and the late first trimester were available. Potential associations of AMH and follistatin levels with PCOS-related parameters were compared between the subgroups as well as longitudinally before and in the first trimester of pregnancy. For statistical analysis, the Spearman’s correlation, Wilcoxon test, t test, Friedman test and multiple linear regression analysis was performed.


In contrast to AMH, follistatin levels differed not between controls and PCOS patients before and in pregnancy. In both subgroups, AMH levels significantly decreased and follistatin levels significantly increased in longitudinally performed measurements before conceiving and in the first trimester of pregnancy.


Follistatin levels are not suited as a biomarker for PCOS, but could be involved in suppressing ovarian activity, as reflected by AMH levels at the beginning of pregnancy.


Anti-mullerian hormone Follistatin Pregnancy Ovarian suppression Polycystic ovarian syndrome 



We thank the laboratory staff and the nurses of the University Hospital of Essen, Department of Gynecology and Obstetrics, for technical assistance and data documentation. We are grateful to Dr. Florence Witte for English editing and critical reading of the manuscript.

Author contribution

A.Kö: project development, data collection, data analysis, manuscript writing; A.Ka: data collection, data analysis, biochemical analysis; PM: data analysis; BS: data analysis, manuscript editing; TS: data analysis, manuscript editing; RK: project development; AG: project development, manuscript writing.


This study was funded by the University of Duisburg-Essen.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Research Ethics Committee of the Faculty of Medicine, University Duisburg-Essen, Germany (No. 11-4643).

Informed consent

Written informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gynecology and ObstetricsUniversity of Duisburg-EssenEssenGermany
  2. 2.Institute for Medical Informatics, Biometry and Epidemiology (IMIBE)University of Duisburg-EssenEssenGermany
  3. 3.Department of Gynecological Endocrinology and Reproductive MedicineUniversity of HeidelbergHeidelbergGermany

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