Correlation of Homeostatic Model Assessment-Insulin Resistance, Anti-Mullerian Hormone, and BMI in the Characterization of Polycystic Ovary Syndrome

Bahadur, Anupama; Verma, Neha; Mundhra, Rajlaxmi; Chawla, Latika; Ajmani, Megha; Sri, Modalavalasa Swetha; Arora, Shivaani

doi:10.7759/cureus.16047

Cited by 11 publications

(7 citation statements)

References 28 publications

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“…Recently, AMH was evaluated in women with polycystic ovarian syndrome, and was found to be significantly and negatively correlated with BMI and waist-to-height ratio [ 28 ]. The mechanisms underlying this inverse correlation between AMH and BMI are still unclear, though the impact of insulin resistance on follicular development in PCOS has been speculated [ 29 ]. Interestingly, it has been suggested that the inverse relationship between serum levels of AMH and BMI could be the result of hormone dilution due to higher blood volume in women with elevated BMI [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of anti-Müllerian hormone in pre-menopausal women stratified according to thyroid function, autoimmunity and age

Giusti

Mittica²

2022

Thyroid Res

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Background AMH is a reliable index of ovarian reserve. It is not clear whether, or how much, thyroid function and/or thyroid autoimmunity can impair ovarian function and AMH secretion in the long term. Aim This retrospective cross-sectional study compared AMH levels in pre-menopausal women with/without positive thyroid autoimmunity or hypofunction. Methods From January 2019 to May 2022, AMH was evaluated in 250 pre-menopausal women not undergoing assisted fertility procedures who were referred to a secondary endocrine centre. Thyroid function and autoimmunity, sonographically measured thyroid volume, FSH and E2 in the early follicular phase, and PRL and progesterone in the luteal phase were also evaluated. Exclusion criteria were: age < 18 years, genetic hypogonadism, pregnancy and previous treatments that have potentially damaging effects on gonads. Results We evaluated 171 women (mean age ± SD: 31.5 ± 9.0 years) off L-T4 treatment and 79 women on L-T4 treatment (39.7 ± 9.5 years; P < 0.001). AMH (median, IQR, CI) was 16.1 pmol/l (7.1 – 35.7 pmol/l, 21.4 – 29.9 pmol/l) and 7.6 pmol/l (1.4 – 17.8 pmol/l, 8.6 – 14.7 pmol/l; P < 0.001), respectively. When the women were stratified according to age (18-25, 26-30, 31-35, 36-40, 41-45, > 46 years) no significant difference emerged between those on/off L-T4 treatment in groups of the same age-range. In women on- or off-L-T4 treatment, AMH was negatively related with age on univariate and multivariate analyses (P < 0.0001). In both groups, AMH was negatively related to FSH (P < 0.0001). On multivariate analysis, AMH was positively related to the age of the mother on spontaneous menopause (P = 0.006) and negatively to thyroid volume (P = 0.02) in women on L-T4. AMH levels were significantly (P = 0.03) higher in TPOAb-negative than in TPOAb-positive women, but age was significantly (P = 0.001) lower in TPOAb-negative than in TPOAb-positive women. Conclusions In our cohort of women, age proved to be a better predictor of AMH levels than any of the other factors linked to thyroid function and autoimmunity. Our data do not support the hypothesis that subclinical hypothyroidism and/or autoimmunity are associated with decreased ovarian reserve. However, a larger number of cases is needed in order to obtain conclusive data.

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Section: Discussionmentioning

confidence: 99%

Evaluation of anti-Müllerian hormone in pre-menopausal women stratified according to thyroid function, autoimmunity and age

Giusti

Mittica²

2022

Thyroid Res

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“…Early onset adiposity has been implicated in the pathogenesis of PCOS and can be predictive of a more severe phenotype. It is also linked to the development of low-grade inflammation, greater cardiometabolic dysfunction and future risk of atherosclerosis [12][13][14][15]. Our data shows that as an indicator of visceral fat function, VAI correlates well with severity of menstrual dysfunction and ovarian dysmorphology, and seems to be predictive of impaired glucose tolerance, thus indicating propensity for development of diabetes in the future.…”

Section: Discussionmentioning

confidence: 63%

Visceral Adiposity Index as an Indicator for Menstrual Disturbance, Hormonal and Metabolic Dysfunction in Polycystic Ovarian Syndrome

Sarkar¹,

Kaur²,

Gupta³

et al. 2022

Cureus

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Background: Increase in visceral adiposity is characteristic of polycystic ovarian syndrome (PCOS) and is the main cause of insulin resistance and hyperandrogenism. This study tried to compare the visceral adiposity index (VAI) in PCOS women and control population, thereby exploring its correlation with ovarian morphology, hormonal and metabolic dysfunction.Materials and Methods: Reproductive-age women who fulfilled the Rotterdam criteria for PCOS constituted the cases. Control population consisted of the same number of non-PCOS women. History of menstrual irregularity and features of hyperandrogenism were noted. Overnight fasting serum hormonal profile on second day of the cycle, oral glucose tolerance test (OGTT) and serum fasting insulin and lipid profile were obtained. Ultrasound evaluation was done simultaneously. Free androgen index (FAI), homeostatic model assessment of insulin resistance (HOMA-IR) and VAI were calculated.Results: Serum androgen levels and OGTT were greater in PCOS women. No significant difference was noted in serum fasting glucose, fasting insulin and lipid profile between cases and controls. Both systolic and diastolic blood pressures were significantly higher among women with PCOS. Mean ovarian volume, antral follicle count, FAI and HOMA-IR were higher in PCOS women. VAI was significantly higher in cases compared to controls. VAI demonstrated a strong negative correlation with number of menstrual cycles per year. Increasing VAI was associated with longer menstrual cycles and correlated positively with greater severity of anovulation. VAI also showed highly significant correlation with fasting blood glucose and statistically significant moderately strong positive correlation with OGTT values at two hours post glucose challenge, systolic blood pressure and mean ovarian volume. There was no demonstrable correlation between androgen levels or HOMA-IR values.Conclusion: VAI is higher in women with PCOS. It correlates positively with features of disease severity and ovarian morphology. An assessment of VAI in PCOS women could be predictive of a greater propensity for development of classical metabolic risk factors.

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“…Excessive insulin levels have been shown to alter granulosa cell uptake, and subsequently, AMH production. 23 In addition, the increased leptin production associated with obesity may directly suppress AMH production. This condition stems from the inhibitory effect of leptin on the expression of the AMH receptor gene.…”

Section: Discussionmentioning

confidence: 99%

Ovarian Reservation in Women with Ovarian Endometriosis Cyst after Laparoscopic Cystectomy and Leuprorelin Acetate Administration

Akhmad,

Trisetiyono,

Setiawan

et al. 2023

Indones J Obstet Gynecol

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Objective: To determine differences in ovarian reserve in women with ovarian endometrial cysts after laparoscopic cystectomy and leuprorelin acetate administrationMethods: Single cohort prospective pre and post-test design study with 25 research subjects. The independent variables were interventional laparoscopic cystectomy, and leuprorelin acetate administration. The dependent variable is ovarian reserve as measured by AMH levels.Results: The research subjects had a mean age of 31 years and a BMI of 23.55 kg/m2. There were 8 subjects with unilateral cysts and 17 subjects with bilateral cysts. Preoperative AMH levels had a median value of 1.32 ng/mL (0.88-5.13), postoperative AMH levels had a median value of 1.07 ng/mL (0.60-4.53), and postoperative AMH levels + Leuprorelin Acetate injection had a median value of 1.06 ng/mL (0.50-4.65). There was a significant difference between preoperative AMH and postoperative AMH (p<0.001). There was no significant difference between postoperative AMH and postoperative AMH + Leuprorelin Acetate injection (p=0.149). BMI has a relationship (p=0.048) with pre-operative AMH levels with a weak and opposite relationship (r= -0.399).Conclusion: There was a statistically significant 18.9% decrease between pre-operative post-operative AMH levels. Body Mass Index (BMI) and pre-operative AMH levels are associated with one another.Keywords: anti-müllerian hormone, leuprorelin acetate, ovarian cystectomy, ovarian reserve.AbstrakTujuan: Mengetahui perbedaan cadangan ovarium pada perempuan dengan kista endometrium ovarium setelah laparoskopi kistektomi dan injeksi leuprorelin asetat.Metode: Desain penelitian pre dan post-test prospektif kohort tunggal dengan 25 subjek penelitian. Variabel bebas adalah intervensi laparoskopi kistektomi, dan injeksi leuprorelin asetat. Variabel terikat adalah cadangan ovarium yang diukur dengan kadar AMH.Hasil: Subjek penelitian memiliki rerata usia 31 tahun dan IMT 23,55 kg/m2. Terdapat 8 subjek dengan kista unilateral, 17 subjek dengan kista bilateral. Kadar AMH praoperasi memiliki nilai median 1,32 ng/mL (0,88-5,13), kadar AMH pascaoperasi memiliki nilai median 1,07 ng/mL (0,60-4,53), dan kadar AMH pascaoperasi + injeksi Leuprorelin Asetat memiliki nilai median 1,06 ng/mL (0,50-4,65). Ada perbedaan yang signifikan antara AMH pra operasi dan AMH pascaoperasi (p<0,001). Tidak ada perbedaan bermakna antara AMH pascaoperasi dengan injeksi AMH + Leuprorelin Asetat pascaoperasi (p=0,149). IMT memiliki hubungan (p=0,048) dengan kadar AMH pra operasi dengan hubungan yang lemah dan berlawanan (r= -0,399).Kesimpulan: Terdapat penurunan 18,9% antara tingkat AMH pra-operasi dan tingkat AMH pasca-operasi yang signifikan secara statistik. Ada hubungan antara BMI dan tingkat AMH pra-operasiKata kunci: cadangan ovarium, hormon anti-müllerian, kistektomi ovarium, leuprorelin asetat.

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Correlation of Homeostatic Model Assessment-Insulin Resistance, Anti-Mullerian Hormone, and BMI in the Characterization of Polycystic Ovary Syndrome

Abstract: Bahadur et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 11 publications

References 28 publications

Evaluation of anti-Müllerian hormone in pre-menopausal women stratified according to thyroid function, autoimmunity and age

Evaluation of anti-Müllerian hormone in pre-menopausal women stratified according to thyroid function, autoimmunity and age

Visceral Adiposity Index as an Indicator for Menstrual Disturbance, Hormonal and Metabolic Dysfunction in Polycystic Ovarian Syndrome

Ovarian Reservation in Women with Ovarian Endometriosis Cyst after Laparoscopic Cystectomy and Leuprorelin Acetate Administration

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