Serum Anti-Müllerian Hormone as a Surrogate for Antral Follicle Count for Definition of the Polycystic Ovary Syndrome

TLDR

Polycystic ovary syndrome is common yet difficult to diagnose, prompting the Rotterdam consensus to add ultrasonographic follicle count as a diagnostic criterion. The study aimed to determine whether serum anti‑Müllerian hormone (AMH) could serve as a reliable surrogate for antral follicle count in PCOS diagnosis. Serum AMH was measured with a second‑generation immunoassay in 73 PCOS patients and 96 controls, and its diagnostic performance was evaluated using receiver operating characteristic curves. AMH levels were three‑fold higher in PCOS patients, correlated with follicle number, yielded an AUC of 0.851, and a 60 pmol/l threshold provided 92 % specificity and 67 % sensitivity, confirming AMH as an accurate marker that could replace follicle count in the Rotterdam definition.

Abstract

Despite its frequency, the polycystic ovary syndrome (PCOS) is still a difficult diagnosis in endocrinology, gynecology, and reproductive medicine. To help solve this issue, the Rotterdam consensus conference proposed to include the ultrasonographic follicle count as a new diagnostic criterion, in addition to hyperandrogenism and oligo-anovulation. Unfortunately, its assessment does not offer sufficient reliability worldwide.The aim of our study was to check whether anti-Müllerian hormone (AMH) measurement in the serum could be a surrogate for antral follicle count in the diagnostic criteria of PCOS.Serum AMH was measured with a second-generation immunoassay in a cohort of 73 PCOS patients and 96 controls, and its diagnostic power was evaluated by receiver operating characteristic curves. PCOS was diagnosed according to the Rotterdam definition.Serum AMH levels were 3-fold higher in PCOS patients than in controls (81.6 vs. 33.5 pmol/liter; P < 0.001) and were significantly related to the follicle number in the two groups. The area under the receiver operating characteristic curve for the AMH assay was 0.851, indicating a good diagnostic potency. Setting the threshold at 60 pmol/liter offered the best compromise between specificity (92%) and sensitivity (67%).The serum AMH level is an accurate marker of the ovarian early antral follicle number and offers a good diagnostic potency. In situations where accurate ultrasonographic data are not available, AMH could thus be used instead of the follicle count as a diagnostic criterion and incorporated as such in the Rotterdam definition of PCOS.