Antimüllerian hormone levels are independently related to ovarian hyperandrogenism and polycystic ovaries

Capsule:
Antimullerian hormone (AMH) levels correlate independently with polycystic ovaries and ovarian hyperandrogenism. AMH levels in PCOS overlap those in volunteers with normal-variant polycystic ovaries. Only substantial AMH elevations are diagnostic of PCOS.

Authors:
Robert L. Rosenfield, M.D., Kristen Wroblewski, M.S., Vasantha Padmanabhan, Ph.D., Elizabeth Littlejohn, M.D., Monica Mortensen, D.O., David A. Ehrmann, M.D.
Volume 98, Issue 1 , Pages 242-249.e4, July 2012

Objective:
To determine the relationship of antimüllerian hormone (AMH) levels to polycystic ovaries and ovarian androgenic function.

Design:
Prospective case-control study.

Setting:
General clinical research center.

Participant(s):
Eumenorrheic asymptomatic volunteers without (V-NO; n = 19; reference population) or with (V-PCO; n = 28) a polycystic ovary and hyperandrogenemic anovulatory subjects grouped according to ovarian function into typical PCOS (PCOS-T; n = 37) and atypical PCOS (PCOS-A; n = 18).

Intervention(s):
Pelvic ultrasonography, short dexamethasone androgen-suppression test (SDAST), and GnRH agonist (GnRHag) test.

Main Outcome Measure(s):
Baseline AMH levels were related to polycystic ovary status, testosterone response to SDAST, and 17-hydroxyprogesterone response to GnRHag test.

Result(s):
AMH levels correlated with SDAST and GnRHag test outcomes. AMH was elevated (>6.2 ng/mL) in 32% of V-PCO versus 5% V-NO. The 21% of V-PCO who met Rotterdam PCOS criteria all had functional ovarian hyperandrogenism, but AMH levels were similar to nonhyperandrogenic V-PCO. AMH >10.7 ng/mL discriminated V-PCO from PCOS with 96% specificity and 41% sensitivity for PCOS-T, and insignificantly for PCOS-A.

Conclusion(s):
AMH levels are independently related to ovarian androgenic function and polycystic ovaries. Very high AMH levels are specific but insensitive for PCOS. In the absence of hyperandrogenism, moderate AMH elevation in women with normal-variant polycystic ovaries seems to indicate an enlarged oocyte pool.

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