Age-related aspects of estimation of AMH levels in polycystic ovary syndrome


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Abstract

Objective. To determine anti-Müllerian hormone (AMH) threshold levels significant for the diagnosis of polycystic ovary syndrome (PCOS), by examining the age-related features of AMH secretion. Subject and methods. The investigation enrolled 546 reproductive-aged women: 272 with PCOS (mean age 24.9±4.5years; mean body mass index (BMI) 24.2±5.6 kg/m2) and 274 (mean age 25.0±4.1 years; mean BMI 25.2±4.7kg/m2) without reproductive dysfunction and hyperandrogenism. Complex clinical laboratory examination, including pelvic ultrasound, was conducted; the androgenic profile, serum AMH, luteinizing hormone, follicle-stimulating hormone, prolactin, and thyroid-stimulating hormone levels were estimated. ROC-analysis was used to develop normative values. Results. The mean AMH values did not substantially change in PCOS patients aged 18 to 34 years; these decreased from 5.1±1.7 to 2.6±1.0 ng/ml (p < 0.05). A negative correlation was found between AMH levels and age (r = -0.542, p < 0.005). The AMH threshold level for PCOS, which was determined disregarding the patients’ age, was 5.8 ng/ml (AUC 0.98, 94% sensitivity, 93%, specificity, 95% confidence interval (CI)). The age stratification of patients showed the low specificity of this indicator in the 20-24-year-old age subgroups and in 18-19-year-olds in particular. Conclusion. The assessment of the specif ic features of AMH secretion in patients with PCOS versus healthy women gives grounds to develop AMH threshold values in different age groups. The determination of the age threshold values of AMH can considerably increase the sensitivity and specificity of the technique and consequently improve the accuracy of PCOS diagnosis.

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About the authors

Alina A. Naidukova

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: aleeshka@mail.ru
graduate student

Elena K. Kaprina

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

graduate student

Tatiana Yu. Ivanets

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: t-ivanets@oparina4.ru
PhD, head of research and diagnostic laboratory

Galina E. Chernukha

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: c-galina1@yandex.ru
MD, department of gynecological endocrinology

References

  1. National Institutes of Health. Evidence-based methodology workshop on polycystic ovary syndrome. December 3-5, 2012. Final report. EXECUTIVE SUMMARY (7).
  2. Weenen C., Laven J.S., Von Bergh A.R., Cranfield M., Groome N.P., Visser J.A. et al. Anti- Müllerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol. Hum. Reprod. 2004; 10(2): 77-83.
  3. Bezard J., Vigier B., Tran D., Mauleon P., Josso N. Immunocytochemical study of anti-Müllerian hormone in sheep ovarian follicles during fetal and postnatal development. J. Reprod. Fertil. 1987; 80(2): 509-16.
  4. Baarends W.M., Uilenbroek J.T., Kramer P., Hoogerbrugge J.W., van Leeuwen E., Grootegoed J.A. Anti-müllerian hormone and anti-müllerian hormone type II receptor messenger ribonucleic acid expression in rat ovaries during postnatal development, the estrous cycle, and gonadotropin-induced follicle growth. Endocrinology. 1995; 136(11): 4951-62.
  5. Dewailly D., Andersen C.Y., Balen A., Broekmans F., Dilaver N., Fanchin R. et al. The physiology and clinical utility of anti-Müllerian hormone in women. Hum. Reprod. Update. 2014; 20(3): 370-85.
  6. Pellatt L., Rice S., Dilaver N., Heshri A., Galea R., Brincat M. et al. Anti-Müllerian hormone reduces follicle sensitivity to follicle stimulating hormone in human granulosa cells. Fertil. Steril. 2011; 96(5): 1246-51. e1.
  7. Попова П.В., Рязанцева Е.М., Рулёва ОК., Зазерская И.Е., Гринёва Е.Н. Антимюллеров гормон как предиктор менструального ответа при лечении женщин с синдромом поликистозных яичников с помощью изменения образа жизни и терапии метформином. Вестник репродуктивного здоровья. 2010; 3-4: 24-9. [Popova P.V., Ryazantseva E.M., Rulyova O.E., Zazerskaya I.E., GrinYova E.N. Anti-Müllerian hormone as a predictor of response in the treatment of menstrual women with polycystic ovary syndrome with lifestyle changes and metformin. Vestnik reproduktivnogo zdorovya. 2010; 3-4: 24-9.
  8. Стрельченко Д.А., Перминова С.Г., Донников А.Е. Предикторы синдрома гиперстимуляции яичников в программе ЭКО. Акушерство и гинекология. 2015; 10: 19-26. [Strelchenko D.A., Perminova S.G., Donnikov A.E. Predictors for the development of ovarian hyperstimulation syndrome in an IVF program. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2015; (10): 19-26. (in Russian)]
  9. Pigny P., Merlen E., Robert Y., Cortet-Rudelli C., Decanter C., Jonard S., Dewailly D. Elevated serum level of anti-mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J. Clin. Endocrinol. Metab. 2003; 88(12): 5957-62.
  10. Apridonidze T., Essah P.A., Luorno M.J., Nestler J.E. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 2005; 90(4): 1929-35.
  11. Боярский К.Ю., Гайдуков С.Н., Машкова Е.А. Роль антимюллерова гормона (АМГ) в норме и при различных гинекологических заболеваниях. Журнал акушерства и женских болезней. 2009; 58(3): 74-83. [Boyarskiy K.Yu., Gaydukov S.N., Mashkova E.A. Role of Anti-Müllerian hormone (AMH) in normal and various gynecological diseases. Zhurnal akusherstva i zhenskih bolezney. 2009; 58(3): 74-83. (in Russian)]
  12. Rosenfield R.L., Wroblewski K., Padmanabhan V., Littlejohn E., Mortensen M., Ehrmann D.A. Antimüllerian hormone levels are independently related to ovarian hyperandrogenism and polycystic ovaries. Fertil. Steril. 2012; 98(1): 242-9.
  13. Kelsey T.W., Wright P., Nelson S.M., Anderson R.A., Hamish W. A validated model of serum Anti-müllerian hormone from conception to menopause. Plos One. 2011; 6(7): e22024.
  14. Nelson S.M., Messow M.C., Wallace A.M., Fleming R., McConnachie A. Nomogram for the decline in serum antimüllerian hormone: a population study of 9,601 infertility patients. Fertil. Steril. 2011; 95(2): 736-41. e1-3.
  15. Mulders A.G., Laven J.S., Eijkemans M.J., de Jong F.H., Themmen A.P., Fauser B.C. Changes in anti-Müllerian hormone serum concentrations over time suggest delayed ovarian ageing in normogonadotrophic anovulatory infertility. Hum. Reprod. 2004; 19(9): 2036-42.
  16. Eilertsen T.B., Vanky E., Carlsen S.M. Anti-Mullerian hormone in the diagnosis of polycystic ovarian syndrome: can morphologic description be replaced? Hum. Reprod. 2012; 27(8): 2494-502.
  17. Pigny P., Jonard S., Robert Y., Dewailly D. Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 2006; 91(3): 941-5.
  18. Dewailly D., Gronier H., Poncelet E., Robin G., Leroy M., Pigny P. et al. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum. Reprod. 2011; 26(11): 3123-9.
  19. Li H.W., Anderson R.A., Yeung W.S., Ho P.C., Ng E.H. Evaluation of serum antimullerian hormone and inhibin B concentrations in the differential diagnosis of secondary oligoamenorrhea. Fertil. Steril. 2011; 96(3): 774-9.
  20. de Kat A.C., van der Schouw Y.T., Eijkemans M.J., Herber-Gast G.C., Visser J.A., Verschuren W.M., Broekmans F.J. Back to the basics of ovarian aging: a population-based study on longitudinal anti-Müllerian hormone decline. BMC Med. 2016; 14(1): 151.
  21. Carmina E., Campagna A.M., Lobo R.A. A 20-year follow-up of young women with polycystic ovary syndrome. Obstet. Gynecol. 2012; 119(2, Pt 1): 263-9.
  22. Kushnir V.A., Halevy N., Barad D.H., Albertini D.F., Gleicher N. Relative importance of AMH and androgens changes with aging among non-obese women with polycystic ovary syndrome. J. Ovarian Res. 2015; 8: 45.
  23. Табеева Г.И., Немова Ю.И., Найдукова А.А., Кузнецова Е.Б., Залетаев Д.Б., Чернуха Г.Е. Полиморфизм гена FMR1 при синдроме поликистозных яичников. Акушерство и гинекология. 2006; 3: 50-6. [Tabeeva G.I., Nemova Yu.I., Naydukova A.A., Kuznetsova E.B., Zaletaev D.B., Chernuha G.E. Polymorphism of the FMR1 gene in polycystic ovary syndrome. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2006; (3): 50-6. (in Russian)]

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