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Anti-Mullerian hormone and insulin resistance in classic phenotype lean PCOS

  • Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

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

  1. Dunaif A (1997) Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 8:774–800

    Article  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  CAS  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. 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

    Article  Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. 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

    Article  CAS  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Google Scholar 

  15. 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

    Article  PubMed  CAS  Google Scholar 

  16. 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

    Article  CAS  Google Scholar 

  17. 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

    Article  PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  CAS  Google Scholar 

  19. 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

    Article  PubMed  CAS  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. Visser JA, de Jong FH, Laven JS, Themmen AP (2006) Anti-Müllerian hormone: a new marker for ovarian function. Reproduction 131:1–9

    Article  PubMed  CAS  Google Scholar 

  23. 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

    Article  PubMed  CAS  Google Scholar 

  24. 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

    Article  PubMed  CAS  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    Article  PubMed  CAS  Google Scholar 

  27. 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

    Article  PubMed  CAS  Google Scholar 

  28. Carlsen SM, Vanky E, Fleming R (2009) Anti-Müllerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome. Hum Reprod 24:1732–1738

    Article  PubMed  CAS  Google Scholar 

  29. 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

    Article  PubMed  CAS  Google Scholar 

  30. 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

    Article  PubMed  CAS  Google Scholar 

  31. Franks S, Stark J, Hardy K (2008) Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update 14:367–378

    Article  PubMed  CAS  Google Scholar 

  32. 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

    Article  PubMed  CAS  Google Scholar 

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The authors declare that no actual or potential conflict of interest in relation to this article exists.

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Correspondence to Gamze Sinem Caglar.

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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

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