Role of anti-mullerian hormone as a diagnostic tool for polycystic ovary syndrome

Shakun Singh, Arshiya Firdaus, Rachna Choudhary, Vandana Dhama


Background: PCOS has been recognized as the most frequent endocrinopathy among reproductive aged women. This study has been done to determine whether the measurement of serum AMH can be used to diagnose PCOS and as a tool to predict the prognosis of PCOS.

Methods: This was a prospective case control study on a woman attending gynae OPD of LLRM Medical College, Meerut, from May 2018 to June 2019. Study comprised of 50 women diagnosed with PCOS using Rotterdam criteria and 50 controls. Clinical data were collected including history, oligomenorrhea, hirsutism, examination included BMI, FG score and blood investigations including serum FSH, LH, TSH, prolactin, estradiol and serum AMH level. USG was done for all women.

Results: Both PCOS cases and controls were matched for age and BMI. Mean level of AMH in PCOS cases and controls was 7.1096 and 2.423 respectively, AMH was two to three times higher in women with PCOS than controls which was statistically significant (p<0.05). Most frequent phenotype of PCOS in this study was phenotype A (48%). Highest mean level of AMH was also found in phenotype A (OA+HA+PCOM), thus reflecting the severity of PCOS. Maximum diagnostic potential for PCOS was at cut off 4.22 ng/ml with sensitivity of 92.5% and specificity of 100%.

Conclusions: AMH level can be used as diagnostic and prognostic modalities in PCOS. AMH value rises when hyperandrogenism is present therefore serum AMH levels also reflect the phenotype of PCOS and severity of PCOS.


Anti-mullerian hormone, Hyperandrogenism, Oligomenorrhea, Polycystic morphology, Polycystic ovarian syndrome, Rotterdam criteria

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Sahmay S, Atakul N, Aydogan B, Aydın Y, Imamoglu M, Seyisoglu H. Elevated serum levels of anti‐Müllerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2013;92(12):1369-74.

Bozdag G, Mumusoglu S, Coskun ZY, Yarali H, Yildiz BO. Anti-müllerian hormone as a diagnostic tool for PCOS under different diagnostic criteria in an unselected population. Reprod Biomed. 2019;39(3):522-9.

Umland EM, Weinstein LC, Buchanan EM. Menstruation-related disorders. In: DiPiro JT, Talbert RL, Yee GC, et al. Editors. Pharmacotherapy: a pathophysiologic approach. 8th ed. New York: McGraw-Hill; 2011:1393.

Lin LH, Baracat MC, Maciel GA, Soares JM, Baracat EC. Androgen receptor gene polymorphism and polycystic ovary syndrome. Int J Gynaecol Obstet. 2013;120:115-118.

Aubuchon M, Legro RS. Polycystic ovary syndrome: Current infertility management. Clin Obstet Gynecol. 2011;54(4):675-84.

Broekmans FJ, de Ziegler D, Howles CM, Gougeon A, Trew G, Olivennes F. The antral follicle count: practical recommendations for better standardization. Fertil Steril. 2010;94(3):1044-51.

Duijkers IJ, Klipping C. Polycystic ovaries, as defined by the 2003 Rotterdam consensus criteria, are found to be very common in young healthy women. Gynecol Endocrinol. 2010;26(3):152-60.

Johnstone EB, Rosen MP, Neril R, Trevithick D, Sternfeld B, Murphy R, et al. The polycystic ovary post-Rotterdam: a common, age dependent finding in ovulatory women without metabolic Bibliography 85 significance. J Clin Endocrinol Metabol. 2010;95(11):4965-72.

Kristensen SL, Ramlau-Hansen CH, Ernst E, Olsen SF, Bonde JP, Vested A, et al. A very large proportion of young Danish women have polycystic ovaries: is a revision of the Rotterdam criteria needed?. Human Reprod. 2010;25(12):3117-22.

Bako AU, Morad S, Atiomo WA. Polycystic ovary syndrome: an overview. Rev Gynaecol Pract. 2005;5(2):115-22.

Saxena U, Ramani M, Singh P. Role of AMH as diagnostic tool for polycystic ovarian syndrome. The J Obstet Gynecol India. 2018;68(2):117-22.

Wiweko B, Maidarti M, Priangga MD, Shafira N, Fernando D, Sumapraja K, et al. Anti-mullerian hormone as a diagnostic and prognostic tool for PCOS patients. J Assisted Reprod Genet. 2014;31(10):1311-6.

Johnstone EB, Rousseau JA, Lamb JD, Huddleston HG, Cedars MI. Age bias in polycystic ovary syndrome (PCOS) diagnostic criteria limits diagnosis among those at greatest cardiovascular risk. Fertil Steril. 2009;92(3):S38.

Johnstone EB, Rosen MP, Neril R, Trevithick D, Sternfeld B, Murphy R, et al. The polycystic ovary post-rotterdam: a common, age-dependent finding in ovulatory women without metabolic significance. J Clin Endocrinol Metab. 2010;95(11):4965-72.

Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Human Reprod. 2012;27(10):3067-73.

Pigny P, Jonard S, Robert Y, Dewailly D. Serum anti-mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metabol. 2006;91(3):941-5.

Li Y, Ma Y, Chen X, Wang W, Li Y, Zhang Q, et al. Different diagnostic power of anti-mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet. 2012;29(10):1147-51.

Hart R, Doherty DA, Norman RJ, Franks S, Dickinson JE, Hickey M, et al. Serum anti-mullerian hormone (AMH) levels are elevated in adolescent girls with polycystic ovaries and the polycystic ovarian syndrome (PCOS). Fertil Steril. 2010;94:1118-21.

Pellatt L, Hanna L, Brincat M, Galea R, Brain H, Whitehead S, et al. Granulosa cell production of anti-mullerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2007;92(1):240-5.

Weerakiet S, Lertvikool S, Tingthanatikul Y, Wansumrith S, Leelaphiwat S, Jultanmas R. Ovarian reserve in women with polycystic ovary syndrome who underwent laparoscopic ovarian drilling. Gynecol Endocrinol. 2007;23(8):455-60.

Dewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, et al. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod. 2011;26(11):3123-9.

Saikumar P, SelVi VK, Prabhu K, VenKateSh P, KriShna P. Anti-mullerian hormone: a potential marker for recruited non growing follicle of ovarian pool in women with polycystic ovarian syndrome. J Clin Diagn Res. 2013;7(9):1866-9.

Woo H, Kim KH, Rhee EJ, Park H, Lee MK. Differences of the association of anti-Mullerian hormone with clinical or biochemical characteristics between women with and without polycystic ovary syndrome. Endocr J. 2012;59(9):781-90.

Lin Y, Chiu WC, Wu CH, Tzeng CR, Hsu CS, Hsu MI. Antimullerian hormone and polycystic ovary syndrome. Fertil Steril. 2011;96:230-5.