Phenotypic variation in anti-Mullerian hormone (AMH) production per follicle in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian morphology (PCOM): an observational cross-sectional study

Abstract

This observational study compares the ratio of serum anti-Mullerian hormone (AMH) to the total antral follicle count (AFC) (as a marker of AMH production per follicle) in the various phenotypes of women with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian morphology (PCOM). Two hundred and sixty-two women were recruited. Women with PCOS were divided into four phenotypes based on the diagnostic inclusion criteria of oligo-anovulation (OA), hyperandrogenism (HA) and polycystic ovarian morphology (PCOM). These included Group A (OA + HA + PCOM), Group B (OA + HA), Group C (HA + PCOM) and Group D (OA + PCOM). A ratio of serum AMH to total AFC was calculated and expressed as the AMH/AFC ratio which was compared in the phenotypes of PCOS and isolated PCOM. The median AMH/AFC ratios in PCOS-A, PCOS-D, PCOS-C and PCOM were 1.5, 1.6, 1.2 and 1.1, respectively. There were significant differences in the groups compared [F(3, 238) = 6.14, p = 0.000)]. The ratios were significantly higher in the oligo-anovulatory phenotypes PCOS-A and PCOS-D than the PCOM (p = 0.004 and 0.002, respectively). There was no significant difference in the ratio between ovulatory phenotype PCOS-C and PCOM (p = 0.59). The role of androgens and LH in per-follicle AMH production remains limited. The findings support the hypothesis of a key role for AMH in the mechanism of anovulation in PCOS.

Chinese abstract

这项观察性研究比较了不同表型的多囊卵巢综合征（PCOS）和孤立多囊卵巢形态（PCOS）患者的血清抗苗勒管激素（AMH）水平与总窦卵泡计数（AFC）（作为卵泡产生AMH的标志）的比值, 共二百六十二名女性入组, 基于低排卵（OA）, 雄激素过多（HA）和多囊卵巢形态（PCOM）的诊断标准, 将PCOS患者分为四种表型。它们包括A组（OA + HA + PCOM）, B组（OA + HA）, C组（HA + PCOM）和D组（OA + PCOM）。计算血清AMH与总AFC的比例, 以AMH/AFC表示, 并在不同表型PCOS和PCOM比较AMH/AFC大小。PCOS-A, PCOS-D, PCOS-C和PCOM中的AMH/AFC中位数分别为1.5,1.6,1.2和1.1。组间差异有统计学意义（F（3,238）= 6.14, p = 0.000）]。低排卵表型PCOS-A和PCOS-D中的AMH/AFC显著高于对照组PCOM（分别为p = 0.004和p = 0.002）。 PCOS-C和PCOM之间这一比例无显著统计学差异（p = 0.59）。雄激素和LH对卵泡产生AMH的刺激作用不是很明显。这些研究结果验证了AMH在PCOS排卵机制中起到关键作用这一假说。

Keywords:

• AMH/AFC ratio
• PCOS
• phenotype

Acknowledgements

The authors wish to thank the staff at the Homerton Fertility Centre for their assistance in screening and recruitment of participants for the study.

Declaration of interest

None of the authors have any conflict of interest to declare.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.