Comparison of 3 Different AMH Assays With AMH Levels and Follicle Count in Women With Polycystic Ovary Syndrome

Abstract

Context Anti-Müllerian hormone (AMH) levels strongly correlate with antral follicles number (TFC) in the ovary. In women with polycystic ovary syndrome (PCOS), this is reflected by significantly increased serum AMH levels. Different assays have been developed to measure AMH. However, little is known about the inter-assay correlation in women with increased AMH levels. Objective To investigate the correlation of AMH values between different AMH assays and with TFC in PCOS patients. Design AMH levels were measured in 1660 PCOS patients, using three different AMH assays: Gen II [Beckman Coulter]; picoAMH [Ansh Labs]; and Elecsys [Roche]. Passing Bablok regression was used to compare assay methods. Spearman’s correlation was used to correlate AMH levels and TFC. Results Strong inter-assay correlations were present over the total range of AMH levels (0.81–0.94). Stratification in subgroups, revealed an AMH level dependent inter-assay correlation with strong inter-assay correlations in the low (<2.80 ng/ml) and high (>7.04 ng/ml) subgroups (0.62–0.86). However, the correlation in the mid AMH subgroup (2.80–7.04 ng/ml) was only moderate (0.28–0.56). A strong correlation was present between the total range of AMH levels and TFC (0.57–0.62). However, in all three AMH subgroups the correlation became moderate at best, independently of assay method (0.11–0.45). Conclusion In conclusion, both the inter-assay correlation and the correlation between AMH level and follicle count depend on the range of serum AMH level. This once more emphasizes the need of a standardization of AMH measurement for an accurate interpretation of AMH in clinical practice.

Functional analysis of rare anti-Müllerian hormone protein-altering variants identified in women with PCOS

“…AMH levels in sera from women with PCOS who were carriers or noncarriers of AMH protein-altering variants, and control women, were measured using both picoAMH ELISA and automated Lumipulse G1200 ( Table II ). In line with our previous study ( Moolhuijsen et al , 2022 ), higher AMH levels were measured by the picoAMH ELISA compared to the Lumipulse ELISA, particularly for AMH values in the higher range (results not shown). Carriers of AMH variants had ∼50% lower AMH levels compared to noncarriers, albeit not significantly lower ( Table II ).…”

Current Guidelines for Diagnosing PCOS

“…Levels of AMH are significantly higher among those with PCOS compared to those without PCOS [ 73 ], and many have attempted to assess the diagnostic accuracy of this hormone for PCOS and PCOM [ 36 , 38 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. While results are promising, there is significant heterogeneity between study methodologies and proposed diagnostic thresholds, and standardization of AMH measurement is still needed to ensure inter-assay accuracy [ 74 ]. Because of these limitations, most recent guidelines do not recommend the use of AMH levels as an alternative for the detection of PCOM or as a single test for the diagnosis of PCOS [ 23 ].…”

AMH regulates ovarian granulosa cell growth in PCOS rats through SMAD4

“…These ndings suggest that the production of AMH is highest in patients with PCOS, leading to a stagnation in follicle development. Furthermore, serum AMH levels are signi cantly higher in these patients [9][10][11]. Du et al [12] conducted an analyzed of follicle density and discovered that the initial count of primordial follicles in patients with PCOS was elevated, which was positively associated with heightened AMH levels.…”