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

Dewailly, Didier; Gronier, Héloïse; Poncelet, E.; Robin, Geoffroy; Leroy, Maryse; Pigny, Pascal; Duhamel, Alain; Catteau-Jonard, Sophie

doi:10.1093/humrep/der297

Cited by 410 publications

(308 citation statements)

References 32 publications

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“…The overall analysis revealed a marked decline of 2.13 ng/mL, which represents 43% of the cut-off level of serum AMH concentration (4.9 ng/ mL) in women with PCOS (Dewailly et al 2011). This decline in circulating AMH seems to be sustained for up to 6 months after LOD.…”

Section: Discussionmentioning

confidence: 86%

The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

Amer¹,

Shamy²,

James³

et al. 2017

Reproduction

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Laparoscopic ovarian drilling (LOD) has been widely used as an effective treatment of anovulatory women with polycystic ovarian syndrome (PCOS). However, there has been a growing concern over a possible damaging effect of this procedure on ovarian reserve. The objective of this study was to investigate the hypothesis that LOD compromises ovarian reserve as measured by post-operative changes in circulating anti-Müllerian hormone (AMH). This meta-analysis included all cohort studies as well as randomised controlled trials (RCTs) investigating serum AMH concentrations and other ovarian reserve markers in women with PCOS undergoing LOD. Various databases were searched including MEDLINE, EMBASE, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov and Cochrane Library from January 2000 to December 2016. Sixty studies were identified, of which seven were deemed eligible for this review. AMH data were extracted from each study and entered into the RevMan software to calculate the weighted mean difference (WMD) between pre-and post-operative values. Pooled analysis of all studies (n = 442) revealed a statistically significant decline in serum AMH concentration after LOD (WMD −2.13 ng/mL; 95% confidence interval (CI) −2.97 to −1.30). Subgroup analysis based on duration of follow-up, AMH kit, laterality of surgery and amount of energy applied during LOD consistently showed a statistically significant fall in serum AMH concentration. In conclusion, although LOD seems to markedly reduce circulating AMH, it remains uncertain whether this reflects a real damage to ovarian reserve or normalisation of the high pre-operative serum AMH levels. Further long-term studies on ovarian reserve after LOD are required to address this uncertainty.Reproduction (2017) 154 R13-R21

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Section: Discussionmentioning

confidence: 86%

The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

Amer¹,

Shamy²,

James³

et al. 2017

Reproduction

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“…A significant proportion (17%) of respondents claimed that they sometimes or often use AMH measurement as a tool for the diagnosis of ovarian dysfunction in women with PCOS. This could reflect the notion that some authors claimed that AMH measurement might be a more specific and sensitive surrogate marker to identify polycystic ovarian morphology than the ultrasound techniques (14). In this respect, it is noteworthy that the guidelines for the definition of polycystic ovarian morphology recently published by the Androgen Excess & PCOS Society conclude that '.although serum AMH generated great expectations as a surrogate marker for the follicle excess, standardization of AMH assays is needed before they can be routinely used for clinical practice and research' (15).…”

Section: Discussionmentioning

confidence: 95%

European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS Special Interest Group's Questionnaire

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

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Background: There is evidence for differences between endocrinologists and other specialists in their approach to diagnosis and management of the polycystic ovary syndrome (PCOS). Objective: A mailed survey consisting of a simple questionnaire aiming to understand current practice for diagnosis and management of the PCOS by specialists across Europe. Methods: The questionnaire consisted of 23 questions grouped to achieve information on i) the general characteristics of the respondents, ii) patients with PCOS seen by endocrinologists, iii) the main diagnostic criteria, iv) biochemical parameters used in the differential diagnosis of hyperandrogenism, v) long-term concerns, and, finally vi) treatment choices. A total of 357 questionnaires representing 13.3% of the members of European Society of Endocrinology (ESE) were available for final analysis; 93% of the respondents were endocrinologists Results: In relation to the diagnostic criteria, respondents were most likely to select menstrual irregularity as the most frequent criteria used for the diagnosis of PCOS although very high rates were achieved for the use of hirsutism and biochemical hyperandrogenism. It therefore appears that the NIH criteria were followed by the majority of respondents. The most frequent biochemical parameters in the differential diagnosis of hyperandrogenism were total testosterone or free androgen index. Obesity and type 2 diabetes were regarded as the principal long-term concerns for PCOS. The most common treatments for patients with PCOS were metformin (33%), lifestyle modification (25%), and oral contraceptives (22%). More direct treatments of infertility include clomiphene citrate alone or in combination with metformin, prescribed by 9 and 23%, respectively, whereas only 6% used other methods for induction of ovulation.

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“…However, in the remaining 180 CCS, we were not able to distinguish between PCOS and non-PCOS subjects because data on hyperandrogenism (clinical and biochemical) and total FC (transvaginal ultrasound) were not available. As we were not able to use the Rotterdam criteria in these remaining cases, and Dewailly et al (19) suggested a cutoff limit of AMH O5 mg/l to define PCOM, we used this marker and cutoff limit for the presence of PCOM.…”

Section: Discussionmentioning

confidence: 99%

Decreased ovarian function is associated with obesity in very long-term female survivors of childhood cancer

Dorp

Blijdorp

Laven³

et al. 2013

European Journal of Endocrinology

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Objective: Obesity and gonadal dysfunction are known major side effects of treatment in adult childhood cancer survivors (CCS). In the general population, obesity has a negative influence on female fertility. We aimed to evaluate whether obesity and serum insulin are associated with decreased ovarian reserve markers in CCS. Design: Retrospective single-center cohort study. Methods: Data of 191 female survivors of childhood cancer were analyzed. Median follow-up time was 18.8 (2.3-48.8) years. Outcome measures were serum anti-Mü llerian hormone (AMH) and total follicle count (FC). Potential risk factors were: BMI; body composition measures, determined by dualenergy X-ray absorptiometry (total fat percentage, lean body mass, and visceral fat percentage); and fasting insulin. Results: Lower serum AMH was found in obese subjects (b (%) K49, PZ0.007) and in subjects with fasting insulin in the highest tertile (b (%) K43, PZ0.039). Total fat percentage tends to be associated with serum AMH (b (%) K2.1, PZ0.06). Survivors in the highest tertile of insulin had significantly lower FC than survivors in the lowest tertile (b K6.3, PZ0.013). BMI and other measures of body composition were not associated with FC. Correlation between serum AMH and antral follicle count (AFC) was rZ0.32 (PZ0.08). Conclusions: Obesity and insulin resistance are associated with gonadal damage, as reflected by decreased AMH and reduced FC in adult survivors of childhood cancer. In contrast to its highly predictive value for AFC in the healthy female population, serum AMH does not seem to correlate as well with AFC in CCS.European Journal of Endocrinology 168 905-912

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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

Abstract: For the definition of PCOM, the former threshold of >12 for FN is no longer valid. A serum AMH >35 pmol/l (or >5 ng/ml) appears to be more sensitive and specific than a FN >19 and should be therefore included in the current diagnostic classifications for PCOS.

Cited by 410 publications

References 32 publications

The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS Special Interest Group's Questionnaire

Decreased ovarian function is associated with obesity in very long-term female survivors of childhood cancer

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