Anti-mullerian hormone and antral follicle count in polycystic ovary syndrome and non-polycystic ovary syndrome women

Jwan J. Namik; Shahla K. Alalaf; Namir G. Al Tawil

doi:10.15218/zjms.2018.038

Authors

Jwan J. Namik Maternity Teaching Hospital, Erbil, Iraq.
Shahla K. Alalaf Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq.
Namir G. Al Tawil Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2018.038

Keywords:

Antimullerian hormone, Antral follicular count, Polycystic ovarian syndrome

Abstract

Background and objective: Although the ultimate pathogenesis of polycystic ovary syndrome remains obscure, the distinctive feature is the failure of follicular maturation resulting in an ovulation and accumulation of preantral and small antral follicles which contribute significantly to the production of the anti-mullerian hormone. This study aimed to compare anti-mullerian hormone concentration and antral follicle count in polycystic ovary syndrome and non-polycystic ovary syndrome women regarding clinical, hormonal and ultrasound parameter in both groups.

Methods: A cross-sectional study with comparison group study was conducted in the fertility and gynecology outpatient clinic in the Maternity Teaching Hospital, Erbil, Kurdistan region, Iraq from April 1^st, 2015, to December 31^st, 2015. The study involved a total of 100 infertile women aged 18 - 39 years; 50 polycystic ovary syndrome women based on the Rotterdam criteria and 50 infertile non-polycystic ovary syndrome selected as a comparison group. Anti-mullerian hormone and antral follicle count in both groups were compared.

Results: A strong, inverse and significant correlation was found between anti-mullerian hormone and age in each of the two study groups. A weak correlation was detected between anti-mullerian hormone with body mass index, luteinizing hormone, follicular stimulating hormone, and total testosterone, in each of the two study groups. A significant inverse correlation was detected between anti-mullerian hormone and luteinizing hormone/follicular stimulating hormone ratio in the non-polycystic ovary syndrome group (P <0.001). There was a statistically strong, significant and positive correlation between anti-mullerian hormone and antral follicle count in each of the study groups.

Conclusion: Anti-mullerian hormone and antral follicle count are higher in polycystic ovary syndrome group than in non-polycystic ovary syndrome group. Elevated levels of the anti-mullerian hormone were associated and related to increased number of follicles in women with polycystic ovary syndrome.

Metrics

Metrics Loading ...

References

Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89:2745–9.

Farquhar C. Introduction and history of polycystic ovary syndrome. In Kovacs G, Norman R, editors. Polycystic ovary syndrome. 2nd ed. Cambridge, UK: Cambridge University Press; 2007. P. 4–24.

Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, Merriam GR, editors. Polycystic Ovary Syndrome. Boston: Blackwell Scientific; 1992. P. 377–84.

Escobar-Morreale HF, San Millan JL. Abdominal adiposity and the polycystic ovary syndrome. Trends Endocrinol Metab 2007; 18(7):266–72.

Dewailly D, Pigny P, Soudan B, Catteau-Jonard S, Decanter C, Poncelet E, et al. Reconciling the definitions of polycystic ovary syndrome: The ovarian follicle number and serum anti-mullerian hormone concentrations aggregate with the markers of hyperandrogenism. J Clin Endocrinol Metabol 2010; 95(9):4399–405.

Kwee J, Schats R, McDonnell J, Themmen A, De Jong F, Lambalk C. Evaluation of anti-Mullerian hormone as a test for the prediction of ovarian reserve. Fertil Steril 2008; 90:737–43.

Pigny P, Merlen E, Robert Y, Cortet-Rudelli C, Decanter C, Jonard S, et al. Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab 2003; 88:5957–62.

Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81:19–25.

Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutis implications, etiology, and management. Am J Obstet Gynecol 1981; 140:815–30.

WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363(9403):157–63.

Balen AH, Dresner M, Scott EM, Drife JO. Should obese women with polycystic ovary syndrome receive treatment for infertility? Br Med J 2006; 332:434–5.

Hollinrake E, Abreu A, Maifeld M, Van Voorhis B, Dokras A. Increased risk of depressive disorders in women with polycystic ovary syndrome. Infertil Steril 2007; 87:1369–76.

Ehrmann DA, Lilijenquest DR, Kasza K, Azziz R, Ghazzi MN. Prevalence &predictors of metabolic syndrome in women with polycystic ovary syndrom . J Clin Endocrinol Metab 2006; 91(1):48–53.

Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for PCOS. J Clin Endocrinol Metab 2008; 93:162–8.

Yildirim B, Sabir N, Kaleli B. Relation of intra-abdominal fat distribution to metabolic disorders in non-obese patients with polycystic ovary syndrome. Fertil Steril 2003; 79(6):1358–64.

Azziz R, Marin C, Hog L, Badamgarav E, Song P. Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metabol 2005; 90(8):4650–8.

Williamson K, Gunn AJ, Johnson N, Milsom SR. The impact of ethnicity on the presentation of polycystic ovarian syndrome. Aust N Z J Obstet Gynaecol 2001; 41: 202–6

Wijeyaratne CN, Balen AH, Barth JH, Belchetz PE Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among South Asians and Caucasians: Is there a difference? Clin Endocrinol 2002; 57:343–50.

Dewailly D, Catteau-Jonard S, Reyss AC, Leroy M, Pigny P. Oligoanovulation with polycystic ovaries but not overt hyperandrogenism. J Clin Endocrinol Metabol 2006; 91:3922–92.

Sung YA, Oh JY, Lee H, Chung H. Hyperandrogenemia is implicated in both the metabolic and reproductive morbidities of PCOS. Fertil Steril 2014; 101:840–5.

Woo HY, Kim KH, Rhee EJ, Park H, Lee MK. Differences of the association of AMH with clinical and biochemical characteristics between women with and without PCOS. Endocr J 2012; 59:781–90.

Laven JS, Mulders AG, Visser JA, Themmen AP, De Jong FH, Fauser BC. Anti-Mullerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab 2004; 89:318–23.

Lin Y-H, Chiu W-C, Wu C-H, Tzeng C-R, Hsu C-S, Hsu M-I. Antimüllerian hormone and polycystic ovary syndrome. Fertil Steril 2011; 230:235–96.

Fanchin R, Maria SL, Righini C, Guobourdenche J, Frydman R, Taeib JM. Serum AMH is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3. Hum Reprod 2003; 323:327.

Peltonen T, Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A, Tapanainen JS. Serum anti-Mullerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome. Hum Reprod 2005; 20(7):1820–6.

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; 26:3123–9.

Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, et al. Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod 2013; 28(5):1361–8.

Eldar-Geva T, Margalioth EJ, Gal M, Ben-Chetrit A, Algur N, Zylber-Haran E, et al. Serum anti-Mullerian hormone levels during controlled ovarian hyperstimulation in women with polycystic ovaries with and without hyperandrogenism. Hum Reprod 2005; 20:1814–9.

Nardo LG, Yates AP, Roberts SA, Pemberton P, Laing I. The relationships between AMH, androgens, insulin resistance and basal ovarian follicular status in non-obese subfertile women with and without polycystic ovary syndrome. Hum Reprod 2009; 23:2917–24.