Evaluating serum anti-Müllerian hormone as a diagnostic biomarker for polycystic ovary syndrome in Pakistani women.

BACKGROUND

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders. Its prevalence varies depending on the criteria used for diagnosis. According to National Institutes of Health, a U.S. government agency responsible for biomedical and public health research,  criteria, it affects 6%-10% of women; according to the Rotterdam criteria, it affects 14%-17% of women of childbearing age. Clinically, it can present with oligo/anovulation, infertility, hyperandrogenism, obesity, insulin resistance, and long-term consequences, including metabolic syndrome, type 2 diabetes mellitus, cardiovascular dysfunction, and endometrial cancer. Diagnosing PCOS is challenging due to the lack of unified criteria. According to the Rotterdam criteria, a diagnosis requires at least two of the following three features: Oligo/anovulation Hyperandrogenism (HA) Polycystic ovaries (PCOM), defined as 12 or more follicles measuring 2-9 mm in diameter or an ovarian volume greater than 10 mL. Anti-Müllerian hormone (AMH), also known as Müllerian inhibiting substance (MIS), is produced by granulosa cells of pre-antral and small antral follicles. Its levels vary by age, with low levels until age 8, a sharp rise until age 25, and a steady decline from age 25 to menopause when its production nearly ceases. AMH levels are 2-3 times higher in women with PCOS. Because AMH levels positively correlate with PCOM and androgen levels, they might serve as a reasonable alternative to PCOM on pelvic ultrasound for diagnosing PCOS.

AIMS AND OBJECTIVES

This study aimed to evaluate the diagnostic performance of AMH in women aged 18-40 years with PCOS in Pakistan and to compare its utility with PCOM based on the Rotterdam criteria.

METHODOLOGY

This quantitative study was conducted at Isra University, Karachi, from June 2023 to June 2024. Data were collected from 100 participants clinically diagnosed with PCOS. Exclusion criteria included women younger than 18 or older than 40 years, those with PCOS-related infertility, or those with a history of ovarian surgery or recent hormonal treatments. Serum AMH levels were measured using ELISA kits, and statistical analyses were performed to assess correlations between AMH, PCOM, age, body mass index (BMI), and other variables.

RESULTS

Anti-Müllerian hormone levels showed a significant positive correlation with PCOM (P < 0.0001), confirming its reliability as a diagnostic marker for PCOS. No significant associations were found between AMH and age (P = 0.824), BMI (P = 0.933), or other confounders. No significant association was found between AMH and confounders including age, BMI, and free androgen index (FAI).

CONCLUSION

The study demonstrates the high diagnostic reliability of AMH in PCOS, even in resource-limited settings. AMH might serve as a practical diagnostic option in the absence of ultrasound, particularly in settings where imaging access is limited and costly. However, its cost-effectiveness should be evaluated in local clinical contexts.