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Follicle Excess and Abnormalities in Women with PCOS: Pathophysiology, Assessment and Clinical Role

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Infertility in Women with Polycystic Ovary Syndrome

Abstract

The pathophysiology of polycystic ovary syndrome (PCOS) is still not fully understood but the follicle excess plays a central role, and its mechanism in the folliculogenesis are multiple. According to the Rotterdam consensus held in 2003, the polycystic ovarian morphology (PCOM) is one of the three diagnostic criteria used to define PCOS. More specifically, PCOM is defined by an excessive antral follicle count with a follicle number per ovary (FNPO) ≥12 and/or ovarian volume ≥ 10 mL. With the improvement in ultrasonographic technology, the number of follicles seen on ultrasound has increased but it remains dependent on the specific equipment and operator. Serum anti-Müllerian hormone (AMH) is nowadays known to be a valuable tool to assess the ovarian follicle content, as AMH is synthetised by all growing follicles up to the stage of small antral follicles. Serum AMH might therefore be used as a surrogate for the FNPO in the diagnosis of PCOS, but so far technical issues have prevented from making it ‘the’ marker of follicle excess. If the assessment of follicle excess is important for the diagnosis of PCOS, it is also helpful for the management of those patients and in particular for reproductive issues.

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References

  1. Sigala J, Sifer C, Dewailly D, Robin G, Bruyneel A, Ramdane N, Lefebvre-Khalil V, Mitchell V, Decanter C. Is polycystic ovarian morphology related to a poor oocyte quality after controlled ovarian hyperstimulation for intracytoplasmic sperm injection? Results from a prospective, comparative study. Fertil Steril. 2015;103:112–8.

    Article  PubMed  Google Scholar 

  2. Block E. Quantitative morphological investigations of the follicular system in women; variations at different ages. Acta Anat (Basel). 1952;14:108–23.

    Article  CAS  Google Scholar 

  3. Webber LJ, Stubbs S, Stark J, Trew GH, Margara R, Hardy K, Franks S. Formation and early development of follicles in the polycystic ovary. Lancet. 2003;362:1017–21.

    Article  CAS  PubMed  Google Scholar 

  4. Maciel GA, Baracat EC, Benda JA, Markham SM, Hensinger K, Chang RJ, Erickson GF. Stockpiling of transitional and classic primary follicles in ovaries of women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2004;89:5321–7.

    Article  CAS  PubMed  Google Scholar 

  5. Catteau-Jonard S, Dewailly D. Physiopathologie des perturbations de la folliculogenèse dans le SOPK. Méd Reprod Gynécol Endocrinol. 2009;11:191–7.

    Google Scholar 

  6. Das M, Djahanbakhch O, Hacihanefioglu B, Saridogan E, Ikram M, Ghali L, Raveendran M, Storey A. Granulosa cell survival and proliferation are altered in polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93:881–7.

    Article  CAS  PubMed  Google Scholar 

  7. Webber LJ, Stubbs SA, Stark J, Margara RA, Trew GH, Lavery SA, Hardy K, Franks S. Prolonged survival in culture of preantral follicles from polycystic ovaries. J Clin Endocrinol Metab. 2007;92:1975–8.

    Article  CAS  PubMed  Google Scholar 

  8. 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;89:318–23.

    Article  CAS  PubMed  Google Scholar 

  9. Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, Dewailly D. 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;88:5957–62.

    Article  CAS  PubMed  Google Scholar 

  10. Gilling-Smith C, Willis DS, Beard RW, Franks S. Hypersecretion of androstenedione by isolated thecal cells from polycystic ovaries. J Clin Endocrinol Metab. 1994;79:1158–65.

    CAS  PubMed  Google Scholar 

  11. Carlsen SM, Vanky E, Fleming R. Anti-Mullerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome. Hum Reprod. 2009;24:1732–8.

    Article  CAS  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. Pache TD, Hop WC, de Jong FH, Leerentveld RA, van Geldorp H, Van de Kamp TM, Gooren LJ, Fauser BC. 17 beta-Oestradiol, androstenedione and inhibin levels in fluid from individual follicles of normal and polycystic ovaries, and in ovaries from androgen treated female to male transsexuals. Clin Endocrinol. 1992;36:565–71.

    Article  CAS  Google Scholar 

  14. Vendola KA, Zhou J, Adesanya OO, Weil SJ, Bondy CA. Androgens stimulate early stages of follicular growth in the primate ovary. J Clin Invest. 1998;101:2622–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Jonard S, Dewailly D. The follicular excess in polycystic ovaries, due to intra-ovarian hyperandrogenism, may be the main culprit for the follicular arrest. Hum Reprod Update. 2004;10:107–17.

    Article  PubMed  Google Scholar 

  16. 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;83:3984–91.

    CAS  PubMed  Google Scholar 

  17. Jakimiuk AJ, Weitsman SR, Navab A, Magoffin DA. Luteinizing hormone receptor, steroidogenesis acute regulatory protein, and steroidogenic enzyme messenger ribonucleic acids are overexpressed in thecal and granulosa cells from polycystic ovaries. J Clin Endocrinol Metab. 2001;86:1318–23.

    CAS  PubMed  Google Scholar 

  18. Hillier SG. Current concepts of the roles of follicle stimulating hormone and luteinizing hormone in folliculogenesis. Hum Reprod. 1994;9:188–91.

    Article  CAS  PubMed  Google Scholar 

  19. Weenen C, Laven JS, Von Bergh AR, Cranfield M, Groome NP, Visser JA, Kramer P, Fauser BC, Themmen AP. Anti-Mullerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod. 2004;10:77–83.

    Article  CAS  PubMed  Google Scholar 

  20. Catteau-Jonard S, Jamin SP, Leclerc A, Gonzales J, Dewailly D, di Clemente N. Anti-Mullerian hormone, its receptor, FSH receptor, and androgen receptor genes are overexpressed by granulosa cells from stimulated follicles in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93:4456–61.

    Article  CAS  PubMed  Google Scholar 

  21. Alebic MS, Stojanovic N, Duhamel A, Dewailly D. The phenotypic diversity in per-follicle anti-Mullerian hormone production in polycystic ovary syndrome. Hum Reprod. 2015;30:1927–33.

    Article  CAS  PubMed  Google Scholar 

  22. Bhide P, Dilgil M, Gudi A, Shah A, Akwaa C, Homburg R. Each small antral follicle in ovaries of women with polycystic ovary syndrome produces more antimullerian hormone than its counterpart in a normal ovary: an observational cross-sectional study. Fertil Steril. 2014;103:537–41.

    Article  PubMed  Google Scholar 

  23. Pellatt L, Hanna L, Brincat M, Galea R, Brain H, Whitehead S, Mason H. Granulosa cell production of anti-Mullerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2007;92:240–5.

    Article  CAS  PubMed  Google Scholar 

  24. Grynberg M, Pierre A, Rey R, Leclerc A, Arouche N, Hesters L, Catteau-Jonard S, Frydman R, Picard JY, Fanchin R, Veitia R, di Clemente N, Taieb J. Differential regulation of ovarian anti-mullerian hormone (AMH) by estradiol through alpha- and beta-estrogen receptors. J Clin Endocrinol Metab. 2012;97:E1649–57.

    Article  CAS  PubMed  Google Scholar 

  25. Pellatt L, Rice S, Dilaver N, Heshri A, Galea R, Brincat M, Brown K, Simpson ER, Mason HD. Anti-Mullerian hormone reduces follicle sensitivity to follicle-stimulating hormone in human granulosa cells. Fertil Steril. 2011;96:1246–51.e1.

    Article  CAS  PubMed  Google Scholar 

  26. Pierre A, Peigne M, Grynberg M, Arouche N, Taieb J, Hesters L, Gonzales J, Picard JY, Dewailly D, Fanchin R, Catteau-Jonard S, di Clemente N. Loss of LH-induced down-regulation of anti-Mullerian hormone receptor expression may contribute to anovulation in women with polycystic ovary syndrome. Hum Reprod. 2013;28:762–9.

    Article  CAS  PubMed  Google Scholar 

  27. Pellatt L, Rice S, Mason HD. Anti-Mullerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction. 2010;139:825–33.

    Article  CAS  PubMed  Google Scholar 

  28. Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003;9:505–14.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, Escobar-Morreale HF. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2014;20:334–52.

    Article  CAS  PubMed  Google Scholar 

  31. Christ JP, Willis AD, Brooks ED, Vanden Brink H, Jarrett BY, Pierson RA, Chizen DR, Lujan ME. Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome. Fertil Steril. 2014;101:280–87.e1.

    Article  PubMed  Google Scholar 

  32. Broekmans FJ, de Ziegler D, Howles CM, Gougeon A, Trew G, Olivennes F. The antral follicle count: practical recommendations for better standardization. Fertil Steril. 2010;94:1044–51.

    Article  PubMed  Google Scholar 

  33. Sample WF, Lippe BM, Gyepes MT. Gray-scale ultrasonography of the normal female pelvis. Radiology. 1977;125:477–83.

    Google Scholar 

  34. Jonard S, Robert Y, Dewailly D. Revisiting the ovarian volume as a diagnostic criterion for polycystic ovaries. Hum Reprod. 2005;20:2893–8.

    Article  PubMed  Google Scholar 

  35. Ardaens Y, Guérin du Masgenêt B, Coquel P, Levaillant JM, Poncelet E. Échographie et imagerie pelvienne en pratique gynécologique. Issy-les-Moulineaux: Elsevier Masson; 2012.

    Google Scholar 

  36. Lam PM, Raine-Fenning N. The role of three-dimensional ultrasonography in polycystic ovary syndrome. Hum Reprod. 2006;21:2209–15.

    Article  PubMed  Google Scholar 

  37. Dewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, Duhamel A, Catteau-Jonard S. 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.

    Article  CAS  PubMed  Google Scholar 

  38. Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, Haider E, Pierson RA, Chizen DR. Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod. 2013;28:1361–8.

    Article  PubMed  Google Scholar 

  39. Kristensen SL, Ramlau-Hansen CH, Ernst E, Olsen SF, Bonde JP, Vested A, Toft G. A very large proportion of young Danish women have polycystic ovaries: is a revision of the Rotterdam criteria needed? Hum Reprod. 2010;25:3117–22.

    Article  CAS  PubMed  Google Scholar 

  40. Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, Griesinger G, Kelsey TW, La Marca A, Lambalk C, Mason H, Nelson SM, Visser JA, Wallace WH, Anderson RA. The physiology and clinical utility of anti-Mullerian hormone in women. Hum Reprod Update. 2014;20:370–85.

    Article  PubMed  Google Scholar 

  41. Dewailly D, Alebic MS, Duhamel A, Stojanovic N. Using cluster analysis to identify a homogeneous subpopulation of women with polycystic ovarian morphology in a population of non-hyperandrogenic women with regular menstrual cycles. Hum Reprod. 2014;29:2536–43.

    Article  CAS  PubMed  Google Scholar 

  42. Carmina E, Orio F, Palomba S, Longo RA, Lombardi G, Lobo RA. Ovarian size and blood flow in women with polycystic ovary syndrome and their correlations with endocrine parameters. Fertil Steril. 2005;84:413–9.

    Article  CAS  PubMed  Google Scholar 

  43. Rajpert-De Meyts E, Jorgensen N, Graem N, Muller J, Cate RL, Skakkebaek NE. Expression of anti-Mullerian hormone during normal and pathological gonadal development: association with differentiation of Sertoli and granulosa cells. J Clin Endocrinol Metab. 1999;84:3836–44.

    PubMed  Google Scholar 

  44. Jost A. The age factor in the castration of male rabbit fetuses. Proc Soc Exp Biol Med. 1947;66:302.

    Article  CAS  PubMed  Google Scholar 

  45. Kuiri-Hanninen T, Kallio S, Seuri R, Tyrvainen E, Liakka A, Tapanainen J, Sankilampi U, Dunkel L. Postnatal developmental changes in the pituitary-ovarian axis in preterm and term infant girls. J Clin Endocrinol Metab. 2011;96:3432–9.

    Article  CAS  PubMed  Google Scholar 

  46. Durlinger AL, Kramer P, Karels B, de Jong FH, Uilenbroek JT, Grootegoed JA, Themmen AP. Control of primordial follicle recruitment by anti-Mullerian hormone in the mouse ovary. Endocrinology. 1999;140:5789–96.

    Article  CAS  PubMed  Google Scholar 

  47. Durlinger AL, Gruijters MJ, Kramer P, Karels B, Kumar TR, Matzuk MM, Rose UM, de Jong FH, Uilenbroek JT, Grootegoed JA, Themmen AP. Anti-Mullerian hormone attenuates the effects of FSH on follicle development in the mouse ovary. Endocrinology. 2001;142:4891–9.

    Article  CAS  PubMed  Google Scholar 

  48. Durlinger AL, Gruijters MJ, Kramer P, Karels B, Ingraham HA, Nachtigal MW, Uilenbroek JT, Grootegoed JA, Themmen AP. Anti-Mullerian hormone inhibits initiation of primordial follicle growth in the mouse ovary. Endocrinology. 2002;143:1076–84.

    Article  CAS  PubMed  Google Scholar 

  49. Iliodromiti S, Kelsey TW, Anderson RA, Nelson SM. 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;98:3332–40.

    Article  CAS  PubMed  Google Scholar 

  50. Salmon NA, Handyside AH, Joyce IM. Oocyte regulation of anti-Mullerian hormone expression in granulosa cells during ovarian follicle development in mice. Dev Biol. 2004;266:201–8.

    Article  CAS  PubMed  Google Scholar 

  51. van Houten EL, Themmen AP, Visser JA. Anti-Mullerian hormone (AMH): regulator and marker of ovarian function. Ann Endocrinol (Paris). 2010;71:191–7.

    Article  Google Scholar 

  52. Fanchin R, Schonauer LM, Righini C, Guibourdenche J, Frydman R, Taieb J. Serum anti-Mullerian 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.

    Article  CAS  PubMed  Google Scholar 

  53. Jeppesen JV, Anderson RA, Kelsey TW, Christiansen SL, Kristensen SG, Jayaprakasan K, Raine-Fenning N, Campbell BK, Yding Andersen C. Which follicles make the most anti-Mullerian hormone in humans? Evidence for an abrupt decline in AMH production at the time of follicle selection. Mol Hum Reprod. 2013;19:519–27.

    Article  CAS  PubMed  Google Scholar 

  54. Li HW, Anderson RA, Yeung WS, Ho PC, Ng EH. Evaluation of serum antimullerian hormone and inhibin B concentrations in the differential diagnosis of secondary oligoamenorrhea. Fertil Steril. 2011;96:774–9.

    Article  CAS  PubMed  Google Scholar 

  55. Pigny P, Gorisse E, Ghulam A, Robin G, Catteau-Jonard S, Duhamel A, Dewailly D. Comparative assessment of five serum antimullerian hormone assays for the diagnosis of polycystic ovary syndrome. Fertil Steril. 2016;105:1063–1069.e3.

    Article  CAS  PubMed  Google Scholar 

  56. Pigny P. Anti-Mullerian hormone assay: what's up in 2013? Médecine de la reproduction. Gynecol Endocrinol. 2014;16:16–20.

    Google Scholar 

  57. Pankhurst MW, McLennan IS. Human blood contains both the uncleaved precursor of anti-Mullerian hormone and a complex of the NH2- and COOH-terminal peptides. Am J Physiol Endocrinol Metab. 2013;305:E1241–7.

    Article  CAS  PubMed  Google Scholar 

  58. Nachtigal MW, Ingraham HA. Bioactivation of Mullerian inhibiting substance during gonadal development by a kex2/subtilisin-like endoprotease. Proc Natl Acad Sci U S A. 1996;93:7711–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Han X, McShane M, Sahertian R, White C, Ledger W. Pre-mixing serum samples with assay buffer is a prerequisite for reproducible anti-Mullerian hormone measurement using the Beckman Coulter gen II assay. Hum Reprod. 2014;29:1042–8.

    Article  CAS  PubMed  Google Scholar 

  60. van Helden J, Weiskirchen R. Performance of the two new fully automated anti-Mullerian hormone immunoassays compared with the clinical standard assay. Hum Reprod. 2015;30:1918–26.

    Article  PubMed  Google Scholar 

  61. Nelson SM, Pastuszek E, Kloss G, Malinowska I, Liss J, Lukaszuk A, Plociennik L, Lukaszuk K. Two new automated, compared with two enzyme-linked immunosorbent, antimullerian hormone assays. Fertil Steril. 2015;104:1016–21.e6.

    Article  CAS  PubMed  Google Scholar 

  62. Eilertsen TB, Vanky E, Carlsen SM. Anti-Mullerian hormone in the diagnosis of polycystic ovary syndrome: can morphologic description be replaced? Hum Reprod. 2012;27:2494–502.

    Article  CAS  PubMed  Google Scholar 

  63. Singh AK, Singh R. Can anti-Mullerian hormone replace ultrasonographic evaluation in polycystic ovary syndrome? A review of current progress. Indian J Endocrinol Metab. 2015;19:731–43.

    Article  PubMed  PubMed Central  Google Scholar 

  64. La Marca A, Stabile G, Artenisio AC, Volpe A. Serum anti-Mullerian hormone throughout the human menstrual cycle. Hum Reprod. 2006;21:3103–7.

    Article  PubMed  Google Scholar 

  65. Tsepelidis S, Devreker F, Demeestere I, Flahaut A, Gervy C, Englert Y. Stable serum levels of anti-Mullerian hormone during the menstrual cycle: a prospective study in normo-ovulatory women. Hum Reprod. 2007;22:1837–40.

    Article  CAS  PubMed  Google Scholar 

  66. van Disseldorp J, Lambalk CB, Kwee J, Looman CW, Eijkemans MJ, Fauser BC, Broekmans FJ. Comparison of inter- and intra-cycle variability of anti-Mullerian hormone and antral follicle counts. Hum Reprod. 2010;25:221–7.

    Article  PubMed  Google Scholar 

  67. Tran ND, Cedars MI, Rosen MP. The role of anti-mullerian hormone (AMH) in assessing ovarian reserve. J Clin Endocrinol Metab. 2011;96:3609–14.

    Article  CAS  PubMed  Google Scholar 

  68. Freeman EW, Gracia CR, Sammel MD, Lin H, Lim LC, Strauss 3rd JF. Association of anti-mullerian hormone levels with obesity in late reproductive-age women. Fertil Steril. 2007;87:101–6.

    Article  CAS  PubMed  Google Scholar 

  69. Moy V, Jindal S, Lieman H, Buyuk E. Obesity adversely affects serum anti-mullerian hormone (AMH) levels in Caucasian women. J Assist Reprod Genet. 2015;32:1305–11.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Kriseman M, Mills C, Kovanci E, Sangi-Haghpeykar H, Gibbons W. Antimullerian hormone levels are inversely associated with body mass index (BMI) in women with polycystic ovary syndrome. J Assist Reprod Genet. 2015;32:1313–6.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Somunkiran A, Yavuz T, Yucel O, Ozdemir I. Anti-Mullerian hormone levels during hormonal contraception in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2007;134:196–201.

    Article  CAS  PubMed  Google Scholar 

  72. Dolleman M, Verschuren WM, Eijkemans MJ, Dolle ME, Jansen EH, Broekmans FJ, van der Schouw YT. Reproductive and lifestyle determinants of anti-Mullerian hormone in a large population-based study. J Clin Endocrinol Metab. 2013;98:2106–15.

    Article  CAS  PubMed  Google Scholar 

  73. Kallio S, Puurunen J, Ruokonen A, Vaskivuo T, Piltonen T, Tapanainen JS. Antimullerian hormone levels decrease in women using combined contraception independently of administration route. Fertil Steril. 2013;99:1305–10.

    Article  CAS  PubMed  Google Scholar 

  74. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American association of clinical endocrinologists, american college of endocrinology, and androgen excess and pcos society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 1. Endocr Pract. 2015;21:1291–300.

    Article  PubMed  Google Scholar 

  75. Eldar-Geva T, Margalioth EJ, Gal M, Ben-Chetrit A, Algur N, Zylber-Haran E, Brooks B, Huerta M, Spitz IM. Serum anti-Mullerian hormone levels during controlled ovarian hyperstimulation in women with polycystic ovaries with and without hyperandrogenism. Hum Reprod. 2005;20:1814–9.

    Article  CAS  PubMed  Google Scholar 

  76. Catteau-Jonard S, Bancquart J, Poncelet E, Lefebvre-Maunoury C, Robin G, Dewailly D. Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? Ultrasound Obstet Gynecol. 2012;40:223–9.

    Article  CAS  PubMed  Google Scholar 

  77. Dewailly D, Pigny P, Soudan B, Catteau-Jonard S, Decanter C, Poncelet E, Duhamel A. 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.

    Article  CAS  PubMed  Google Scholar 

  78. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF. The androgen excess and PCOS society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456–88.

    Article  PubMed  Google Scholar 

  79. Hwang YI, Sung NY, Koo HS, Cha SH, Park CW, Kim JY, Yang KM, Song IO, Koong MK, Kang IS, Kim HO. Can high serum anti-Mullerian hormone levels predict the phenotypes of polycystic ovary syndrome (PCOS) and metabolic disturbances in PCOS patients? Clin Exp Reprod Med. 2013;40:135–40.

    Article  PubMed  PubMed Central  Google Scholar 

  80. 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;170:157–61.

    Article  CAS  PubMed  Google Scholar 

  81. Carmina E, Campagna AM, Fruzzetti F, Lobo RA. AMH measurement versus ovarian ultrasound in the diagnosis of polycystic ovary sundrome in different phenotypes. Endocr Pract. 2016;22:287–93.

    Article  PubMed  Google Scholar 

  82. Mahran A, Abdelmeged A, El-Adawy AR, Eissa MK, Shaw RW, Amer SA. The predictive value of circulating anti-Mullerian hormone in women with polycystic ovarian syndrome receiving clomiphene citrate: a prospective observational study. J Clin Endocrinol Metab. 2013;98:4170–5.

    Article  CAS  PubMed  Google Scholar 

  83. Kaya C, Pabuccu R, Satiroglu H. Serum antimullerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle are predictive of the fertilization, implantation, and pregnancy in polycystic ovary syndrome patients undergoing assisted reproduction. Fertil Steril. 2010;94:2202–7.

    Article  CAS  PubMed  Google Scholar 

  84. Xi W, Gong F, Lu G. Correlation of serum anti-Mullerian hormone concentrations on day 3 of the in vitro fertilization stimulation cycle with assisted reproduction outcome in polycystic ovary syndrome patients. J Assist Reprod Genet. 2012;29:397–402.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Knez J, Kovacic B, Medved M, Vlaisavljevic V. What is the value of anti-Mullerian hormone in predicting the response to ovarian stimulation with GnRH agonist and antagonist protocols? Reprod Biol Endocrinol. 2015;13:58.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Broer SL, Dolleman M, van Disseldorp J, Broeze KA, Opmeer BC, Bossuyt PM, Eijkemans MJ, Mol BW, Broekmans FJ, Group I-ES. Prediction of an excessive response in in vitro fertilization from patient characteristics and ovarian reserve tests and comparison in subgroups: an individual patient data meta-analysis. Fertil Steril. 2013;100:420–9. e7

    Article  PubMed  Google Scholar 

  87. Aghssa MM, Tarafdari AM, Tehraninejad ES, Ezzati M, Bagheri M, Panahi Z, Mahdavi S, Abbasi M. Optimal cutoff value of basal anti-mullerian hormone in iranian infertile women for prediction of ovarian hyper-stimulation syndrome and poor response to stimulation. Reprod Health. 2015;12:85.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Ocal P, Sahmay S, Cetin M, Irez T, Guralp O, Cepni I. Serum anti-Mullerian hormone and antral follicle count as predictive markers of OHSS in ART cycles. J Assist Reprod Genet. 2011;28:1197–203.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008;23:462–77.

    Article  Google Scholar 

  90. Elmashad AI. Impact of laparoscopic ovarian drilling on anti-Mullerian hormone levels and ovarian stromal blood flow using three-dimensional power Doppler in women with anovulatory polycystic ovary syndrome. Fertil Steril. 2011;95:2342–6.

    Article  CAS  PubMed  Google Scholar 

  91. Amer SA, Li TC, Ledger WL. The value of measuring anti-Mullerian hormone in women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian diathermy. Hum Reprod. 2009;24:2760–6.

    Article  CAS  PubMed  Google Scholar 

  92. Abu Hashim H. Predictors of success of laparoscopic ovarian drilling in women with polycystic ovary syndrome: an evidence-based approach. Arch Gynecol Obstet. 2015;291:11–8.

    Article  CAS  PubMed  Google Scholar 

  93. Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC. A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Fertil Steril. 2002;77:91–7.

    Article  PubMed  Google Scholar 

  94. Imani B, Eijkemans MJ, Faessen GH, Bouchard P, Giudice LC, Fauser BC. Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency. Fertil Steril. 2002;77:83–90.

    Article  PubMed  Google Scholar 

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Correspondence to Didier Dewailly .

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Dumont, A., Plouvier, P., Dewailly, D. (2018). Follicle Excess and Abnormalities in Women with PCOS: Pathophysiology, Assessment and Clinical Role. In: Palomba, S. (eds) Infertility in Women with Polycystic Ovary Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-45534-1_8

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