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The relationships of anti-Müllerian hormone (AMH) and different diagnostic criteria of polycystic ovary syndrome (PCOS) diagnosed according to the Rotterdam criteria (RC) in subfertile women

INTRODUCTION It has been reported that AMH level is related to hyperandrogenism (HA) and oligo/amenorrhoea (OA) in PCOS. Objectives of this study were: 1) to determine whether AMH is predominantly associated with OA or HA in Croatian subfertile women with polycystic ovarian morphology (POM) diagnosed as having PCOS according to the Rotterdam criteria (RC), 2) to determine whether AMH association with the number of follicles measuring 2-9 mm in diameter (AFC) is independent of other clinical and biochemical characteristics that define PCOS. METHODS A total of 233 subfertile women of the Department of Human Reproduction with POM who met the RC criteria for PCOS were divided into phenotype groups as follows: PCOS A - POM, HA and OA, n=90 ; PCOS C – POM and HA, n=51 ; PCOS D – POM and OA, n=91. POM was defined as the presence of >11 AFC in at least one ovary. HA was defined as testosterone (T) level >2.8 nmol/L and/or modified Ferriman-Gallwey score (mFG) >7. OA was defined as menstrual cycle length (MCL) >35 days. Kruskal-Wallis test with post-hoc analysis for pairwise comparison of groups was used to determine between-group differences of AMH values and other patient characteristics. The relationships between AMH and patient characteristics that define RC were assessed by multiple regression analysis. P-value of <0.05 was considered statistically significant. RESULTS The difference in AMH values was observed when two hyperandrogenic PCOS phenotypes differing in MCL (PCOS A vs. PCOS C) were compared (P < 0.001). In contrast, the AMH values of the two OA- phenotypes of PCOS (PCOS A vs. PCOS D) did not differ despite the difference in the presence of HA (P = 0.174). AMH was found to be associated with AFC, T and MCL, but not with mFG. Together with MCL, T and mFG, AMH was only included in the model explaining 36.9% of the variance of AFC. CONCLUSION Compared to HA, OA seems to be the PCOS feature predominantly associated with the AMH levels in PCOS women with POM. The antral follicle accumulation in PCOS could be explained, at least partially, by androgen-independent role of AMH.

AMH; PCOS; AFC; hyperandrogenism; oligo/amenorrhoea

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