The relationship of serum anti-Mullerian hormone with polycystic ovarian morphology and polycystic ovary syndrome: a prospective cohort study.

STUDY QUESTION

What is the relationship of serum anti-Mullerian hormone (AMH) with polycystic ovarian morphology (PCOM) and polycystic ovary syndrome (PCOS)?

SUMMARY ANSWER

Serum AMH concentrations are capable of differentiating between normal ovaries, PCOM and PCOS.

WHAT IS KNOWN ALREADY

Serum AMH levels are high in PCOS reflecting the number of small antral follicles and an intrinsic defect of individual granulosa cells.

STUDY DESIGN, SIZE, DURATION: Data were collected prospectively and analysed from three groups of women: those with PCOS according to Rotterdam criteria, those with PCOM but no symptoms and those with normal ovaries.

PARTICIPANTS/MATERIAL, SETTING, METHODS: Women with PCOS (n = 90), with PCOM (n = 35) and with normal ovaries (controls, n = 90), matched for age and body mass index, were all being treated for infertility at Homerton University Hospital, a tertiary referral centre.

MAIN RESULTS AND THE ROLE OF CHANCE

Using adequate numbers and statistical methods for demographically similar groups, there were significant differences in the mean serum AMH concentrations between women with PCOS [77.6 pmol/l (95% CI 64.8-90.3)], those with PCOM [52.2 pmol/l (95% CI 40.1-64.2)] and controls [23.6 pmol/l (95% CI 20.5-26.7)] (P < 0.001). The combination of AMH >48 pmol/l and LH > 6 IU/l diagnosed 82.6% of women with PCOS. The mean serum FSH was lower in both PCOS and PCOM compared with controls, whereas LH was higher in PCOS compared with PCOM and controls and correlated positively with AMH (r = 0.321, P < 0.01).

LIMITATIONS, REASONS FOR CAUTION: Further research is needed to determine the relationship of AMH, PCOS and PCOM. The study was restricted to women who sought out treatment for infertility.

WIDER IMPLICATIONS OF THE FINDINGS

The study suggests that the severity of symptoms of PCOS is positively related to the number of small follicles and that AMH may play an important part in the pathophysiology of anovulation.

STUDY FUNDING/COMPETING INTEREST: None.