Anti-müllerian hormone: A new diagnostic marker for polycystic ovary syndrome?

Introduction

Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 5–15% of women of reproductive age. Diagnosis based on the Rotterdam criteria includes ovarian ultrasound, which is operator-dependent and subject to several limitations. Anti-Müllerian hormone (AMH), produced by granulosa cells of antral follicles, is emerging as an alternative biomarker. This study aims to determine an optimal AMH diagnostic threshold for Tunisian women.

Materials and methods

This multicenter, cross-sectional case-control study included 31 PCOS patients diagnosed according to the Rotterdam criteria and 31 age- and BMI-matched controls. Serum AMH levels were measured using an electrochemiluminescence assay. Pelvic ultrasound was performed transabdominally and, when feasible, transvaginally or transrectally. Correlations between AMH, age, testosterone levels, and antral follicle count were assessed using linear regression analysis.

Results and discussion

The mean AMH level was 3.6 times higher in PCOS patients (7.69 ng/mL) than in controls (2.12 ng/mL; P <10⁻³). A significant positive correlation was observed between AMH and antral follicle count (B = 0.25; P <10⁻³) as well as with testosterone levels (B = 0.07; P <10⁻³). A negative correlation with age (B = −0.15; P <10⁻³) was also demonstrated. ROC curve analysis identified an optimal diagnostic threshold of 3.41 ng/mL, with a sensitivity of 97% and a specificity of 90%.

Conclusion and limitations

AMH is a reliable biomarker for PCOS in hyperandrogenic Tunisian women, potentially replacing ovarian ultrasound when it is unavailable, inconclusive, or lacks an experienced operator. Study limitations include the absence of phenotype D in our cohort and the need for validation in larger populations.