Age-stratified thresholds of anti-Müllerian hormone improve prediction of polycystic ovary syndrome over a population-based threshold

Summary

Objective

Due to its consistent elevation in polycystic ovary syndrome (PCOS) and correlation with polycystic ovarian morphology (PCOM), anti-Mullerian hormone (AMH) has been proposed as a marker of the syndrome. However, prior studies reporting thresholds of AMH for a PCOS diagnosis have been limited by small sample size, inappropriate controls, and heterogeneous AMH assays. We sought to evaluate the suitability of a standardized AMH assay as a biomarker of PCOS.

Design

Cross-sectional study at academic medical centers across the United States.

Patients

Women with PCOS were diagnosed by Rotterdam Criteria and included 282 subjects from the multi-site PPCOS II trial and 109 patients from a tertiary academic center's multidisciplinary PCOS clinic. Controls included 245 participants in the Ovarian Aging (OVA) study, a community-based cohort of ovulatory women not seeking treatment for fertility.

Measurements

Determination of AMH by a central laboratory. Receiver operating characteristic (ROC) analyses were used to investigate the accuracy of AMH thresholds for prediction of PCOS diagnosis with stratification by age.

Results

The optimal threshold of AMH to distinguish PCOS from controls was 55.36 pmol/L (sensitivity: 0.82, specificity: 0.78, J: 0.60). When examining the population by age groups, the optimal AMH threshold decreased with increasing age.

Conclusions

AMH is an effective biomarker of PCOS. Age-stratified thresholds more accurately predicted PCOS than an overall population-based threshold.

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