Antimüllerian hormone alone not adequate for PCOS diagnosis

Antimüllerian hormone alone not adequate for PCOS diagnosis | Image Credit: © SewcreamStudio - © SewcreamStudio - stock.adobe.com.

Antimüllerian hormone (AMH) levels by themselves cannot be used to define polycystic ovary syndrome (PCOS), according to a recent study published in Fertility and Sterility.¹

PCOS is an endocrine disorder that presents in 12% of reproductive-aged women, impacting reproduction, metabolism, endocrinology, dermatology, and psychosocial well-being. There is a diversity in phenotypes that present in PCOS patients, leading to difficulties toward identification and subsequent management.²

As of 2018, the Rotterdam criteria for PCOS includes at least 2 of 3 features: oligo- or anovulation, hyperandrogenism, and polycystic ovarian morphology (PCOM) on ultrasound.¹ However, accuracy may be impacted by the use of transabdominal ultrasound vs transvaginal ultrasound, with many patients considering the latter to be too invasive.

AMH levels have been proposed as an alternative PCOS diagnosing tool to avoid ultrasound challenges. However, data about the diagnostic role of this hormone remains lacking.

To assess the accuracy of AMH for PCOS diagnosis and PCOM detection, investigators conducted a systematic review and meta-analysis. Studies published from January 1, 2017, to July 31, 2023, were identified through searches of the Medline, Embase, Web of Science, Cochrane, CINAHL, and PsycINFO databases.

Title and abstract screening were performed by 2 independent reviewers using COVIDENCE. Studies were eligible if they used AMH levels as a predictor for PCOS or PCOM, calculated sensitivity, specificity, or the area under the curve (AUC), were published in English, had full-text available, and were performed in humans.

Full-text screening was performed by the same 2 reviewers. Extracted data included the investigators’ name, publication year, study design, study population, country, mean age and body mass index (BMI), age and BMI differences between cases and controls, oral contraceptive use, AMH assay used, AMH cut-off value, sensitivity, specificity, and AUC values.

There were 82 studies included in the final analysis, 68 of which evaluated PCOS in adults, 11 PCOS in adolescents, and 7 PCOM in adults. Rotterdam criteria was used to diagnose PCOS in 66 studies, while 2 used National Institute of Health criteria.

The grading of recommendations assessment, development, and evaluation evidence indicated a lack of reliability from AMH levels toward diagnosing PCOS. This score was based on a significant risk of bias and imprecision. In the pooled analysis, AMH had a highly heterogenic sensitivity of 0.80 and specificity of 0.87 for diagnosing PCOS.

In studies with low or moderate risk of bias, the pooled sensitivity and specificity were 0.80 and 0.86, respectively. For studies with a high risk of bias, the sensitivity and specificity were 0.80 and 0.86, respectively.

Among adolescents, a pooled sensitivity of 0.66 and specificity of 0.78 were reported, with a heterogeneity of 74% for sensitivity and 45% for specificity. When detecting PCOM in adults, AMH levels had a pooled sensitivity of 0.79 with a heterogeneity of 94% and specificity of 0.87 with a heterogeneity of 94%.

These results indicated reasonable sensitivity and specificity from AMH levels toward identifying PCOM in adults, but inadequacy as a single diagnostic test for PCOS. Investigators concluded AMH levels alone should not be used for the diagnosis of PCOS.

References

1. Van der Ham K, Laven JSE, Thien Tay C, Mousa A, Teede H, Louwers YV. Anti-müllerian hormone as a diagnostic biomarker for polycystic ovary syndrome and polycystic ovarian morphology: a systematic review and meta-analysis. Fertility and Sterility. 2024;122(4):727-739.
2. Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102(2):604-612. doi:10.1210/jc.2016-2963