The polycystic ovary syndrome presents with a set of symptoms that range from mild to severe and has reproductive, endocrine, and metabolic implications [23]. PCOS is one of the leading causes for female sub-fertility and the most common endocrine disorder among the reproductive age women. Despite many decades of extensive research, the exact etiology and pathogenesis of this complex disorder remain hidden. AMH is a promising marker, as its concentration is constant throughout the menstrual cycle and is not affected by fluctuations of other reproductive hormones [23].
Although serum AMH levels are used as a predictive marker of ovarian response during IVF, there are conflicting reports of its predictive value for folliculogenesis in ovulation induction with clomiphene citrate [23]. Measurement of AMH levels allows for the further investigation of PCOS and its clinical implications. Addressing AMH values in the present study, we determined that they could distinguish between PCOM and PCOS as separate entities, adding strength to the notion that PCOM is a precursor to PCOS and suggest that PCOM is not merely a normal variation of ovarian morphology.
This study was to examine the relationship between serum AMH levels, antral follicle count, and the ovarian volume in healthy women and women having PCOS. The results confirmed that fasting blood glucose is significantly higher in the PCOS group (5.98 ± 2.1 mmol/L) than in the control group (5.05 ± 0.99 mmol/L). The fasting insulin levels are significantly higher as well (22.1 ± 5.1 µU/mL vs 12.02 ± 2.44 µU/mL).
This study confirmed that HOMA/IR is significantly higher in the PCOS group (6.1 ± 2.49) compared to that in the control group (2.4 ± 0.5). There was a highly significant direct correlation between HOMA/IR and cholesterol values. Such a result was consistent with other studies that showed a significant correlation between HOMA-IR and variables such as TG, LDL cholesterol and HDL [24]. In our study, the HOMA/IR cut-off value was ≥ 3.22 with 87.3% sensitivity and 87.3% specificity, which turned out to be consistent with the recent research [24]. The Ferriman-Gallwey (FG) score was significantly higher in the PCOS group (26.49 ± 3.6 vs 7.73 ± 1.66), with a cut-off value of ≥ 15.7 at 100% sensitivity and 100% specificity. Some authors [23, 24] conducted an extensive review of publications in which they reported a cut-off point for mFG of ≥ 11 for indigenous women in China [24]. Androgenic disorders may be present with normal body hair; therefore, the absence of hirsutism does not exclude consideration of PCOS with other symptoms of androgen excess such as the presence of acne, alopecia, infertility or menstrual dysfunction [24].
The mean cholesterol level was significantly higher in the PCOS group (218 ± 20 mg/dl vs 167.7 ± 17.19 mg/dl). There was a significant increase in the mean triglyceride level in women with PCOS (99.6 ± 10 mg/dl) as compared to healthy controls (85.00 ± 9 mg/dl). In this study, the PCOS group had a significantly lower mean concentration of HDL 39.45 ± 7.25 mg/dl vs 55.80 ± 4.53 mg/dl), indicating a high risk of developing metabolic syndrome. Such a result was consistent with the study claiming low HDL cholesterol as a criterion which best explained the high prevalence of the metabolic syndrome in PCOS subjects which, in turn, was influenced by hyperinsulinemia, rather than hyperandrogenemia [25]. In the current study, a significant increase in BMI was observed in patients with PCOS (34.78 ± 3.43 kg/m²) as compared to controls (27.44 ± 1.73 kg/m²). A direct correlation was observed between the serum AMH levels and all other parameters in all subjects under study.
We found that exercises decreased the level of AMH in overweight women with PCOS. These findings were consistent with other publications [26].
In this study, the serum AMH concentrations in women with PCOS (12.90 ± 3.3 ng/ml) were significantly higher as compared to controls (4.3 ± 0.5 ng/ml).These AMH values were in line with data in [2]. The authors found that elevated AMH (> 4.5 ng/ml) may be useful as an alternative to PCOM if the ultrasound findings are not conclusive [27]. In this study, the mean AMH level was 2.72-fold higher in patients with PCOS as compared to healthy controls. This was consistent with data from previous researchers [11]. The have reported 2- to 3-fold higher serum AMH levels in women with PCOS as compared to ovulatory women, which corresponded to an increase in the number of small follicles seen in PCOS. Normally, the serum AMH concentrations in patients with PCOS are higher than in ‘normal’ women [28]. The present study showed a diagnostic cut-off value of serum AMH for PCOS, 5.8 ng/ml, yielding a sensitivity of 100% and specificity of 100%. In contrast, Lin et al. reported an AMH cut-off value of 7.3 ng/ml (specificity, 76%; sensitivity, 70%) [29]. In addition, the measurement of serum AMH levels may also be used as an indicator of the PCOS patients’ response to therapeutic approaches, including evaluation after treatment with insulin sensitizers and monitoring after laparoscopic ovarian resection.
In this study, the mean number of follicles (26.6 ± 6) in both ovaries is significantly higher in the PCOS group than in the control group (9 ± 2). These data are coherent with [3], which confirmed ≥ 12 threshold for the follicle number per ovary in Chinese women. The 2003 Rotterdam consensus, the most common ultrasound definition employed to date, was based on the Balen’s study and on expert agreement [30]. Many authors found that PCOS cases differ from controls on transvaginal ultrasound with a threshold of ≥ 12 follicles measuring 2–9 mm in diameter (mean of both ovaries) [29].
In terms of ovarian volume, the PCOS group demonstrated significantly higher values (11.56 ± 3.1 cm3 vs 6.23 ± 0.73 cm3) as well as a significant correlation between AMH and OV at r = 0.853 and P < 0.0001. Without contradicting the present results, other researchers demonstrated that AMH had a statistically significant positive correlation with the ovarian volume (r = 0.623, P < 0.01) [24]. In a recent study, the ovarian volume showed the strongest positive correlation (r = 0.62) with the serum AMH level among related factors [3]. Here, it also demonstrated a highly significant correlation with AFC (r = 0.861, P < 0.0001). The AMH/AFC ratio was 0.46 in the PCOS group and 0.48 in the control group, indicating the concentration of AMH per follicle. Therefore, the number of follicles depends on the serum AMH level. Here, a significant correlation was observed between serum AMH levels and variations in testosterone, AFC, and OV on ultrasound [31]. A very significant correlation between AMH and AFC values among PCOS patients was in line with the results obtained by other researchers [29]. According to them, the AMH levels may be used to replace the number of follicles as a diagnostic criterion if the ultrasound cannot provide accurate.