Abstract
Requests for serum antimüllerian hormone (AMH) measurement are increasing. Their main current use is in assisted conception to predict oocyte yield before commencing ovarian stimulation. A less common but diagnostically important use is in paediatric units for the investigation of sexual development disorders. There is limited evidence available to support measurement of AMH in other clinical situations.
Hart et al. have carried out a large prospective study investigating the relationship between AMH and polycystic ovarian syndrome (PCOS). Two recognized diagnostic criteria were used: the Rotterdam definition and the National Institutes of Health. Both require clinical and biochemical androgen investigations along with evidence of oligo/anovulation. However, the Rotterdam definition will also accept ultrasound evidence of polycystic ovaries.
Adolescent women (n = 207, median age 15.1 y) underwent numerous investigations including androgen analysis (visits standardized to between 15:30 and 16:40 h) and transabdominal ultrasound. Appointments were scheduled for days 2–5 of the menstrual cycle to ensure all participants were in the early follicular phase. Clinical hyperandrogenism was defined as a Ferriman-Gallway score of ≥8 and biochemical hyperandrogenism as a calculated free testosterone >24.5 pmol/L (upper 25th percentile).
Significantly higher AMH concentrations were found in girls with polycystic ovaries and also PCOS with both definitions. However, the most effective cut-off (30 pmol/L) was insufficient to discriminate between normal and abnormal outcomes (PPV 14.7–33.4%).
There were many limitations of the study. It was restricted to an adolescent population likely to have a higher incidence of menstrual irregularities. In addition, along with other studies and recommendations, an established cut-off for biochemical hyperandrogenism was lacking. The measurement of a single analyte for the diagnosis of PCOS is a desirable goal, but this article highlights the limitations of AMH used in this way.