Role of Anti-Müllerian Hormone in the Pathogenesis of Polycystic Ovary Syndrome

Abstract

Besides its interest for diagnosis, the finding of an elevated serum AMH level in PCOS has open major pathophysiological issues. This review addresses the three most important issues: 1-the role of AMH in the disturbed folliculogenesis of PCOS; 2-the role of AMH in the gonadotropin dysregulation of PCOS and 3-the role of AMH in the trans-generational transmission of PCOS. For each of those issues, the clinical and experimental evidences currently available are discussed and pathophysiological hypothesis are proposed.

High Serum Anti-Müllerian Hormone Concentrations Are Associated With Poor Pregnancy Outcome in Fresh IVF/ICSI Cycle but Not Cumulative Live Birth Rate in PCOS Patients

“…There was an inverse relationship between serum FSH and AMH levels in PCOS patients, which has been reported in previous studies (11,33,34) and remains unexplained to date (35,36). Our opinion is consistent with a previous study (36) in which it is not believed that the negative impact of FSH on the production of AMH was responsible for the phenomenon. In contrast, there is evidence showing the positive impact of FSH on the production of AMH in the case of congenital gonadotrophic insufficiency (37).…”

“…Decreased AMH production by the follicle unit instead of hemodilution may contribute to reduced AMH with increasing BMI (31). There was an inverse relationship between serum FSH and AMH levels in PCOS patients, which has been reported in previous studies (11,33,34) and remains unexplained to date (35,36). Our opinion is consistent with a previous study (36) in which it is not believed that the negative impact of FSH on the production of AMH was responsible for the phenomenon.…”

“…In addition, ovarian hyperstimulation and the associated high estrogen-induced endometrial receptivity damage no longer affects the FET cycle outcome. Although there are data showing that high AMH concentration may cause disturbed folliculogenesis in PCOS ( 33 , 36 , 54 – 56 ), our data suggested that higher AMH may have little effect on oocyte quality compared to medium high AMH level or the increase in oocyte production may counteract the decrease in oocyte quality. Further clinical studies and molecular biology experiments were needed to explore the possible impact of AMH on PCO folliculogenesis and oocyte quality.…”

“…As for the explanation of the correlation between higher AMH and poor reproductive outcome in fresh cycle in PCOS women, firstly, AMH excess in GCs from PCO would be involved in the follicle excess of PCO (54)(55)(56) and the follicular arrest in anovulatory patients (33,36), thus high AMH levels may result in the disturbed folliculogenesis of PCOS. In addition, as mentioned above, AMH levels are related to the severity of PCOS, and a positive link between AMH c oncentration and s everity of hyperandrogenemia has been found (16,32,34,57), which has a detrimental effect on oocyte quality and therefore contributes to lower fertilization rates (58).…”

Circulating kisspeptin and anti-müllerian hormone levels, and insulin resistance in women with polycystic ovary syndrome: A systematic review, meta-analysis, and meta-regression

“…On the other hand, women with PCOS display increased circulating anti-müllerian hormone (AMH) that correlates with the number of antral follicles, and the AMH measurement diagnostic efficacy is superior to follicular count [15]. Besides, it seems to be a specific PCOS and reproducible marker from one menstrual cycle to another [16]. Metabolic syndrome components and indexes of insulin resistance, including homeostasis model assessment IR index (HOMA-IR), are frequently altered in patients with PCOS [10,11].…”