The role of AMH in the pathophysiology of polycystic ovarian syndrome

Abstract

Polycystic ovarian syndrome (PCOS) affects 5 - 10% of reproductive age women, but its pathogenesis is still poorly understood. The aim of this review is to collate evidence and summarize our current knowledge of the role of anti-Müllerian hormone (AMH) in PCOS pathogenesis. AMH is increased and correlated with the various reproductive and metabolic/endocrine alterations in PCOS. AMH plays an inhibitory role in follicular development and recruitment, contributing to follicular arrest. AMH inhibitory action on FSH-induced aromatase production likely contributes to hyperandrogenism in PCOS, which further enhances insulin resistance in these women. Elevated serum AMH concentrations are predictive of poor response to various treatments of PCOS including weight loss, ovulation induction and laparoscopic ovarian drilling, while improvement in various clinical parameters following treatment is associated with serum AMH decline, further supporting an important role for AMH in the pathophysiology of this syndrome. This review emphasizes the need for understanding the exact mechanism of action of AMH in the pathophysiology of PCOS. This may lead to the development of new treatment modalities targeting AMH to treat PCOS, as well as help clinicians in prognostication and better tailoring existing treatments for this disease.

Weight loss in obese girls with polycystic ovarian syndrome is associated with a decrease in Anti‐Muellerian Hormone concentrations

“…This finding points against a more severe phenotype in the PCOS girls without weight loss. Our observation is in concordance with reports in adult women showing that elevated serum AMH concentrations are predictive of poor response to various treatments of PCOS including weight loss …”

High serum Antimullerian hormone levels are associated with lower live birth rates in women with polycystic ovarian syndrome undergoing assisted reproductive technology

“…In addition, granulosa cells within each follicle have been shown to overproduce AMH up to 75-fold the normal amount [5,26]. Elevated AMH may cause abnormal folliculogenesis through two different mechanisms [27]. AMH inhibits FSH-dependent selection of a dominant follicle, leading to decreased granulosa cell FSH sensitivity and potential follicular arrest [28].…”

Studying the Effect of Laparoscopic Ovarian Drilling on Ovarian Reserve via Measurement of Anti-Mullerian Hormone in Polycystic Ovarian Syndrome Patients

“…Moreover, high AMH is a poor prognostic marker for medical or surgical treatment modalities for PCOS patients. So, any measure that decreases AMH may improve ovulation in these patients [3] [4].…”