Skip to main content

Different diagnostic power of anti-Mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism

Journal of Assisted Reproduction and Genetics volume 29, pages 1147–1151 (2012)Cite this article

Abstract

Purpose

The aim of this study is to compare the secretory profiles and diagnostic power of anti-Mullerian hormone (AMH) for the PCOS patient with and without hyperandrogenism.

Methods

One hundred and thirty-one PCOS patients with oligomenorrhea or amenorrhea were recruited into the study. Sixty-two and sixty-nine patients had and did not have hyperandrogenism (HA+) hyperandrogenism (HA−), respectively. Sera were collected for determining the levels of AMH, basal sexual hormones, glucose and lipid metabolic indicators.

Results

The AMH serum levels of PCOS patients were significantly higher than the control group, with the highest AMH serum level in the HA+ group. The cut-off value for predicting PCOS patients of all types was 3.92 ng/mL, with a sensitivity of 65 %, and specificity of 62 %. The cut-off value for predicting PCOS patients in the HA+ group was 4.23 ng/mL, with a sensitivity of 82 %, and specificity of 64 %. The cut-off value for predicting PCOS patients in the HA− group was 3.76 ng/mL, with a sensitivity of 64 %, and specificity of 62 %. In the HA+ group, AMH was negatively associated with FSH and positively associated with LH. In the HA− group, AMH was negatively associated with HDL and positively associated with BMI, fasting glucose and LDL.

Conclusions

AMH is only suitable for predicting the PCOS patients with hyperandrogenism. The diagnostic power of AMH is limited when used to predict patients without hyperandrogenism. It reflects the differences in pathophysiology and severity of disrupted folliculogenesis between the two subtypes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006;91(11):4237–45. doi:10.1210/jc.2006-0178.

    PubMed  Article  CAS  Google Scholar 

  2. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91(2):456–88. doi:10.1016/j.fertnstert.2008.06.035.

    PubMed  Article  Google Scholar 

  3. Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C, et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod. 1995;10(8):2107–11.

    PubMed  CAS  Google Scholar 

  4. Broekmans FJ, Visser JA, Laven JS, Broer SL, Themmen AP, Fauser BC. Anti-Mullerian hormone and ovarian dysfunction. Trends Endocrinol Metab: TEM. 2008;19(9):340–7. doi:10.1016/j.tem.2008.08.002.

    PubMed  Article  CAS  Google Scholar 

  5. Chang WY, Knochenhauer ES, Bartolucci AA, Azziz R. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril. 2005;83(6):1717–23. doi:10.1016/j.fertnstert.2005.01.096.

    PubMed  Article  Google Scholar 

  6. Conway GS, Honour JW, Jacobs HS. Heterogeneity of the polycystic ovary syndrome: clinical, endocrine and ultrasound features in 556 patients. Clin Endocrinol. 1989;30(4):459–70.

    Article  CAS  Google Scholar 

  7. 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(9):4399–405. doi:10.1210/jc.2010-0334.

    PubMed  Article  CAS  Google Scholar 

  8. Durlinger AL, Gruijters MJ, Kramer P, Karels B, Kumar TR, Matzuk MM, et al. Anti-Mullerian hormone attenuates the effects of FSH on follicle development in the mouse ovary. Endocrinology. 2001;142(11):4891–9.

    PubMed  Article  CAS  Google Scholar 

  9. Durlinger AL, Visser JA, Themmen AP. Regulation of ovarian function: the role of anti-Mullerian hormone. Reproduction. 2002;124(5):601–9.

    PubMed  Article  CAS  Google Scholar 

  10. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223–36. doi:10.1056/NEJMra041536.

    PubMed  Article  CAS  Google Scholar 

  11. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999;22(1):141–6.

    PubMed  Article  CAS  Google Scholar 

  12. Eldar-Geva T, Margalioth EJ, Gal M, Ben-Chetrit A, Algur N, Zylber-Haran E, et al. Serum anti-Mullerian hormone levels during controlled ovarian hyperstimulation in women with polycystic ovaries with and without hyperandrogenism. Hum Reprod. 2005;20(7):1814–9. doi:10.1093/humrep/deh873.

    PubMed  Article  CAS  Google Scholar 

  13. Hart R, Doherty DA, Norman RJ, Franks S, Dickinson JE, Hickey M, et al. 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.

    PubMed  Article  CAS  Google Scholar 

  14. La Marca A, Volpe A. Anti-Mullerian hormone (AMH) in female reproduction: is measurement of circulating AMH a useful tool? Clin Endocrinol. 2006;64(6):603–10. doi:10.1111/j.1365-2265.2006.02533.x.

    Article  Google Scholar 

  15. Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC. Anti-Mullerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab. 2004;89(1):318–23.

    PubMed  Article  CAS  Google Scholar 

  16. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84(1):165–9.

    PubMed  Article  CAS  Google Scholar 

  17. Li L, Chen X, Mo Y, Chen Y, Wenig M, Yang D. Elevated serum anti-mullerian hormone in adolescent and young adult Chinese patients with polycystic ovary syndrome. Wien Klin Wochenschr. 2010;122(17–18):519–24. doi:10.1007/s00508-010-1426-x.

    PubMed  Article  CAS  Google Scholar 

  18. Li Y, Wei LN, Liang XY (2011) Follicle-stimulating hormone suppressed excessive production of antimullerian hormone caused by abnormally enhanced promoter activity in polycystic ovary syndrome granulosa cells. Fertil Steril 95(7):2354–8, 2358 e2351. doi:10.1016/j.fertnstert.2011.03.047

    Google Scholar 

  19. Moran LJ, Harrison CL, Hutchison SK, Stepto NK, Strauss BJ, Teede HJ (2011) Exercise decreases anti-mullerian hormone in anovulatory overweight women with polycystic ovary syndrome: a pilot study. Hormone and Metabolic Research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. Hormone and Metabolic Research. 43 (13):977–9. doi:10.1055/s-0031-1291208

  20. Moran LJ, Noakes M, Clifton PM, Norman RJ. The use of anti-mullerian hormone in predicting menstrual response after weight loss in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2007;92(10):3796–802. doi:10.1210/jc.2007-1188.

    PubMed  Article  CAS  Google Scholar 

  21. Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet. 2007;370(9588):685–97. doi:10.1016/S0140-6736(07)61345-2.

    PubMed  Article  CAS  Google Scholar 

  22. Pellatt L, Hanna L, Brincat M, Galea R, Brain H, Whitehead S, et al. Granulosa cell production of anti-Mullerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2007;92(1):240–5. doi:10.1210/jc.2006-1582.

    PubMed  Article  CAS  Google Scholar 

  23. Pellatt L, Rice S, Mason HD. Anti-Mullerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction. 2010;139(5):825–33. doi:10.1530/REP-09-0415.

    PubMed  Article  CAS  Google Scholar 

  24. 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(3):941–5. doi:10.1210/jc.2005-2076.

    PubMed  Article  CAS  Google Scholar 

  25. 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):E238–43. doi:10.1152/ajpendo.90684.2008.

    PubMed  Article  CAS  Google Scholar 

  26. 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 

  27. Siow Y, Kives S, Hertweck P, Perlman S, Fallat ME. Serum Mullerian-inhibiting substance levels in adolescent girls with normal menstrual cycles or with polycystic ovary syndrome. Fertil Steril. 2005;84(4):938–44. doi:10.1016/j.fertnstert.2005.02.052.

    PubMed  Article  CAS  Google Scholar 

  28. Skalba P, Cygal A, Madej P, Dabkowska-Huc A, Sikora J, Martirosian G, et al. Is the plasma anti-Mullerian hormone (AMH) level associated with body weight and metabolic, and hormonal disturbances in women with and without polycystic ovary syndrome? Eur J Obstet Gynecol Reprod Biol. 2011;158(2):254–9. doi:10.1016/j.ejogrb.2011.06.006.

    PubMed  Article  CAS  Google Scholar 

  29. Thomson RL, Buckley JD, Moran LJ, Noakes M, Clifton PM, Norman RJ, et al. The effect of weight loss on anti-Mullerian hormone levels in overweight and obese women with polycystic ovary syndrome and reproductive impairment. Hum Reprod. 2009;24(8):1976–81. doi:10.1093/humrep/dep101.

    PubMed  Article  CAS  Google Scholar 

  30. Visser JA, de Jong FH, Laven JS, Themmen AP. Anti-Mullerian hormone: a new marker for ovarian function. Reproduction. 2006;131(1):1–9. doi:10.1530/rep. 1.00529.

    PubMed  Article  CAS  Google Scholar 

  31. Visser JA, Themmen AP. Anti-Mullerian hormone and folliculogenesis. Mol Cell Endocrinol. 2005;234(1–2):81–6. doi:10.1016/j.mce.2004.09.008.

    PubMed  Article  CAS  Google Scholar 

  32. Willis DS, Watson H, Mason HD, Galea R, Brincat M, Franks S. Premature response to luteinizing hormone of granulosa cells from anovulatory women with polycystic ovary syndrome: relevance to mechanism of anovulation. J Clin Endocrinol Metab. 1998;83(11):3984–91.

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by the Young Teacher’s Fund Supported by Sun Yat-sen University, the Science Technology Research Project of Guangdong Province (2010B031600058), the Science Technology Research Project of Guangzhou city (2010Y1-C431), the Specialized Research Fund for the Doctoral Program of Chinese Ministry of Education (20100171110085) and the Chinese National Science Technology Research Project (81070466).

Disclosure statement

The authors have nothing to declare.

Author information

Affiliations

  1. Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Yi Li, Yun Ma, Xianghong Chen, Wenjun Wang, Yu Li, Qingxun Zhang & Dongzi Yang

Authors
  1. Yi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yun Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xianghong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenjun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qingxun Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dongzi Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dongzi Yang.

Additional information

Capsule

AMH is suitable for predicting the PCOS patients with hyperandrogenism and not suitable for the patients without hyperandrogenism, thus reflecting the differences in pathophysiology between the two subtypes.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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 29, 1147–1151 (2012). https://doi.org/10.1007/s10815-012-9839-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-012-9839-2

Keywords

  • Anti-Mullerian hormone
  • Polycystic ovary syndrome
  • Hyperandrogenism
  • Folliculogenesis