Anti Mullerian Hormone: A Potential Marker for Recruited Non Growing Follicle of Ovarian Pool in Women with Polycystic Ovarian Syndrome

Abstract

Background: Polycystic ovarian disease is one of the most common causes of infertility in women of reproductive age. Anti-mullerian hormone (AMH), a member of transforming growth factor (TGF) family which is secreted by granulosa cells of growing follicle, is found to be increased to three to four fold in Poly Cystic Ovarian Syndrome (PCOS) patients as evidenced by previous studies. But the level of AMH in relation to the infertile status of PCOS was not studied yet. The present study was focused to determine the discriminative power of AMH in infertility subjects with regular cycles and infertility subjects associated with PCOS. Methods:The subjects under study were one hundred and twenty infertile women of age group ranging from 27-35 years. Subjects, were further divided into sixty infertile with regular cycles as controls (Group1) and sixty infertile subjects with PCOS as cases (Group 2). Hormones like FSH, E2 and AMH were assayed for all the subjects. Mean and student t-test for all hormones were compared between controls and cases. The diagnostic power of AMH pertaining to sensitivity and specificity was evaluated by Receiver operating characteristic (ROC) curve.Results: Serum AMH level were two fold higher in PCOS patients than in controls. The mean value of AMH also shows a test of significance between the two groups. The area under the receiver operating characteristic curve for the AMH assay was 0.95 in infertile group when 3.34ng/ml was used as cut off point indicating its better discriminative power and good diagnostic potency. Setting the AMH value at 3.34ng/ml sensitivity, specificity,Positive Predictive Value(PPV) and Negative Predictive Value(NPV) were observed 98% ,93%, 93% and 98% respectively. Conclusion:The diagnostic potency of Area Under Curve (AUC) for AMH in infertile subjects reflects that AMH is a potential marker for recruited non growing follicles rather than a simple marker for ovarian reserve as it is predominantly produced by small follicles rather than a simple marker for ovarian reserve. BACkgROundThe primary function of the human ovary is the production of sex steroid hormones and gametes. At around 20 weeks of foetal development, the female gamete forms primordial follicles and with the onset of menarche, the follicles grow in size. Recruitment of follicles for the ovulation process continues until the primordial follicle pool is exhausted, resulting in menopause in women.The size of the primordial follicle stocks is difficult to measure directly and studies have suggested that the number of growing follicles is correlated to the size of primordial follicle stock from which they are recruited [1, 2]. A marker is required to ascertain the transition from the primordial follicle to the growing follicle, which reflects the qualitative and quantitative assessment of the ovarian reserve. Transvaginal ultrasonography measurement of antral follicular count (AFC) and ovarian volume (OV) indicate and reflect the size of primordial follicle pool. The ovarian volume (OV) indirectl...

The role of antimullerian hormone in the hormonal workup of women with persistent acne

“…26,29,30 In our study, 100.00% sensitivity and 95.83% specificity were seen with a cutoff value of 3.6 ( Table 4) which is similar to another study from India (3.34 ng/mL). 30 AMH has been assessed for diagnosis of PCOS with reference to the major classifications of PCOS. 26,31 Eilertsen et al 31 concluded that AMH could successfully replace PCOM for the diagnosis of PCOS and that substitution of AMH with PCOM was equally effective for diagnosis in both the AES (Androgen Excess Society) and Rotterdam criteria an opinion that was supported by Sahmay S et al 26 Thus, in the hormonal workup of persistent acne in females, AMH may be used as a parameter to diagnose PCOM and is superior to testing for androgens and gonadotropins (K€ oninger A et al).…”

“…33 Various studies have found a high sensitivity and specificity of AMH in the diagnosis of PCOS with a cutoff value ranging from 3.34 to 4.7 ng/mL. 26,29,30 In our study, 100.00% sensitivity and 95.83% specificity were seen with a cutoff value of 3.6 ( Table 4) which is similar to another study from India (3.34 ng/mL). 30 AMH has been assessed for diagnosis of PCOS with reference to the major classifications of PCOS.…”

“…In addition, AMH is an objective, easily doable, noninvasive test, sensitive and specific in diagnosis of PCOS and gives an estimate of the ovarian reserve. [24][25][26][27][28][29][30][31][32][33] The limitations of our study are in its retrospective nature and small sample size. Future prospectively designed studies with larger populations in persistent acne patients will help in assessing the use of AMH as a tool to diagnose PCOS in acne population.…”

“…4.23.24 AMH is a simple blood test to confirm PCOS and has been studied extensively in nondermatological literature. 4,[24][25][26][27][28][29][30][31][32] Serum AMH levels are significantly higher in women with PCOS as compared to women with normal ovaries and 27 correlate with antral follicle count, ovarian volume, and severity of PCOS. Importantly, it is not affected by the adiposity, time of the cycle and has consistent age-dependent values.…”

Transcription factor-microRNA synergistic regulatory network revealing the mechanism of polycystic ovary syndrome

“…Of these genes, the JUN and fra-1 mediated cell cycle pathway; SMAD3 and SMAD4 were downstream of TGF-β, which was found to be increased by 3–4 fold in PCOS. This its dysregulation may contribute to ( 1 ) the fetal origins of PCOS, ( 2 ) reproductive abnormalities in PCOS and ( 4 ) cardiovascular and metabolic abnormalities in PCOS ( 28 , 37 ), suggesting JUN-associated pathways may be important in PCOS.…”