Müllerian Duct Anomalies and Anti-Müllerian Hormone Levels in Women With Polycystic Ovary Syndrome

Abstract

Background: Significant associations between the presence of polycystic ovary syndrome (PCOS) and uterine anomalies have been reported. It is unclear whether high anti-Müllerian hormone (AMH) levels coexist with the development of uterine malformations in women with PCOS. This study sought to investigate the association between Müllerian duct anomalies and anti-Müllerian hormone (AMH) levels in women with PCOS. Methods: In this retrospective cohort study, the records of 1,391 women with PCOS were analyzed. The cohort was divided into a low-AMH group (n = 700) and a high-AMH group (n = 691), based on an AMH cutoff value of 8.45 ng/ml. Müllerian duct anomalies were classified into four subtypes based on three-dimensional ultrasonography: septate uterus, bicornuate uterus, uterus didelphys, unicornuate uterus, and arcuate uterus. The primary outcome was the overall incidence of Müllerian duct anomalies. The secondary outcome was the prevalence of the abovementioned specific types of Müllerian duct anomalies. The prevalence of Müllerian duct anomalies was analyzed using the chi-squared test or Fisher’s exact test. Results: Among the patients with PCOS, the prevalence of unicornuate uterus anomalies was higher in the high-AMH group than in the low-AMH group (1.0% vs. 0.1%, P = 0.04). No statistically significant difference in the overall incidence of uterine malformations was found between the two AMH groups (4.3% vs. 5.7%, P = 0.22). Conclusions: Our study confirmed a higher prevalence of unicornuate uterus in PCOS women with high AMH levels. Clinicians might decide to investigate the possibility of a unicornuate uterus in PCOS women with high AMH levels.

A survey of the frequency of polycystic ovary morphology in infertile patients with uterine abnormalities: a cross-sectional study

“…Several investigations have demonstrated markedly elevated levels of AMH in individuals a icted with polycystic ovary syndrome (PCOS) (20)(21)(22)(23). Given the substantial heredity of PCOS and the role that AMH plays in the early degeneration of Müllerian ducts, high prenatal AMH exposure may cause both PCOS and Müllerian duct abnormalities in female offspring (11).…”

“…Mullerian ducts serve as the embryological precursors of the female reproductive tract, which consists of the fallopian tubes, uterus, cervix, and superior segment of the vagina (10,11). The development of the reproductive system in females involves a series of mechanisms in the Mullerian duct system that are involve differentiation, migration, fusion, and canalization (12).…”

“…The development of the reproductive system in females involves a series of mechanisms in the Mullerian duct system that are involve differentiation, migration, fusion, and canalization (12). Müllerian duct anomalies arise when the Müllerian ducts undergo abnormal development (10,11). Müllerian anomalies are categorized by the ASRM (2021) into nine groups: Müllerian agenesis, cervical agenesis, unicornuate uterus, uterus didelphys, bicornuate uterus, septate uterus, longitudinal vaginal septum, transverse vaginal septum and complex anomalies (13).…”

Anti-Müllerian Hormone: A Molecular Key to Unlocking Polycystic Ovary Syndrome?

“…32 During PCOS pregnancies, precocious mid-gestation elevation of fetal female AMH levels 61 accompany an increased incidence of uterine morphological abnormalities consistent with AMH-delayed fusion of the Müllerian ducts in women with PCOS. 62 In some [63][64][65] but not all 59,66 umbilical cord blood studies, fetal AMH levels at term are higher in daughters of women with PCOS, and increased AMH levels persist from infancy 67 through adolescence 68 in daughters of women with PCOS. Mid-gestation fetal testosterone excess likely accompanies fetal AMH excess in daughters of women with PCOS, since increased anogenital distance, as a relevant biomarker, is found in newborn daughters of women with PCOS 69 and in women with PCOS themselves.…”

Combining proteomic markers to construct a logistic regression model for polycystic ovary syndrome

“…Other conditions that may cause hyperandrogenemia or reduced ovulation should also be excluded. In addition, many international experts have put forward expert consensus on the treatment of PCOS, such as the NIH criteria developed by the National Institutes of Health in 1990 (10), AES standard developed by the American AE-PCOS Association in 2006 (11), and the Diagnostic Criteria for Polycystic Ovarian Syndrome issued by our Ministry of Health in 2011 (12). Such a variety of diagnostic criteria undoubtedly poses a challenge for the diagnosis of PCOS.…”