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Anti‐Müllerian hormone measurement for the diagnosis of polycystic ovary syndrome
Author(s) -
Sathyapalan Thozhukat,
AlQaissi Ahmed,
Kilpatrick Eric S.,
Dargham Soha R.,
Atkin Stephen L.
Publication year - 2018
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13517
Subject(s) - anti müllerian hormone , polycystic ovary , medicine , free androgen index , endocrinology , testosterone (patch) , population , percentile , ovarian reserve , androgen , hormone , gynecology , sex hormone binding globulin , obesity , insulin resistance , biology , infertility , pregnancy , statistics , mathematics , environmental health , genetics
Summary Objective Anti‐Müllerian hormone ( AMH ) is derived from the small antral follicles, and an elevated level has been suggested to add value to the Rotterdam criteria for the diagnosis of PCOS in cases of diagnostic uncertainty. Therefore, the role of AMH in the classical phenotype of PCOS was defined within a Caucasian population. Design This was a cross‐sectional study. Patients Sixty Five women without PCOS and 110 women with PCOS fulfilling all 3 diagnostic Rotterdam criteria. Measurements The main outcomes were the utility of serum AMH for the diagnosis of PCOS and its relationship to the metabolic parameters. Results Anti‐Müllerian hormone was increased in PCOS compared to controls ( P < .001). Areas under the receiver operator curve showed AMH to be predictive of PCOS (0.76) using a cut‐off AMH of 46 pmol/L, which is derived from the 95 th percentile of the controls that gave a 41% sensitivity and 86% specificity; an AMH cut‐off of 35 pmol/L gave a 55% sensitivity and 79% specificity. Age‐ and BMI ‐adjusted multiple logistic regression showed that AMH was more predictive of PCOS independently of either serum testosterone (T) ( OR = 4.04; 95% CI 1.42‐11.11; P = .007) or free androgen index ( FAI ) ( OR = 3.90; 95% CI 1.40‐10.83; P = .009). Conclusion Whilst an elevated AMH has poor sensitivity, it is fourfold more likely to be associated with a diagnosis of PCOS , and supplementary to biochemical parameters will make a positive diagnosis of PCOS in 22% of patients when neither serum testosterone nor FAI is elevated.