Age‐stratified thresholds of anti‐Müllerian hormone improve prediction of polycystic ovary syndrome over a population‐based threshold

Abstract

In this issue, Quinn et al report their experience on the diagnostic value of the anti-Müllerian hormone (AMH) assay for the recognition of polycystic ovary syndrome (PCOS). This subject remains very much debated and, in particular, there is no consensus on a specific threshold discriminating PCOS from normal women. One of the reasons, but certainly not the only one, is the heterogeneity of the control groups between the various studies reported to date. In their work, Quinn et al have benefited from the formation of a cohort of women from the general population, which is undeniably a strength compared with other studies that used female controls recruited mainly through infertility not related to an ovarian problem. However, the recruitment of patients with PCOS also differs between the various studies, mostly because of selection bias. The Quinn et al's study does not escape this bias, having used a PCOS population including a majority of patients with the phenotype A of the Rotterdam classification ("fullblown" phenotype), whereas the so-called mild phenotypes (C and D) were hardly represented (supplemental Table 1). Therefore, if their control group confirm this fact in their control group. On the other hand, it is interesting to note that the median AMH levels in the PCOS group are much less affected by age, which should make the AMH assay particularly effective in older women, as claimed by the authors. But actually, we would have expected better results from the ROC analysis in this group, which is not so evident in Figure 2. To understand this, we must look at the values of the IQR. In Table 2, it can be seen in the control group that these values decrease parallel to the median values along with advancing age. On the other hand, in the PCOS group, the IQR increases with age, which in my opinion is quite interesting. Indeed, this suggests that AMH levels are much more dispersed among older women. This may suggest that PCOS patients are not all equal to the effect of ovarian ageing, which some studies have found to alleviate PCOS symptoms. 6 Therefore, one can ask the question of the interest of diagnosing a fading PCOS. Would a higher threshold for women over 35 years be more relevant in order to diagnose only those with still active PCOS?Other factors besides age may also influence the AMH threshold for PCOM. The authors mention the effect of weight, but the literature is quite controversial on this point. However, recent studies seem to show that the influence of weight is minimal and that there is no need to stratify the threshold for diagnosis of AMH as a function of weight. 7,8 On the other hand, the authors emphasize the value of a diagnostic threshold in younger women and, in particular, in adolescents in whom ultrasound is often noncontributory. I fully agree with them in their desire to have solid studies, exploring the diagnostic value of the AMH assay for the diagnosis of PCOM, and subsequently PCOS, in adolescents.The study of Quinn et al strengthens us in the belief that the AMH assay will ev...

A Model for Predicting Polycystic Ovary Syndrome Using Serum AMH, Menstrual Cycle Length, Body Mass Index and Serum Androstenedione in Chinese Reproductive Aged Population: A Retrospective Cohort Study

“…Previous studies have found different AMH cut-off values to diagnose PCOS. However, because of small sample sizes, inappropriate controls and heterogeneous AMH assays ( 15 ), the application of these cut-offs in the diagnosis of PCOS has been limited. This might be why the introduction of AMH into the diagnosis of PCOS is controversial.…”

“…Although AMH might serve as a potential diagnostic marker for PCOS, it is not currently recommended as a single-test parameter for this by the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018 ( 16 ). Comprehensive models have been established, combining AMH and other indicators ( 15 , 17 – 19 ). Vagios et al ( 18 ) have established a diagnostic model using AMH and BMI to predict PCOS.…”

Clinical Applications of Serum Anti-Müllerian Hormone Measurements in Both Males and Females: An Update

“…Thus, we believe that a mathematical model combining AMH and age and other predictors, such as body mass index, might be required for the future diagnosis of PCOS. Age-stratified thresholds for AMH have been reported for the diagnosis of PCOS, 148 and AMH is predicted to replace AFC as a diagnostic indicator for this syndrome. 149 …”