Age‐group‐specific reference intervals for anti‐Müllerian hormone and its diagnostic performance for polycystic ovary syndrome in a Korean population

Abstract

Background We established age‐group‐specific reference intervals for serum anti‐Müllerian hormone (AMH) levels in a Korean population and investigated the effectiveness of AMH assay for polycystic ovary syndrome (PCOS) diagnosis. Methods We analyzed serum levels of AMH, follicle‐stimulating hormone (FSH), and luteinizing hormone (LH) from 1540 Korean women. Subjects were divided into three groups: healthy, benign gynecologic diseases, and PCOS. Age‐group‐specific reference intervals and AMH diagnostic performance were estimated. Results The PCOS group had a median AMH level of 7.0 µg/L, which was higher than for the healthy (1.8 µg/L) and the benign gynecologic diseases (2.7 µg/L) groups. The upper 97.5% reference limits for age groups 12–20 years, 21–34 years, and 35–46 years were 13.2 µg/L, 15.8 µg/L, and 6.6 µg/L, respectively. The area under the curve (AUC) values to estimate AMH ability to discriminate PCOS from healthy women for each age group were 0.741, 0.785, and 0.789, respectively. AUCs for LH/FSH were 0.719, 0.672, and 0.590. Conclusions The better diagnostic ability of AMH over LH/FSH in women of late childbearing ages indicates that age and other clinical characteristics should be considered when interpreting these test results.

Reference intervals of anti‐Müllerian hormone in Korean women

“…13 Previous studies performed on Korean women did not include women aged 20–24 years or included limited numbers of study subjects of this age group, whose data were combined with those of women aged 25–29 years (Table 1 ). 4 , 7 , 10 The peak serum AMH level observed in the 25–29‐year age group and the decrease to undetectable in the 45–50‐year age group were comparable with previous findings that the serum AMH level starts to decline from age 25 years and reaches an undetectable level at menopause. 1 …”

“…Previous studies performed with Korean women to determine reference intervals used data from analytical methods with different traceability or included only a limited number of subjects. 4 , 7 , 9 , 10 Considering the differences in absolute AMH values among analytical methods, results of the present study provide important information for use in clinical laboratories and for clinical decision making in fertility treatment. 1 , 3 , 6…”

“… 7 , 12 The 97.5th percentile value in the Korean population was similar to the 97.5th percentile value of the present study population, which was higher than reference intervals in Western populations. 7 , 10 , 12 The 90th percentile value of the present study population was similar to the 95th percentile value of reference intervals provided by the manufacturer and to the 97.5th percentile value of reference intervals performed in Western populations using the Elecsys assay by Anckaert et al 12 The upper limit of reference interval defined as the 97.5th percentile value in women younger than 35 years was higher than that of Western populations, while this limit was comparable among the other age groups (≥35 years). In this study, the presence of polycystic ovary syndrome (PCOS) or irregular menstrual cycle was not investigated.…”

“…Previous studies concerning reference intervals of serum AMH assessed in Korean women used data from the Access (Beckman Coulter) or Gen II assay (Beckman Coulter), which had different calibration traceability from the Roche Elecsys assay, or data were obtained from limited numbers of subjects. 4 , 7 , 8 , 9 , 10 , 11 …”

Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review

“…AMH is a glycoprotein of the transforming growth factor beta family secreted by granulosa cells of developing ovarian follicles in females. AMH levels increase through childhood in healthy females before declining with age later in life [ 97 , 98 , 99 , 100 ]. AMH has been related to ovarian follicle count and it is considered a marker of ovarian reserve [ 45 , 101 ].…”