Antimüllerian hormone: A marker for prediction of ovarian function and polycystic ovary syndrome

The antimullerian hormone (AMH) e located in the short arm of chromosome 19 with 2750 nucleotide bases e is a homodimeric glycoprotein that weighs 140 kDa and is a member of the transforming growth factor-s superfamily, which is involved in male sex differentiation and is responsible for the regression of Mullerian ducts. 1 AMH is exclusively produced by granulosa cells and is the only marker that is thought to be stable throughout the menstrual cycle. AMH has been suggested as a marker for the quantity of oocytes remaining within the ovaries as it is a better marker of ovarian reserve than age, basal FSH, estradiol and inhibin. 2 AMH also enables: (1) prediction of both over and poor response in the controlled ovarian stimulation environment; (2) the most appropriate stimulation regimen to be determined; and (3) pretreatment counseling helping couples make an appropriate and informed choices. 3 Recent reports further suggest that AMH may be useful in the following situations, including: (1) prediction of long-term fertility; (2) prediction of the age of menopause; (3) prediction of ovarian ageing in women prior to or following chemotherapy; (4) prediction of long-term fertility following ovarian surgery; and (5) screening for polycystic ovaries (PCO). 3 In this issue, Chao and colleagues aimed to respond to two questions simulta- neously, that is, assessing the age-related changes of AMH levels in Taiwanese women with and without PCO. 4 At first, Chao and colleagues found that AMH levels revealed an age-related decline in the regular menstrual cycle of healthy women. 4 Furthermore, the AMH level rapidly dropped between 30 and 40 years of age, followed by a slow decrease after 40 years of age. This substantiates previous findings that the AMH concentration declines significantly with increasing age in premenopausal women. 5 Polycystic Ovaries Syndrome (PCOS), a common endo- crinopathy characterized by oligo- or anovulation, clinical or biochemical hyperandrogenemia, and polycystic ovaries on ultrasonography, affects 5e10% of women of reproductive age. 6 Recent studies have shown that 50% of women with PCOS fulfill the criteria of metabolic syndrome and that PCOS is frequently associated with insulin resistance accompanied by compensatory hyperinsulinemia, resulting in an increased risk for the development of type 2 diabetes mellitus and cardiovascular disease. 7 PCOS was reported to have a higher level of AMH compared with healthy controls. 8 Pigny et al indicated that serum AMH levels were three-fold higher in PCOS patients than in controls, and the elevated levels of AMH were significantly related to the follicle number in women with PCOS. 9 Chao's report was in agreement with the above finding e AMH levels were significantly higher in women with PCOS than in healthy fertile controls. The sensitivity and specificity of AMH in detecting PCOS was calculated using an AMH cut-off value of 3.5 ng/mL. 4 AMH levels were found to be positively correlated with testosterone, androstendione and the free androgen index. 9 The data in Chao's study were similar; however, the Chao and colleagues failed to investigate the relationship between AMH and insulin sensitivity in Taiwanese women with PCOS. If additional data addressing the above question were avail- able, this report from Chao and colleagues would be more appealing. Based on other reports, we believed this correlation may be present, since the La Marca group found that AMH levels were positively correlated with the homeostasis model's assessment (HOMA) index, 10 and the use of metformin e an insulin-sensitizer e can significantly reduce both androgen and AMH levels in obese women with PCOS. 11