Serum and follicular anti-Mullerian hormone levels in women with polycystic ovary syndrome (PCOS) under metformin

Abstract

BackgroundNo data regarding metformin effects on follicular fluid anti-Müllerian hormone (AMH) levels were to date available in literature. The aim of the present study was to evaluate in patients with polycystic ovary syndrome (PCOS) whether metformin administration affects serum and follicular AMH levels, and whether this is related to ovarian response to the treatment.MethodsTwenty young patients with PCOS who had received metformin were enrolled. Ten patients were anovulatory (Met-anov group), whereas the other 10 were ovulatory (Met-ov group) but had failed to conceive. Further untreated PCOS (PCOS controls, n. 10) and healthy controls (non-PCOS controls, n. 10) who were scheduled for laparoscopic surgery were enrolled. In each subjects, clinical and biochemical evaluations were performed. AMH concentrations in blood and antral follicular fluid were assayed.ResultsIn both Met-anov and Met-ov groups, and without difference between them, serum androgens and AMH, and indices of insulin resistance were significantly (p < 0.05) improved after treatment. On the other hand, significant differences (p < 0.05) between the two groups were detected with respect to the same biochemical parameters in antral follicular fluid. In the Met-anov group, no significant correlation was observed between AMH concentrations in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes; whereas in Met-ov group significant correlations were detected between AMH levels in the follicular fluid and variation in serum androgens, AMH and insulin resistance indexes.ConclusionsMetformin administration in patients with PCOS exerts a differential action on the ovarian AMH levels on the basis of ovulatory response. Changes in AMH levels in antral follicular fluid during metformin treatment could be involved in the local mechanisms mediating the ovulatory restoration.

Effect Of Metformın Therapy On Antı Mullerian Hormone Levels In Patıents Wıth Polycystıc Ovary Syndrome

“…It is also reported that metformin is more effective at insulin resistance but oral contraceptives were more beneficial at amelioration of menstrual irregularity and hyperandrogenemia (20). Also, its effect is proven on serum AMH levels in patients with PCOS (21,22). In our study, Serum AMH levels were significantly higher in patients with PCOS when compared to healthy women.…”

Assessing and treating insulin resistance in women with polycystic ovarian syndrome

“…Studies have attempted for years to show an advantage to metformin for ovulation induction and as an adjunct to more advanced fertility treatments. In ovulatory PCOS wo men metformin was associated with improved serum and follicular fluid AMH levels as well as insulin values; these changes were not seen in anovulatory PCOS women [71] . Despite the demonstration of negative effects of IR on reproductive outcome, the vast majority of evidence does not show improvement in live birth rates when metformin is used strictly for fertility [72] , although treatment does im prove ovulatory status [72,73] .…”

Metformin reduces risk of ovarian hyperstimulation syndrome in patients with polycystic ovary syndrome during gonadotropin-stimulated in vitro fertilization cycles: a randomized, controlled trial

“…Second, metformin also affects the ovarian environment by improving intraovarian hyperandrogenism and insulin resistance in experimental studies (17,34). Androgens stimulate the early stages of follicular growth by enhancing granulosa FSH receptor expression via an increase in the number of FSH-responsive follicles (35)(36)(37)(38).…”