Abstract
Purpose
This study is designed to explore the correlation between AMH levels and IR in normal weight PCOS women.
Materials and methods
This prospective study was conducted on 55 patients, who were admitted to obstetrics and gynecology department of a university clinic. Study group was consisted of 34 patients diagnosed as polycystic ovary syndrome (PCOS) according to the Rotterdam Criteria, whereas control group was consisted of 21 healthy volunteers without any features of clinical or biochemical hyperandrogenism, who had regular menstrual cycles. BMI ≥ 25 kg/m2 were considered overweight and obese and excluded. Blood samples were obtained during days 2–3 after spontaneous menses or progesterone-induced withdrawal bleeding after overnight fasting for at least 12 h. The weight, height, hip and waist circumferences of the patients were measured. Fasting insulin and glucose (FPG) levels were used for calculating different insulin resistance indexes (Homeostatic Model Assessment (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI)).
Results
No significant difference was found between PCOS and control groups regarding the mean age, BMI, waist to hip ratio (WHR), mean values of FPG, FPG/insulin ratio and HOMA B (p > 0.05). AMH values were significantly higher in PCOS cases when compared with controls (4.7 vs. 3.4 ng/mL) (p < 0.05).The mean values of HOMA-IR and QUICKI indexes were significantly higher among PCOS cases when compared with controls. E2 levels were significantly lower and Total-T were significantly higher in PCOS patients. When PCOS cases are categorized according to the existence of IR, no difference in Total-T and AMH levels between both groups. Although not statistically significant, a negative correlation of AMH with HOMA-IR and a positive correlation with QUICKI index were found. Among the hormone parameters, AMH was found to be positively correlated with Total-T (r = 0.332, p = 0.013).
Conclusion
Although the relation between AMH and androgen production is supported by current evidence, the mechanism underlying the relation between AMH and insulin resistance is not clear yet.
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References
Dunaif A (1997) Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 8:774–800
Wu XK, Zhou SY, Liu JX, Pöllänen P, Sallinen K, Mäkinen M, Erkkola R (2003) Selective ovary resistance to insulin signaling in women with polycystic ovary syndrome. Fertil Steril 80:954–965
Yen HW, Jakimiuk AJ, Munir I, Magoffin DA (2004) Selective alterations in insulin receptor substrates-1, -2 and -4 in theca but not granulosa cells from polycystic ovaries. Mol Hum Reprod 10:473–479
Nestler JE, Jakubowicz DJ, de Vargas AF, Brik C, Quintero N, Medina F (1998) Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. J Clin Endocrinol Metab 83:2001–2005
Pellatt L, Rice S, Mason HD (2010) Anti-Müllerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction 139:825–833
Skałba P, Cygal A, Madej P, Dąbkowska-Huć A, Sikora J, Martirosian G, Romanik M, Olszanecka-Glinianowicz M (2011) Is the plasma anti-Müllerian 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 158:254–259
Broer SL, Mol BW, Hendriks D, Broekmans FJ (2009) The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril 91:705–714
Lin Y, Fridström M, Hillensjö T (1997) Insulin stimulation of lactate accumulation in isolated human granulosa-luteal cells: a comparison between normal and polycystic ovaries. Hum Reprod 12:2469–2472
La Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS; ESHRE Special Interest Group for Reproductive Endocrinology—AMH Round Table (2009) Anti-Mullerian hormone (AMH): what do we still need to know? Hum Reprod 24:2264–2275
Chen MJ, Yang WS, Chen CL, Wu MY, Yang YS, Ho HN (2008) The relationship between anti-Mullerian hormone, androgen and insulin resistance on the number of antral follicles in women with polycystic ovary syndrome. Hum Reprod 23:952–957
Park HT, Cho GJ, Ahn KH, Shin J, Kim YT, Hur JY, Kim SH, Lee KW, Kim T (2010) Association of insulin resistance with anti-Mullerian hormone levels in women without polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf) 72:26–31
La Marca A, Orvieto R, Giulini S, Jasonni VM, Volpe A, De Leo V (2004) Mullerian-inhibiting substance in women with polycystic ovary syndrome: relationship with hormonal and metabolic characteristics. Fertil Steril 82:970–972
Nardo LG, Yates AP, Roberts SA, Pemberton P, Laing I (2009) The relationships between AMH, androgens, insulin resistance and basal ovarian follicular status in non-obese subfertile women with and without polycystic ovary syndrome. Hum Reprod 24:2917–2923
The Rotterdam ESHRE/ASRM-Sponsored PCOS Workshop Group (2004) Revised 2003 consensus on diagnostic and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419
Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, Quon MJ (2000) Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J ClinEndocrinol Metab 85:2402–2410
Hedblad B, Nilsson P, Engstrom G, Berglund G, Janzon L (2002) Insulin resistance in non-diabetic subjects is associated with increased incidence of myocardial infarction and death. Diabet Med 19:470–475
Muniyappa R, Lee S, Chen H, Quon MJ (2008) Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab 294:E15–E26
Fallat ME, Siow Y, Marra M, Cook C, Carrillo A (1997) Müllerian-inhibiting substance in follicular fluid and serum: a comparison of patients with tubal factor infertility, polycystic ovary syndrome, and endometriosis. Fertil Steril 67:962–965
Cook CL, Siow Y, Brenner AG, Fallat ME (2002) Relationship between serum müllerian-inhibiting substance and other reproductive hormones in untreated women with polycystic ovary syndrome and normal women. Fertil Steril 77:141–146
Pigny P, Jonard S, Robert Y, Dewailly D (2006) Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metab 91:941–945
Visser JA, de Jong FH, Laven JS, Themmen AP (2006) Anti-Müllerian hormone: a new marker for ovarian function. Reproduction 131:1–9
Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC (2004) Anti-Müllerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab 89:318–323
Wetzka B, Textor W, Ochsner A, Geisthövel F (2011) Anti-Mullerian hormone confirms the novel classification of female functional androgenization including polycystic ovary syndrome. Eur J Endocrinol 165:323–330
Pietiläinen KH, Kaprio J, Vaaralahti K, Rissanen A, Raivio T (2012) Circulating anti-Mullerian hormone levels in adult men are under a strong genetic influence. J Clin Endocrinol Metab 97:E161–E164
Bayrak A, Terbell H, Urwitz-Lane R, Mor E, Stanczyk FZ, Paulson RJ (2007) Acute effects of metformin therapy include improvement of insulin resistance and ovarian morphology. Fertil Steril 87:870–875
Fleming R, Harborne L, MacLaughlin DT, Ling D, Norman J, Sattar N, Seifer DB (2005) Metformin reduces serum mullerian-inhibiting substance levels in women with polycystic ovary syndrome after protracted treatment. Fertil Steril 83:130–136
Carlsen SM, Vanky E, Fleming R (2009) Anti-Müllerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome. Hum Reprod 24:1732–1738
Piltonen T, Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A, Tapanainen JS (2005) Serum anti-Müllerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome. Hum Reprod 20:1820–1826
Vendola KA, Zhou J, Adesanya OO, Weil SJ, Bondy CA (1998) Androgens stimulate early stages of follicular growth in the primate ovary. J Clin Invest 101:2622–2629
Franks S, Stark J, Hardy K (2008) Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update 14:367–378
Rice S, Christoforidis N, Gadd C, Nikolaou D, Seyani L, Donaldson A, Margara R, Hardy K, Franks S (2005) Impaired insulin-dependent glucose metabolism in granulosa-lutein cells from anovulatory women with polycystic ovaries. Hum Reprod 20:373–381
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Caglar, G.S., Kahyaoglu, I., Pabuccu, R. et al. Anti-Mullerian hormone and insulin resistance in classic phenotype lean PCOS. Arch Gynecol Obstet 288, 905–910 (2013). https://doi.org/10.1007/s00404-013-2833-9
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DOI: https://doi.org/10.1007/s00404-013-2833-9