Adjusting antimüllerian hormone levels for age and body mass index improves detection of polycystic ovary syndrome

Abstract

Objective: To examine whether accounting for a woman's age and body mass index (BMI) would improve the ability of antim€ ullerian hormone (AMH) to distinguish between women with (cases) and without (controls) polycystic ovarian syndrome (PCOS). Design: An opportunistic case-control dataset of reproductive age women having evaluations for PCOS as defined by National Institutes of Health criteria. Setting: Two medical centers in the United States enrolled women. Serum samples were analyzed for relevant analytes. Patients: Women were between 18 and 39 years of age when samples and clinical information were collected. Residual samples had been stored for 2À17 years. AMH was measured via immunoassay. Interventions: None; this was an observational study. Main outcome measures: Detection and false-positive rates for PCOS were computed for AMH results expressed as multiples of the median (MoM) both before and after adjustment for the woman's age and BMI. Results: Using unadjusted AMH MoM results, 168 cases (78%) cases were at or beyond the 90 th centile of controls (2.47 MoM). After accounting for each woman's age and BMI, 188 (87%) of those women were beyond the 90 th centile of controls (2.20 MoM), a significant increase (P ¼ .015). The adjusted AMH MoM levels fitted logarithmic normal distributions well (mean, standard deviation for controls and cases of 0.0000, 0.2765 and 0.6884, 0.2874, respectively) and this allowed for computation of patient-specific PCOS risks. Conclusions: Accounting for the woman's age and BMI resulted in significantly higher AMH-based detection rates for PCOS at a 10% false-positive rate, and patient-specific PCOS risks could be computed. (Fertil Steril Ò 2020;113:876-84. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Dietary patterns are associated with improved ovarian reserve in overweight and obese women: a cross-sectional study of the Lifestyle and Ovarian Reserve (LORe) cohort

“…BMI at age 18 has been shown to be a predictor of future ovulatory infertility [ 47 ]. Further, studies have demonstrated that BMI has an inverse association with AMH, making the findings we present here even more compelling [ 16 ]. Our findings are important as they offer the potential for building evidence-based tools tailored to help empower at-risk population for improved fertility outcomes.…”

“…To assess the association between markers of ovarian reserve and each dietary pattern, multivariate linear regression was then performed controlling for age, BMI, smoking status, and physical activity. Subjects were stratified by BMI < 25 kg/m 2 and BMI ≥ 25 kg/m 2 as BMI is known to be associated with markers of ovarian reserve [ 16 ]. KPAS and the dietary pattern scores were divided into quartiles, with the lowest quartile representing women least adherent to the behavior.…”

“…Women with overweight and obesity have been shown to have decreased ovarian responsiveness to oral ovulation induction medications and gonadotropin stimulation [ 13 – 15 ]. Further AMH has been shown to be inversely associated with increasing body mass index (BMI) [ 16 ]. Being able to provide evidence-based lifestyle recommendations to optimize outcomes in reproductive age women seeking fertility treatments is critical.…”

Prediction model of persistent ovulatory dysfunction in Korean women with polycystic ovary syndrome

“…These results are similar to those of previous studies, which demonstrated that AMH was correlated with PCOS severity [24][25][26] or AMH was a strong predictor for amenorrhea in PCOS. 26 Also, it has recently been reported that AMH is a valuable marker for the diagnosis of PCOS in numerous studies, [27][28][29][30][31][32][33] although the cutoff value has not yet been determined.…”

The Role of Anti-Mullerian Hormone and Other Correlates in Patients with Polycystic Ovary Syndrome

“…In addition to its low cost and independency of operator ultrasound skills, AMH has been well established to be a signi cant correlator and a biologic marker for the antral follicle counts (AFC), thus re ecting the ovarian reserve in the female population. Therefore, it can potentially replace the ultrasound in the detection of PCOM and hence it may play a role in the diagnosis of PCOS [32]. Moreover, these bene ts may be particularly useful in the adolescent and reproductive age population and in certain cultures since evaluation of the ovaries by transvaginal ultrasonography may not be considered or even possible due to virginal status.…”