Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland.
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Semin Reprod Med. 2024 Mar;42(1):49-59. doi: 10.1055/s-0044-1786731. Epub 2024 May 22.
The 2023 international evidence-based guideline update for the assessment and management of polycystic ovary syndrome (PCOS) recommends using the Rotterdam criteria for the diagnosis of PCOS. The updated guideline has evidence-based recommendation for the diagnosis, and it now also includes serum anti-Müllerian hormone (AMH) measurement as an alternative tool for gynecological ultrasound to diagnose polycystic ovary morphology (PCOM). The aim of this new recommendation was to facilitate PCOS diagnostic workup in primary care and other disciplines, as currently most diagnosing is done in gynecology and infertility clinics. Here, we review factors affecting AMH levels as well as the utility of AMH in PCOS diagnosis. We identified relevant studies that report different cut-offs for AMH to diagnose PCOM as part of PCOS diagnosis. There are, however, some limitations when using AMH that should be acknowledged. These include physiological aspects like age, ethnicity, and obesity and iatrogenic causes like hormonal medication and ovarian surgery. Also reference ranges are different depending on AMH assay used. As a summary, we conclude that AMH is a usable tool in PCOM diagnostics, but it does not have a single cut-off. Therefore, further studies are needed to establish age and assay-based reference ranges.
2023 年国际多囊卵巢综合征（PCOS）评估和管理循证指南更新建议使用鹿特丹标准诊断 PCOS。该更新指南为诊断提供了循证推荐，现在还包括血清抗苗勒管激素（AMH）测量作为妇科超声诊断多囊卵巢形态（PCOM）的替代工具。这一建议的目的是为了促进初级保健和其他学科的 PCOS 诊断工作，因为目前大多数诊断都是在妇科和不孕不育诊所进行的。在这里，我们回顾了影响 AMH 水平的因素，以及 AMH 在 PCOS 诊断中的应用。我们确定了一些相关研究，这些研究报告了不同的 AMH 截断值用于诊断 PCOM，作为 PCOS 诊断的一部分。然而，在使用 AMH 时存在一些需要注意的局限性。这些局限性包括生理方面，如年龄、种族和肥胖，以及医源性因素，如激素药物和卵巢手术。此外，参考范围还取决于所使用的 AMH 检测方法。总的来说，我们得出结论，AMH 是 PCOM 诊断中可用的工具，但它没有单一的截断值。因此，需要进一步的研究来建立基于年龄和检测方法的参考范围。
