Comparative Study of Anti-Mullerian Hormone and its Correlation with Androgens and Insulin Resistance in Lean and Obese Women with Polycystic Ovary Syndrome

Abstract Introduction: Anti-Mullerian hormone (AMH) is a key regulator of ovarian folliculogenesis. Obesity, insulin resistance (IR), hyperandrogenism, and gonadotropins have an inconclusive role in the relation and regulation of AMH to polycystic ovarian syndrome (PCOS). Methods: PCOS cases ( n = 80) and matched controls ( n = 80) were evaluated with AMH levels and correlated with age, body mass index (BMI), insulin levels, IR, insulin sensitivity (IS), gonadotropins, and androgens. Results: Women with PCOS had significantly higher levels of AMH than controls (5.79 ± 4.00 ng/mL in obese cases vs 2.88 ± 2.38 ng/mL in obese controls, P = 0.006; 6.59 ± 4.13 ng/mL in lean cases vs 3.62 ± 2.04 ng/mL in lean controls, P < 0.001). AMH levels did not differ significantly amongst cases with respect to hyperandrogenism, BMI, and PCO morphology. However, women with PCOS who had irregular cycles had significantly greater AMH levels than those with regular menstrual cycles (6.27 ± 4.03 ng/mL vs 2.36 ± 2.02 ng/mL, P = 0.031). There was a negative correlation between AMH and BMI in all four groups, but reached significance only in lean PCOS. AMH did not correlate with insulin levels, HOMA-IR, or IS in any of the four groups. In lean PCOS, AMH correlated significantly with DHEAS ( r = 0.424), androstenedione ( r = 0.413), testosterone ( r = 0.502), and SHBG ( r = 0.412). In obese PCOS, AMH associated positively with androstenedione ( r = 0.490) and testosterone ( r = 0.402). Conclusion: BMI, IR, and androgens might differentially regulate AMH levels in lean and obese PCOS. AMH levels were higher in the subset of PCOS with irregular menses than in those with regular cycles; thus, higher AMH indicates a more severe disease state in PCOS.