The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Differentiation between polycystic ovary syndrome and polycystic ovarian morphology by means of an anti-Müllerian hormone cutoff value

  • Song, Do Kyeong (Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Oh, Jee-Young (Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Lee, Hyejin (Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Sung, Yeon-Ah (Department of Internal Medicine, Ewha Womans University School of Medicine)
  • Received : 2016.02.09
  • Accepted : 2016.05.29
  • Published : 2017.07.01
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Abstract

Background/Aims: Although increased serum $anti-M{\ddot{u}}llerian$ hormone (AMH) level has been suggested to be a surrogate marker of polycystic ovarian morphology (PCOM), its association with polycystic ovary syndrome (PCOS) is controversial, and its diagnostic value has not been determined. We aimed to observe the relationship between the AMH level and PCOS phenotypes and to determine the optimal cutoff value of AMH for the diagnosis of PCOS in young Korean women. Methods: We recruited 207 women with PCOS (120 with PCOM and 87 without PCOM) and 220 regular cycling women with normoandrogenemia (100 with PCOM and 120 without PCOM). Subjects underwent testing at a single outpatient visit. Serum AMH level was measured. Results: Women with PCOS had higher serum AMH levels than did regular cycling women with normoandrogenemia (p < 0.05). Women with PCOM had higher serum AMH levels than women without PCOM, regardless of PCOS status (p < 0.05). The optimal AMH cutoff value for the diagnosis of PCOS was 10.0 ng/mL (71% sensitivity, 93% specificity). Serum AMH was an independent determinant of total testosterone after adjustment for age, body mass index, and the number of menses/year (${\beta}=0.31$, p < 0.01). An association between AMH and hyperandrogenism was only observed in women with PCOS, and it was independent of the presence of PCOM. Conclusion: The serum AMH level can be useful for the diagnosis of PCOS at any age less than 40 years, and the optimal cutoff value for the diagnosis of PCOS identified in this study of young Korean women was 10.0 ng/mL.

Keywords

References

  1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745-2749. https://doi.org/10.1210/jc.2003-032046
  2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
  3. Robin G, Gallo C, Catteau-Jonard S, et al. Polycystic ovary-like abnormalities (PCO-L) in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 2012;97:4236-4243. https://doi.org/10.1210/jc.2012-1836
  4. Keevil BG. How do we measure hyperandrogenemia in patients with PCOS? J Clin Endocrinol Metab 2014;99:777-779. https://doi.org/10.1210/jc.2014-1307
  5. Weenen C, Laven JS, Von Bergh AR, et al. Anti-Mullerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod 2004;10:77-83. https://doi.org/10.1093/molehr/gah015
  6. Pigny P, Merlen E, Robert Y, et al. 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 2003;88:5957-5962. https://doi.org/10.1210/jc.2003-030727
  7. Sahmay S, Atakul N, Oncul M, Tuten A, Aydogan B, Seyisoglu H. Serum anti-Mullerian hormone levels in the main phenotypes of polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2013;170:157-161. https://doi.org/10.1016/j.ejogrb.2013.05.019
  8. Rosenfield RL, Wroblewski K, Padmanabhan V, Littlejohn E, Mortensen M, Ehrmann DA. Antimullerian hormone levels are independently related to ovarian hyperandrogenism and polycystic ovaries. Fertil Steril 2012;98:242-249. https://doi.org/10.1016/j.fertnstert.2012.03.059
  9. Sahmay S, Aydin Y, Oncul M, Senturk LM. Diagnosis of polycystic ovary syndrome: AMH in combination with clinical symptoms. J Assist Reprod Genet 2014;31:213-220. https://doi.org/10.1007/s10815-013-0149-0
  10. Pinola P, Morin-Papunen LC, Bloigu A, et al. Anti-Mullerian hormone: correlation with testosterone and oligo-or amenorrhoea in female adolescence in a population-based cohort study. Hum Reprod 2014;29:2317-2325. https://doi.org/10.1093/humrep/deu182
  11. Iliodromiti S, Kelsey TW, Anderson RA, Nelson SM. Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab 2013;98:3332-3340. https://doi.org/10.1210/jc.2013-1393
  12. Dewailly D, Gronier H, Poncelet E, et al. 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 2011;26:3123-3129. https://doi.org/10.1093/humrep/der297
  13. Li Y, Ma Y, Chen X, et al. Different diagnostic power of anti-Mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet 2012;29:1147-1151. https://doi.org/10.1007/s10815-012-9839-2
  14. Cui Y, Shi Y, Cui L, Han T, Gao X, Chen ZJ. Age-specific serum antimullerian hormone levels in women with and without polycystic ovary syndrome. Fertil Steril 2014;102:230-236. https://doi.org/10.1016/j.fertnstert.2014.03.032
  15. Lauritsen MP, Bentzen JG, Pinborg A, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Mullerian hormone. Hum Reprod 2014;29:791-801. https://doi.org/10.1093/humrep/det469
  16. Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2012;18:146-170. https://doi.org/10.1093/humupd/dmr042
  17. Sung YA. Hyperandrogenism in women: polycystic ovary syndrome. Hanyang Med Rev 2012;32:197-202. https://doi.org/10.7599/hmr.2012.32.4.197
  18. Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 2003;9:505-514. https://doi.org/10.1093/humupd/dmg044
  19. Homburg R, Ray A, Bhide P, et al. The relationship of serum anti-Mullerian hormone with polycystic ovarian morphology and polycystic ovary syndrome: a prospective cohort study. Hum Reprod 2013;28:1077-1083. https://doi.org/10.1093/humrep/det015
  20. Koninger A, Koch L, Edimiris P, et al. Anti-Mullerian hormone: an indicator for the severity of polycystic ovarian syndrome. Arch Gynecol Obstet 2014;290:1023-1030. https://doi.org/10.1007/s00404-014-3317-2
  21. Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC. Anti-Mullerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab 2004;89:318-323. https://doi.org/10.1210/jc.2003-030932
  22. Piltonen T, Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A, Tapanainen JS. Serum anti-Mullerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome. Hum Reprod 2005;20:1820-1826. https://doi.org/10.1093/humrep/deh850
  23. Pigny P, Jonard S, Robert Y, Dewailly D. Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91:941-945. https://doi.org/10.1210/jc.2005-2076
  24. Nardo LG, Yates AP, Roberts SA, Pemberton P, Laing I. 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 2009;24:2917-2923. https://doi.org/10.1093/humrep/dep225
  25. Eldar-Geva T, Margalioth EJ, Gal M, et al. Serum anti-Mullerian hormone levels during controlled ovarian hyperstimulation in women with polycystic ovaries with and without hyperandrogenism. Hum Reprod 2005;20:1814-1819. https://doi.org/10.1093/humrep/deh873
  26. 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;10:107-117. https://doi.org/10.1093/humupd/dmh010
  27. Durlinger AL, Visser JA, Themmen AP. Regulation of ovarian function: the role of anti-Mullerian hormone. Reproduction 2002;124:601-609. https://doi.org/10.1530/rep.0.1240601
  28. Chen MJ, Yang WS, Chen CL, Wu MY, Yang YS, Ho HN. The relationship between anti-Mullerian hormone, androgen and insulin resistance on the number of antral follicles in women with polycystic ovary syndrome. Hum Reprod 2008;23:952-957. https://doi.org/10.1093/humrep/den015
  29. Wang JG, Nakhuda GS, Guarnaccia MM, Sauer MV, Lobo RA. Mullerian inhibiting substance and disrupted folliculogenesis in polycystic ovary syndrome. Am J Obstet Gynecol 2007;196:77.
  30. Hwang YI, Sung NY, Koo HS, et al. Can high serum anti-Mullerian hormone levels predict the phenotypes of polycystic ovary syndrome (PCOS) and metabolic disturbances in PCOS patients? Clin Exp Reprod Med 2013;40:135-140. https://doi.org/10.5653/cerm.2013.40.3.135
  31. Li L, Chen X, Mo Y, Chen Y, Wenig M, Yang D. Elevated serum anti-mullerian hormone in adolescent and young adult Chinese patients with polycystic ovary syndrome. Wien Klin Wochenschr 2010;122:519-524. https://doi.org/10.1007/s00508-010-1426-x
  32. Tremellen K, Zander-Fox D. Serum anti-Mullerian hormone assessment of ovarian reserve and polycystic ovary syndrome status over the reproductive lifespan. Aust N Z J Obstet Gynaecol 2015;55:384-389. https://doi.org/10.1111/ajo.12366
  33. Woo HY, Kim KH, Rhee EJ, Park H, Lee MK. Differences of the association of anti-Mullerian hormone with clinical or biochemical characteristics between women with and without polycystic ovary syndrome. Endocr J 2012;59:781-790. https://doi.org/10.1507/endocrj.EJ12-0055
  34. Han X, McShane M, Sahertian R, White C, Ledger W. 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 2014;29:1042-1048. https://doi.org/10.1093/humrep/deu050
  35. Carmina E, Campagna AM, Mansuet P, Vitale G, Kort D, Lobo R. Does the level of serum antimullerian hormone predict ovulatory function in women with polycystic ovary syndrome with aging? Fertil Steril 2012;98:1043-1046. https://doi.org/10.1016/j.fertnstert.2012.06.017

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