Is the suppressive effect of cyproterone acetate on serum anti-Müllerian-hormone levels in women with polycystic ovary syndrome stronger than under oral contraceptive pill?

Abstract

That any anti-androgen effect could be observed on AMH in our CPA group in addition to the gonadotropin-suppressing effect suggests that either androgens are not involved in AMH regulation or that they act by interfering with gonadotropin effects on granulosa cells.

Role of Anti-Müllerian Hormone in the Pathogenesis of Polycystic Ovary Syndrome

“…However, many confounding factors may play a role, in particular the positive effect of androgens on the number of growing follicles ( 32 ) and thus on the “granulosa mass.” Caanen et al ( 33 ) observed that administration of androgens as part of female-to-male transitions induced a significant decrease in AMH levels, but the protocol included the use of a GnRH agonist, which might have confused the results by lowering serum FSH level (see below). Finally, the decrease in serum AMH levels in PCOS patients receiving high-dose cyproterone acetate, a progestin with a potent anti-gonadotropic and peripheral anti-androgenic action, was no greater than under other anti-gonadotropic drugs, such as estrogen-progestin contraceptives ( 34 , 35 ). But here again, serum FSH level is low in these situations.…”

“…In vivo, Das et al (24) highlighted that the AMH concentration in follicular fluid of 4 to 8 mm antral follicles, was 5 times higher, outside of any ovarian stimulation setting. Catteau-Jonard et al (25) demonstrated increased transcription of the AMH gene and its receptor by quantitative RT-PCR on partially luteinized GCs collected during oocyte puncture for in vitro fertilization in women with PCOS, compared with control women. This increased transcriptional activity was seen in both selected intermediate-sized (8-13 mm mean diameter) and larger dominant follicles (17-22 mm mean diameter).…”

“…In addition to increased expression of AMH, the expression of AMH type 2 receptors (AMHR2) is amplified in PCO GCs (25,39). Activation of AMHR2 results in a significant increase in phosphorylation of SMAD 1,5,8 in the mouse (44) and of SMAD 5 in luteinized human GCs (45).…”

Influence of combined oral contraceptives on polycystic ovarian morphology-related parameters in Korean women with polycystic ovary syndrome

“…Moreover, the AMH assay kits used differed from those in our study. Plouvier et al [21] reported a significant decrease in follicle numbers per ovary and AMH levels after a 3-month trial of COCs. Fábregues et al [22] reported significant TFC reductions after 6 months of COC use, with a significant positive correlation between TFC and AMH level (rho=0.92 and 0.88; P=0.01 and 0.004, respectively).…”

“…Several studies have investigated whether COCs can modulate PCOM in patients with PCOS [13,[19][20][21][22][23][24][25]. According to Mes-Krowinkel et al [19], the mean ovarian volume, mean ovarian follicle count, and AMH level remarkably decreased in patients using COCs than in patients who had never used COCs after correction for confounding variables such as body mass index, age, waist-to-hip ratio, previous pregnancy, infertility treatment, and ethnicity.…”