The Role of Anti-Müllerian Hormone in the Characterization of the Different Polycystic Ovary Syndrome Phenotypes

Abstract

Rotterdam criteria identified 4 polycystic ovary syndrome (PCOS) phenotypes based on the combination of anovulation (ANOV), hyperandrogenism (HA), and polycystic ovaries (PCOs): phenotype 1 (ANOV + HA + PCO), phenotype 2 (ANOV + HA), phenotype 3 (HA + PCO), and phenotype 4 (ANOV + PCO). Anti-Müllerian hormone (AMH) was suggested to play a pathophysiologic and diagnostic role in this syndrome. The aim of this study was to compare AMH levels among the different phenotypes in relation to clinical, endocrine, and metabolic features. We enrolled 117 women with PCOS (body mass index: 25.89 ± 6.20 kg/m(2), age range: 18-37 years) and 24 controls. Anthropometric characteristics, hirsutism score, ultrasound ovarian features, and hormonal parameters, including AMH, were evaluated. Each participant also underwent an oral glucose tolerance test and an euglycemic-hyperinsulinemic clamp. The prevalence of phenotypes 1 to 4 was 62.4%, 8.6%, 11.1%, and 17.9%, respectively. Body mass index and insulin resistance indexes were similar among the groups. Phenotype 1 showed the highest luteinizing hormone, androgens levels, ovarian volume, and AMH concentrations (9.27 ± 8.17 ng/mL,P< .05) versus phenotype 2 and controls. Phenotype 2 women were hirsute, showed an intermediate free androgen index value, low ovarian volume, and low AMH levels (4.05 ± 4.12 ng/mL). Phenotype 3 showed an intermediate state of HA and slightly augmented AMH levels (5.87 ± 4.35 ng/mL). The clinical and endocrine characteristics of phenotype 4 resembled those of controls, except for higher ovarian volume and AMH levels (7.62 ± 3.85 ng/mL;P< .05). Our results highlight the heterogeneity of the association between increased AMH levels, menstrual dysfunction, and HA in the different PCOS phenotypes, thus offering a key to an understanding of the current controversy on the value of AMH measurement in PCOS.

Criteria, prevalence, and phenotypes of polycystic ovary syndrome

“…There is also some evidence that women with the PCOS phenotypes A and B have an increased risk of hepatic steatosis as compared with women with PCOS with the nonhyperandrogenic phenotype and compared with healthy controls (83,84). The highest antim€ ullerian hormone levels are also found in patients with classic PCOS (85)(86)(87). Data from 1,297 women with PCOS from Greece have shown that menstrual cycle pattern is more irregular in these women as compared with phenotype D but seems to normalize with ageing (88).…”

Improving the accuracy and efficacy of diagnosing polycystic ovary syndrome by integrating metabolomics with clinical characteristics: study protocol for a randomized controlled trial

“…This difference might partly be related to epigenetic and environmental influences. Moreover, the free androgen index [34], serum AMH level [35][36][37][38], PPARGC1A (a leukocyte methylation promoter) [39], and some other indices were also found to be potential biomarkers for predicting PCOS and classifying its phenotypes. Although there have been many efforts to address the predicament surrounding the diagnosis of PCOS, the precise classification criteria have yet to be developed.…”

Accuracy and efficacy of diagnosis via integrated with metabolomics in patients with PCOS: study protocol for a randomized controlled trial

“…The difference might partly be related to the epigenetic and environmental influences. Moreover, the free androgen index (FAI) [34], serum anti-Müllerian hormone (AMH) level [35][36][37][38], PPARGC1A (a leukocyte methylation promoter) [39] and some other indexes were also found to be potential biomarkers for the prediction in women with PCOS and classification of its phenotypes. Although many efforts are spending on changing the predicament of clinical diagnosis, the precise classification criteria has yet to be developed.…”