Relationship between serum anti-Mullerian hormone and intrafollicular AMH levels in PCOS women

Abstract

Polycystic ovary syndrome is a complex disease characterized by various endocrine disorders that are the potential cause of anovulation and hyperandrogenism. Anti-Müllerian hormone expression is suspected to be overexpressed in PCOS granulosa cells. AMH acts as a regulator of folliculogenesis: it is produced by the granulosa cells of follicles from the stage of the primary follicle to the initial formation of the antrum. Serum and intrafollicular AMH levels are elevated in patients with PCOS due to increased number of small follicles and an increased secretion within each of these small follicles. This excess of AMH is strongly suspected to play a role in the characteristic follicular arrest of PCOS, through a negative action on aromatase expression and on FSH action. Value above 5 ng/ml or 35 pmol/l might be considered as a diagnostic criterion for PCOS. The aim of our study is to demonstrate the presence of higher AMH serum levels and higher AMH intrafollicular fluid level of PCOS patients, undergone to IVF cycles, compared to normovulatory patients. The results clearly indicate that blood and intrafollicular AMH levels are significantly higher in PCOS women comparing to the normovulatory population. Serum AMH level appears to be a good predictive marker for the risk ovarian hyperstimulation syndrome: thus, its evaluation should be recommended before starting a controlled ovarian stimulation for IVF.

Chinese abstract

多囊卵巢综合征是一种可能由无排卵和高雄激素血症导致多种内分泌紊乱为特点的复杂性疾病。PCOS患者卵巢颗粒细胞中抗苗勒氏管激素被认为高表达。AMH调节卵泡发育：它是初级卵泡形成窦状卵泡的过程中由颗粒细胞生成。由于小卵泡数量增多, 以及这些小卵泡分泌增多, PCOS患者血清和卵泡液中AMH水平均升高。这种过量的AMH通过对芳香化酶表达及对FSH功能的抑制而被严重怀疑在PCOS特征性的卵泡发育停滞中发挥作用。AMH超过5ng/ml或35 pmol/l可以作为PCOS的诊断标准。我们研究的目的是证实与正常排卵的患者相比, 在IVF周期中, PCOS患者体内高AMH血清水平和高AMH卵泡液水平是存在的。结果表明, PCOS妇女血和卵泡内AMH水平显著高于正常排卵的人群。血清AMH水平似乎是罹患卵巢过度刺激综合征的一个很好的预测指标：因此, 推荐在为体外受精作控制性卵巢刺激开始前对AMH进行评估。

Keywords:

• PCOS
• AMH
• IVF
• OHSS

Disclosure statement

The authors declare that there is no conflict of interest regarding the publication of this paper.