Anti-Mullerian hormone reflects the severity of polycystic ovary syndrome

ObjectiveTo examine the relationship between anti-Mullerian hormone (AMH) and the severity of the phenotype of patients with polycystic ovary syndrome (PCOS) and whether AMH can act as a diagnostic marker for PCOS? DesignA prospective diagnostic utility study of AMH as a marker of PCOS. PatientsA consecutive series of women presenting to a tertiary infertility clinic (n = 164) plus a second series of women prepared for assisted conception treatments (n = 89) recruited between June 2012 and May 2013. MeasurementsPolycystic ovary syndrome was diagnosed using the Rotterdam criteria. AMH was measured using the Generation II assay (Beckman Coulter). The diagnostic utility of AMH was established using receiver operator characteristic (ROC) curves. Cut-off values for the individual features of PCOS are proposed. ResultsThere was a significant difference in serum AMH concentration in women with normal ovaries (132 pmol/l), polycystic ovary morphology (PCOM) alone (378 pmol/l) and PCOS (532 pmol/l). Follicle number, increasing cycle length and evidence of hyperandrogenism were all independently associated with serum AMH concentration (P < 001). AMH was significantly affected by the different phenotypic presentations of PCOS with those with all components (PCOM, HA and OA) having the highest mean value [727 pmol/l (P < 001)]. ConclusionsSerum AMH has the capacity to act as a diagnostic test for PCOS. Moreover, since its value rises with the more marked phenotypes, different cut-off values need to be used to differentiate those patients with polycystic ovarian morphology (PCOM), hyperandrogenism (HA) and oligoanovulation (OA).