Fraissinet A, et al. – This study is performed to determine whether the utilization of the serum anti–Müllerian hormone (AMH) assay to replace or complement ultrasound (U/S) influence the diagnosis or phenotypic distribution of polycystic ovary syndrome (PCOS). Combining U/S and the serum AMH assay to characterize polycystic ovarian morphology (PCOM) diagnoses PCOS (as per the Rotterdam classification) in more patients than definitions utilizing one or the other of these indicators exclusively.

Methods

• For this research, they conducted a single–center retrospective study.
• This study was performed 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.
• The standard Rotterdam classification for PCOS was tested against two modified versions that characterized 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 characterized as A (full phenotype, OA+HA+PCOM), B (OA+HA), C (HA+PCOM) and D (OA+PCOM).

Results

• PCOS was more frequently diagnosed when PCOM was characterized 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 utilized had no other important effect 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 majorly 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.