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Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome.
Hum Reprod. 2017 08 01; 32(8):1716-1722.HR

Abstract

STUDY QUESTION

Does the use of the serum anti-Müllerian hormone (AMH) assay to replace or complement ultrasound (U/S) affect the diagnosis or phenotypic distribution of polycystic ovary syndrome (PCOS)?

SUMMARY ANSWER

Combining U/S and the serum AMH assay to define polycystic ovarian morphology (PCOM) diagnoses PCOS (according to the Rotterdam classification) in more patients than definitions using one or the other of these indicators exclusively.

WHAT IS KNOWN ALREADY

Since 2003, PCOM, as defined by U/S, is one of the three diagnostic criteria for PCOS. As it is closely correlated with follicle excess seen at U/S, an excessive serum AMH level could be used as a surrogate for PCOM.

STUDY DESIGN, SIZE, DURATION

Single-center retrospective study from a database of prospectively collected clinical, laboratory and ultrasound data from patients referred for oligo-anovulation (OA) and/or hyperandrogenism (HA) between January 2009 and January 2016.

PARTICIPANTS/MATERIALS, SETTING, METHOD

The standard Rotterdam classification for PCOS was tested against two modified versions that defined PCOM by either excessive serum AMH level alone (AMH-only) or a combination (i.e. 'and/or') of the latter and U/S. The PCOS phenotypes were defined as A (full phenotype, OA+HA+PCOM), B (OA+HA), C (HA+PCOM) and D (OA+PCOM).

MAIN RESULTS AND THE ROLE OF CHANCE

PCOS was more frequently diagnosed when PCOM was defined as the combination 'positive U/S' and/or 'positive AMH' (n = 639) than by either only U/S-only (standard definition, n = 612) or by AMH-only (n = 601). With this combination, PCOM was recognized in 637 of the 639 cases that met the Rotterdam classification, and phenotype B practically disappeared. In this population, U/S and AMH markers were discordant for PCOM in 103 (16.1%) cases (9% U/S-only, 7.1% AMH-only, P = 0.159). The markers used had no other significant impact on the phenotypic distribution (except for phenotype B). However, the percentage of cases positive by U/S-only was significantly higher in phenotype D than in phenotype A (14.1% vs. 5.8%, P < 0.05). Furthermore, in the discordant cases, plasma LH levels were significantly higher in the AMH-only group than in the concordant cases, and fasting insulin serum levels tended to be higher in the U/S-only group.

LIMITATIONS, REASONS FOR CAUTION

This is a retrospective study. A referral bias explains the relatively high proportion of patients with phenotype D (28%). PCOM was defined by in-house thresholds. The AMH assay used is no longer commercially available.

WIDER IMPLICATIONS OF THE FINDINGS

Our results suggest that ideally both U/S data and serum AMH level should be integrated to define PCOM in the Rotterdam classification. In a cost-effectiveness approach, the choice of one or the other has little impact on the diagnosis and the phenotyping of PCOS.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding. The authors have no conflict of interest to declare.

Authors+Show Affiliations

CHU Lille, Department of Endocrine Gynecology and Reproductive Medicine, Hospital Jeanne de Flandre, 2, rue E. Avinée, F-59000 Lille, France.CHU Lille, Department of Endocrine Gynecology and Reproductive Medicine, Hospital Jeanne de Flandre, 2, rue E. Avinée, F-59000 Lille, France.CHU Lille, Department of Endocrine Gynecology and Reproductive Medicine, Hospital Jeanne de Flandre, 2, rue E. Avinée, F-59000 Lille, France.CHU Lille, Department of Endocrine Gynecology and Reproductive Medicine, Hospital Jeanne de Flandre, 2, rue E. Avinée, F-59000 Lille, France.CHU Lille, Department of Endocrine Gynecology and Reproductive Medicine, Hospital Jeanne de Flandre, 2, rue E. Avinée, F-59000 Lille, France.Correspondence address. E-mail: didier.dewailly@chru-lille.fr

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28854589

Citation

Fraissinet, Alice, et al. "Use of the Serum anti-Müllerian Hormone Assay as a Surrogate for Polycystic Ovarian Morphology: Impact On Diagnosis and Phenotypic Classification of Polycystic Ovary Syndrome." Human Reproduction (Oxford, England), vol. 32, no. 8, 2017, pp. 1716-1722.
Fraissinet A, Robin G, Pigny P, et al. Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome. Hum Reprod. 2017;32(8):1716-1722.
Fraissinet, A., Robin, G., Pigny, P., Lefebvre, T., Catteau-Jonard, S., & Dewailly, D. (2017). Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome. Human Reproduction (Oxford, England), 32(8), 1716-1722. https://doi.org/10.1093/humrep/dex239
Fraissinet A, et al. Use of the Serum anti-Müllerian Hormone Assay as a Surrogate for Polycystic Ovarian Morphology: Impact On Diagnosis and Phenotypic Classification of Polycystic Ovary Syndrome. Hum Reprod. 2017 08 1;32(8):1716-1722. PubMed PMID: 28854589.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome. AU - Fraissinet,Alice, AU - Robin,Geoffroy, AU - Pigny,Pascal, AU - Lefebvre,Tiphaine, AU - Catteau-Jonard,Sophie, AU - Dewailly,Didier, PY - 2017/03/22/received PY - 2017/06/14/accepted PY - 2017/9/1/entrez PY - 2017/9/1/pubmed PY - 2018/5/22/medline KW - AMH KW - PCOM KW - PCOS KW - anti-Müllerian hormone KW - diagnosis KW - hyperandrogenism KW - oligo-anovulation KW - polycystic ovarian morphology KW - polycystic ovary syndrome KW - ultrasound SP - 1716 EP - 1722 JF - Human reproduction (Oxford, England) JO - Hum Reprod VL - 32 IS - 8 N2 - STUDY QUESTION: Does the use of the serum anti-Müllerian hormone (AMH) assay to replace or complement ultrasound (U/S) affect the diagnosis or phenotypic distribution of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER: Combining U/S and the serum AMH assay to define polycystic ovarian morphology (PCOM) diagnoses PCOS (according to the Rotterdam classification) in more patients than definitions using one or the other of these indicators exclusively. WHAT IS KNOWN ALREADY: Since 2003, PCOM, as defined by U/S, is one of the three diagnostic criteria for PCOS. As it is closely correlated with follicle excess seen at U/S, an excessive serum AMH level could be used as a surrogate for PCOM. STUDY DESIGN, SIZE, DURATION: Single-center retrospective study from a database of prospectively collected clinical, laboratory and ultrasound data from patients referred for oligo-anovulation (OA) and/or hyperandrogenism (HA) between January 2009 and January 2016. PARTICIPANTS/MATERIALS, SETTING, METHOD: The standard Rotterdam classification for PCOS was tested against two modified versions that defined PCOM by either excessive serum AMH level alone (AMH-only) or a combination (i.e. 'and/or') of the latter and U/S. The PCOS phenotypes were defined as A (full phenotype, OA+HA+PCOM), B (OA+HA), C (HA+PCOM) and D (OA+PCOM). MAIN RESULTS AND THE ROLE OF CHANCE: PCOS was more frequently diagnosed when PCOM was defined as the combination 'positive U/S' and/or 'positive AMH' (n = 639) than by either only U/S-only (standard definition, n = 612) or by AMH-only (n = 601). With this combination, PCOM was recognized in 637 of the 639 cases that met the Rotterdam classification, and phenotype B practically disappeared. In this population, U/S and AMH markers were discordant for PCOM in 103 (16.1%) cases (9% U/S-only, 7.1% AMH-only, P = 0.159). The markers used had no other significant impact on the phenotypic distribution (except for phenotype B). However, the percentage of cases positive by U/S-only was significantly higher in phenotype D than in phenotype A (14.1% vs. 5.8%, P < 0.05). Furthermore, in the discordant cases, plasma LH levels were significantly higher in the AMH-only group than in the concordant cases, and fasting insulin serum levels tended to be higher in the U/S-only group. LIMITATIONS, REASONS FOR CAUTION: This is a retrospective study. A referral bias explains the relatively high proportion of patients with phenotype D (28%). PCOM was defined by in-house thresholds. The AMH assay used is no longer commercially available. WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest that ideally both U/S data and serum AMH level should be integrated to define PCOM in the Rotterdam classification. In a cost-effectiveness approach, the choice of one or the other has little impact on the diagnosis and the phenotyping of PCOS. STUDY FUNDING/COMPETING INTEREST(S): No external funding. The authors have no conflict of interest to declare. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/28854589/Use_of_the_serum_anti_Müllerian_hormone_assay_as_a_surrogate_for_polycystic_ovarian_morphology:_impact_on_diagnosis_and_phenotypic_classification_of_polycystic_ovary_syndrome_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/dex239 DB - PRIME DP - Unbound Medicine ER -