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Journal of Assisted Reproduction and Genetics

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01-02-2014 | Assisted Reproduction Technologies

Diagnosis of Polycystic Ovary Syndrome: AMH in combination with clinical symptoms

Authors: Sezai Sahmay, Yavuz Aydin, Mahmut Oncul, Levent M. Senturk

Published in: Journal of Assisted Reproduction and Genetics | Issue 2/2014

Abstract

Purpose

We assessed the utility of using anti-Müllerian hormone (AMH) and clinical features of polycystic ovary syndrome (PCOS), polycystic ovarian morphology (PCOM), oligo/amenorrhea (OA), and hyperandrogenism (HA) for diagnosing PCOS, and compared their diagnostic accuracy with those of classical diagnostic systems.

Methods

A total of 606 females were admitted to a university hospital with menstrual irregularities or symptoms of hyperandrogenism were enrolled in this cross-sectional study. Fasting blood samples were collected. Pelvic and/or abdominal ultrasonography and clinical examination were performed. Patients were evaluated for the presence of PCOS according to conventional diagnostic criteria. The diagnostic performance of using serum AMH levels alone and in various combinations with the clinical features of PCOM, OA, and HA were investigated.

Results

For the diagnosis of PCOS, the combination of OA and/or HA with AMH showed 83 % sensitivity and 100 % specificity according to the Rotterdam criteria; 83 % sensitivity and 89 % specificity according to the National Institutes of Health (NIH) criteria; and 82 % sensitivity and 93.5 % specificity according to the Androgen Excess Society (AES) criteria.

Conclusions

The serum AMH level is a useful diagnostic marker for PCOS and is correlated with conventional diagnostic criteria. The combination of AMH level with OA and/or HA markedly increased the clinical scope for PCOS diagnosis and can be introduced as a possible objective criterion for the diagnosis of this disease.

March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25:544–51.PubMedCrossRef

Franks S. Polycystic ovary syndrome. N Engl J Med. 1995;333:853–61.PubMedCrossRef

Lee MM, Donahoe PK, Hasegawa T, Silverman B, Crist GB, Best S, et al. Müllerian inhibiting substance in humans: normal levels from infancy to adulthood. J Clin Endocrinol Metab. 1996;81:571–6.PubMed

de Vet A, Laven JS, de Jong FH, Themmen AP, Fauser BC. AntiMüllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril. 2002;77:357–62.PubMedCrossRef

Anderson RA. What does anti-Müllerian hormone tell you about ovarian function? Clin Endocrinol (Oxf). 2012;77:652–5.CrossRef

Fanchin R, Taieb J, Lozano DH, Ducot B, Frydman R, Bouyer J. High reproducibility of serum anti-Müllerian hormone measurements suggests a multi-staged follicular secretion and strengthens its role in the assessment of ovarian follicular status. Hum Reprod. 2005;20:923–7.PubMedCrossRef

Hehenkamp WJ, Looman CW, Themmen AP, de Jong FH, Te Velde ER, Broekmans FJ. Anti-Müllerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. J Clin Endocrinol Metab. 2006;91:4057–63.PubMedCrossRef

Sahmay S, Cetin M, Ocal P, Kaleli S, Senol H, Birol F, et al. Serum anti-Müllerian hormone level as a predictor of poor ovarian response in in vitro fertilization patients. Reprod Biol Endocrinol. 2011;10:9–14.CrossRef

Ocal P, Sahmay S, Cetin M, Irez T, Guralp O, Cepni I. Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles. J Assist Reprod Genet. 2011;28:1197–203.PubMedCrossRef

10.

Sahmay S, Demirayak G, Guralp O, Ocal P, Senturk LM, Oral E, et al. Serum anti-Müllerian hormone, follicle stimulating hormone and antral follicle count measurement cannot predict pregnancy rates in IVF/ICSI cycles. J Assist Reprod Genet. 2012;29:589–95.PubMedCrossRef

11.

Sahmay S, Guralp O, Aydogan B, Cepni I, Oral E, Irez T. Anti-Müllerian hormone and polycystic ovary syndrome: assessment of the clinical pregnancy rates in in vitro fertilization patients. Gynecol Endocrinol. 2013;29:440–3.PubMedCrossRef

12.

Franks S, Stark J, Hardy K. Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update. 2008;14:367–78.PubMedCrossRef

13.

Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, et al. Elevated serum level of anti-Müllerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab. 2003;88:5957–62.PubMedCrossRef

14.

Weenen C, Laven JS, Von Bergh AR, Cranfield M, Groome NP, Visser JA, et al. Anti-Müllerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod. 2004;10:77–83.PubMedCrossRef

15.

Pigny P, Jonard S, Robert Y, Dewailly D. Serum anti-Müllerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91:941–5.PubMedCrossRef

16.

Jonard S, Dewailly D. The follicular excess in polycystic ovaries, due to intra-ovarian hyperandrogenism, may be the main culprit for the follicular arrest. Hum Reprod Update. 2004;10:107–17.PubMedCrossRef

17.

Dewailly D, Pigny P, Soudan B, Catteau-Jonard S, Decanter C, Poncelet E, et al. 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. 2010;95:4399–405.PubMedCrossRef

18.

Rosenfield RL, Wroblewski K, Padmanabhan V, Littlejohn E, Mortensen M, Ehrmann DA. AntiMüllerian hormone levels are independently related to ovarian hyperandrogenism and polycystic ovaries. Fertil Steril. 2012;98:242–9.PubMedCentralPubMedCrossRef

19.

Wang JG, Nakhuda GS, Guarnaccia MM, Sauer MV, Lobo RA. Müllerian inhibiting substance and disrupted folliculogenesis in polycystic ovary syndrome. Am J Obstet Gynecol. 2007;196:77 e1–5.

20.

Das M, Gillott DJ, Saridogan E, Djahanbakhch O. Anti-Müllerian hormone is increased in follicular fluid from unstimulated ovaries in women with polycystic ovary syndrome. Hum Reprod. 2008;23:2122–6.PubMedCrossRef

21.

Taylor AE, McCourt B, Martin KA, Anderson EJ, Adams JM, Schoenfeld D, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1997;82:2248–56.PubMed

22.

Legro RS, Chiu P, Kunselman AR, Bentley CM, Dodson WC, Dunaif A. Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype. J Clin Endocrinol Metab. 2005;90:2571–9.PubMedCrossRef

23.

Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19–25

24.

Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91:456–88.PubMedCrossRef

25.

Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine F, Merriam GR, editors. Polycystic ovary syndrome. Boston: Blackwell Scientific; 1992. p. 377.

26.

Adams J, Franks S, Polson DW, Mason HD, Abdulwahid N, Tucker M, et al. Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin releasing hormone. Lancet. 1985;2:1375–9.PubMedCrossRef

27.

Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003;9:505–14.PubMedCrossRef

28.

Broekmans FJ, de Ziegler D, Howles CM, Gougeon A, Trew G, Olivennes F. The antral follicle count: practical recommendations for better standardization. Fertil Steril. 2010;94:1044–51.PubMedCrossRef

29.

Sahmay S, Atakul N, Ocul M, Tuten A, Aydogan B, Seyisoglu H. Serum anti-Müllerian hormone levels in the main phenotypes of polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):157–61.PubMedCrossRef

30.

Weerakiet S, Lertvikool S, Tingthanatikul Y, Wansumrith S, Leelaphiwat S, Jultanmas R. Ovarian reserve in women with polycystic ovary syndrome who underwent laparoscopic ovarian drilling. Gynecol Endocrinol. 2007;23:455–60.PubMedCrossRef

31.

Cook CL, Siow Y, Brenner AG, Fallat ME. Relationship between serum Müllerian-inhibiting substance and other reproductive hormones in untreated women with polycystic ovary syndrome and normal women. Fertil Steril. 2002;77:141–6.PubMedCrossRef

32.

Piltonen T, Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A, Tapanainen JS. Serum anti-Müllerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome. Hum Reprod. 2005;20:1820–6.PubMedCrossRef

33.

Sahmay S, Guralp O, Senturk L, Imamoglu M, Kucuk M, Irez T. Serum anti-Müllerian hormone concentrations in reproductive age women with and without polycystic ovary syndrome: the influence of body mass index. Reprod Med Biol. 2011;10:113–20.CrossRef

34.

Thomson RL, Buckley JD, Moran LJ, Noakes M, Clifton PM, Norman RJ, et al. The effect of weight loss on anti-Müllerian hormone levels in overweight and obese women with polycystic ovary syndrome and reproductive impairment. Hum Reprod. 2009;24:1976–81.PubMedCrossRef

35.

Bungum L, Jacobsson AK, Rosen F, Becker C, Yding Andersen C, Guner N, et al. Circadian variation in concentration of anti-Müllerian hormone in regularly menstruating females: relation to age, gonadotrophin and sex steroid levels. Hum Reprod. 2011;26:678–84.PubMedCrossRef

36.

Li Y, Ma Y, Chen X, Wang W, Zhang Q, Yang D. Different diagnostic power of anti-Müllerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet. 2012;29:1147–51.PubMedCrossRef

37.

Eldar-Geva T, Margalioth EJ, Gal M, Ben-Chetrit A, Algur N, Zylber-Haran E, et al. Serum anti-Müllerian hormone levels during controlled ovarian hyperstimulation in women with polycystic ovaries with and without hyperandrogenism. Hum Reprod. 2005;20:1814–9.PubMedCrossRef

38.

Fleming R, Harborne L, MacLaughlin DT, Ling D, Norman J, Sattar N, et al. Metformin reduces serum Müllerian-inhibiting substance levels in women with polycystic ovary syndrome after protracted treatment. Fertil Steril. 2005;83:130–6.PubMedCrossRef

39.

La Marca A, Orvieto R, Giulini S, Jasonni VM, Volpe A, De Leo V. Müllerian-inhibiting substance in women with polycystic ovary syndrome: relationship with hormonal and metabolic characteristics. Fertil Steril. 2004;82:970–2.PubMedCrossRef

40.

Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC. Anti-Müllerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab. 2004;89:318–23.PubMedCrossRef

41.

Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D. Anti-Müllerian hormone levels reflect severity of PCOS but are negatively influenced by obesity: relationship with increased luteinizing hormone levels. Am J Physiol Endocrinol Metab. 2009;296:E238–43.PubMedCrossRef

42.

Eilertsen TB, Vanky E, Carlsen SM. Anti-Müllerian hormone in the diagnosis of polycystic ovary syndrome: can morphologic description be replaced? Hum Reprod. 2012;27:2494–502.PubMedCrossRef

Title: Diagnosis of Polycystic Ovary Syndrome: AMH in combination with clinical symptoms
Authors: Sezai Sahmay
Yavuz Aydin
Mahmut Oncul
Levent M. Senturk
Publication date: 01-02-2014
Publisher: Springer US
Published in: Journal of Assisted Reproduction and Genetics / Issue 2/2014
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-013-0149-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnosis of Polycystic Ovary Syndrome: AMH in combination with clinical symptoms

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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