Skip to main content
SpringerLink
Log in

Anti-Mullerian Hormone: an indicator for the severity of polycystic ovarian syndrome

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

Abstract

Purpose

Features of polycystic ovarian syndrome (PCOS) including sonographic aspects, androgens, LH and LH/FSH ratio as well as Anti-Mullerian Hormone (AMH) were evaluated according to their diagnostic potency in detecting different degrees of PCOS severity.

Methods

80 women with PCOS diagnosed according to the Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2003 and 48 controls were enrolled between 2011 and 2013. PCOS patients fulfilling all Rotterdam criteria were defined as having severe PCOS (n = 59), while patients showing oligo-/amenorrhoea and polycystic ovaries but without hyperandrogenemia were defined as having mild PCOS (n = 21). All patients were treated at the University Hospital of Essen, Germany.

Results

The strongest group difference between controls and severe PCOS patients was observed for AMH showing an age-adjusted odds ratio of 2.56 [95 % confidence interval (CI) 2.00–3.27; p < 0.0001]. Age-adjusted receiver operating characteristic analysis showed that the area under the curve (AUC) of 0.88 (95 % CI: 0.80–0.95) for AMH and 0.94 (95 % CI 0.88–0.98) for antral follicle count did not differ significantly in their ability to discriminate between severe PCOS patients and controls. AMH showed higher AUC estimates than androgens, ovarian volume, LH and LH/FSH ratio and an AUC of 0.80 (95 % CI: 0.65–0.91) for detecting mild PCOS.

Conclusions

To our knowledge, this is the first study comparing the diagnostic potency of AMH, sonographic aspects, androgens, and LH/FSH ratio according to different PCOS subgroups while accounting for the age-dependency of AMH. In cases where vaginal scans are not feasible or in patients without hyperandrogenemia AMH may be used as a surrogate parameter in PCOS diagnosis, superior to androgens and gonadotropins.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO (2004) The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89(6):2745–2749

    Article  PubMed  CAS  Google Scholar 

  2. Michelmore KF, Balen AH, Dunger DB, Vessey MP (1999) Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf) 51(6):779–786

    Article  CAS  Google Scholar 

  3. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19(1):41–47

    Article  Google Scholar 

  4. Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, Dewailly D (2003) 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 88(12):5957–5962

    Article  PubMed  CAS  Google Scholar 

  5. Pigny P, Jonard S, 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(3):941–945

    Article  PubMed  CAS  Google Scholar 

  6. Dewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, Duhamel A, Catteau-Jonard S (2011) 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 26(11):3123–3129

    Article  PubMed  CAS  Google Scholar 

  7. Jonard S, Dewailly D (2004) The follicular excess in polycystic ovaries, due to intra-ovarian hyperandrogenism, may be the main culprit for the follicular arrest. Hum Reprod Update 10(2):107–117

    Article  PubMed  Google Scholar 

  8. Fanchin R, Schonäuer LM, Righini C, Guibourdenche J, Frydman R, Taieb J (2003) Serum Anti-Müllerian hormone is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3. Hum Reprod 18(2):323–327

    Article  PubMed  CAS  Google Scholar 

  9. di Clemente N, Ghaffari S, Pepinsky RB, Pieau C, Josso N, Cate RL, Vigier B (1992) A quantitative and interspecific test for biological activity of anti-müllerian hormone: the fetal ovary aromatase assay. Development 114(3):721–727

    PubMed  Google Scholar 

  10. 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(2):323–330

    Article  PubMed  CAS  Google Scholar 

  11. Woo HY, Kim KH, Rhee EJ, Park H, Lee MK (2012) Differences of the association of anti-Müllerian hormone with clinical or biochemical characteristics between women with and without polycystic ovary syndrome. Endocr J 59(9):781–790

    Article  PubMed  CAS  Google Scholar 

  12. 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(11):2917–2923

    Article  PubMed  CAS  Google Scholar 

  13. Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D (2009) Anti-Mullerian hormone levels reflect severity of PCOS but are negatively influenced by obesity: relationship with increased luteinizing hormone levels. Am J Physiol Endocrinol Metab 296(2):E238–E243

    Article  PubMed  CAS  Google Scholar 

  14. Dewailly D, Pigny P, Soudan B, Catteau-Jonard S, Decanter C, Poncelet E, Duhamel A (2010) Reconciling the definitions of polycystic ovary syndrome: the ovarian follicle number and serum anti-Müllerian hormone concentrations aggregate with the markers of hyperandrogenism. J Clin Endocrinol Metab 95(9):4399–4405

    Article  PubMed  CAS  Google Scholar 

  15. Iliodromiti S, Kelsey TW, Anderson RA, Nelson SM (2013) Can Anti-Mullerian Hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab 98:3332–3340

    Article  PubMed  CAS  Google Scholar 

  16. Li Y, Ma Y, Chen X, Wang W, Li Y, Zhang Q, Yang D (2012) Different diagnostic power of anti-Mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet 29(10):1147–1151

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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 

  18. Jensterle M, Weber M, Pfeifer M, Prezelj J, Pfutzner A, Janez A (2008) Assessment of insulin resistance in young women with polycystic ovary syndrome. Int J Gynaecol Obstet 102:137–140

    Article  PubMed  CAS  Google Scholar 

  19. Balen AH, Laven JS, Tan SL, Dewailly D (2003) Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 9(6):505–514

    Article  PubMed  Google Scholar 

  20. Norris CM, Ghali WA, Saunders LD, Brant R, Galbraith D, Faris P, Knudtson ML, Investigators APPROACH (2006) Ordinal regression model and the linear regression model were superior to the logistic regression models. J Clin Epidemiol 59(5):448–456

    Article  PubMed  Google Scholar 

  21. Pepe M, Longton G, Janes H (2009) Estimation and comparison of receiver operating characteristic curves. Stata J 9(1):1

    PubMed  PubMed Central  Google Scholar 

  22. Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35

    Article  PubMed  CAS  Google Scholar 

  23. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria ISBN 3-900051-07-0, URL: http://www.R-project.org/

  24. Mahran A, Abdelmeged A, El-Adawy AR, Eissa MK, Shaw RW, Amer SA (2013) 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 98(10):4170–4175

    Article  PubMed  CAS  Google Scholar 

  25. Han X, McShane M, Sahertian R, White C, Ledger W (2014) 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 29(5):1042–1048

    Article  PubMed  CAS  Google Scholar 

  26. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF (2006) Androgen Excess Society. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 91(11):4237–4245

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the laboratory staff for the support and continual help in analyzing the samples, their storage and documentation of data, especially Gisela Koestner, Jens Rasch, Ute Kirsch and Sieglinde Arndt. We further are grateful to the nurses of University Hospital Essen, Department Obstetrics, for obtaining the patient samples, especially Erika Naber, Angelika Hover and Aileen Balser. We are also grateful to all women who took part in this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Angela Köninger, L. Koch, P. Edimiris, A. Enekwe, S. Kasimir-Bauer & R. Kimmig

  2. Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    J. Nagarajah

  3. Department of Gynecological Endocrinology and Reproductive Medicine, University of Heidelberg, Voßstrasse 9, 69115, Heidelberg, Germany

    T. Strowitzki

  4. Institute for Medical Informatics Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    B. Schmidt

Authors
  1. Angela Köninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Edimiris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Enekwe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Nagarajah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Kasimir-Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Kimmig
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Strowitzki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. B. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angela Köninger.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Köninger, A., Koch, L., Edimiris, P. et al. Anti-Mullerian Hormone: an indicator for the severity of polycystic ovarian syndrome. Arch Gynecol Obstet 290, 1023–1030 (2014). https://doi.org/10.1007/s00404-014-3317-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-014-3317-2

Keywords

Search

Navigation