Anti-Müllerian hormone (AMH) is a homodimeric glycoprotein, a member of the transforming growth factor-β superfamily. Over the last decade, a large number of studies examining the multiple roles of AMH have been published. AMH levels accurately reflect the ovarian follicular reserve and could, therefore, be considered as an extremely sensitive marker of ovarian aging and a valuable tool in the diagnosis and the recognition of recurrence of granulosa cell tumors. Furthermore, AMH evaluation is of clinical importance in predicting the success of in vitro fertilization (IVF). Additionally, AMH could be a surrogate diagnostic marker of polycystic ovary syndrome in cases in which ultrasonographic examination is not possible. This article is a review of the clinical usefulness of AMH evaluation in the fields of gynecological endocrinology, menopause, gynecological oncology and assisted reproduction. Special reference is made to the possible implications of AMH in the pathogenesis of polycystic ovary syndrome and the relationship between AMH and obesity.

Objective: To examine the effect of hypocaloric diet plus sibutramine on body composition, hormonal and metabolic parameters in overweight and obese patients with polycystic ovary syndrome (PCOS). Design: Open-label, randomized study at an outpatient clinic. Patients: A total of 59 overweight and obese (18-39 years old) women with PCOS. Measurements: All patients were placed in a hypocaloric diet plus sibutramine (10 mg per day) for the first month and then on a hypocaloric diet plus sibutramine (10 mg per day, group S) or hypocaloric diet only (group D) for the subsequent 6 months. Body composition, hormonal and metabolic features and insulin sensitivity (oral glucose tolerance test, OGTT) were evaluated at baseline and at 3 and 6 months of treatment. Results: Body weight reduced in both groups but the reduction was greater with sibutramine (À15.4±1.1 vs -11.1±1.9% in groups S and D, respectively, Po0.05). At 6 months, a greater percent of patients lost more than 10% of initial body weight in group S than D (81 vs 52.9%). In both groups, all women with abnormal OGTT at baseline presented normal glucose tolerance after 6 months. Free androgen index (FAI), glucose area under the curve and fasting triglyceride (TG) concentration were reduced after 6 months in group S only (Po0.05). No changes in cardiovascular risk factors, prolactin and hepatic enzymes levels were observed in both groups. Conclusion: A hypocaloric diet and a diet plus sibutramine both result in significant weight loss in overweight and obese women with PCOS. Patients who received sibutramine showed a greater weight loss and improvement in hyperandrogenemia and insulin sensitivity after 6 months of treatment. The amelioration of insulin resistance in this group could not be totally explained by weight loss. Total testosterone, FAI and TG levels reduction could be a possible mechanism. Finally, sibutramine increased compliance to diet and it was well tolerated from these patients.

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Only 2 of 4 Rotterdam phenotypes, identical with those of the classic PCOS definition, have excess cardiometabolic risk. These need to be treated to prevent CVD events.