Anti Mullerian Hormone: A Potential Marker for Recruited Non Growing Follicle of Ovarian Pool in Women with Polycystic Ovarian Syndrome
Dr. P. Saikumar, Professor and H.O.D, Department of Physiology, Sree Balaji Medical College and Hospital, No. 7, CLC Works Road,
New Colony, Chromepet, Chennai-600044, Tamil Nadu, India.
Phone: 98400 98098, E-mail: firstname.lastname@example.org
Background: Polycystic ovarian disease is one of the most common causes of infertility in women of reproductive age. Antiâ€“ mullerian hormone (AMH), a member of transforming growth factor (TGF) family which is secreted by granulosa cells of growing follicle, is found to be increased to three to four fold in Poly Cystic Ovarian Syndrome (PCOS) patients as evidenced by previous studies. But the level of AMH in relation to the infertile status of PCOS was not studied yet. The present study was focused to determine the discriminative power of AMH in infertility subjects with regular cycles and infertility subjects associated with PCOS.
Methods: The subjects under study were one hundred and twenty infertile women of age group ranging from 27â€“35 years. Subjects, were further divided into sixty infertile with regular cycles as controls (Group1) and sixty infertile subjects with PCOS as cases (Group 2). Hormones like FSH, E2 and AMH were assayed for all the subjects. Mean and student tâ€“ test for all hormones were compared between controls and cases. The diagnostic power of AMH pertaining to sensitivity and specificity was evaluated by Receiver operating characteristic (ROC) curve.
Results: Serum AMH level were two fold higher in PCOS patients than in controls. The mean value of AMH also shows a test of significance between the two groups. The area under the receiver operating characteristic curve for the AMH assay was 0.95 in infertile group when 3.34ng/ml was used as cut off point indicating its better discriminative power and good diagnostic potency. Setting the AMH value at 3.34ng/ml sensitivity, specificity,Positive Predictive Value(PPV) and Negative Predictive Value(NPV) were observed 98% ,93%, 93% and 98% respectively.
Conclusion: The diagnostic potency of Area Under Curve (AUC) for AMH in infertile subjects reflects that AMH is a potential marker for recruited non growing follicles rather than a simple marker for ovarian reserve as it is predominantly produced by small follicles rather than a simple marker for ovarian reserve.