Adjusting antimüllerian hormone levels for age and body mass index improves detection of polycystic ovary syndrome

In an opportunistic well-defined case/control dataset, adjusting AMH measurements for the woman’s age and BMI significantly improves PCOS screening. Modeling allows for patient-specific risks, providing more reliable and targeted interpretation.

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Volume 113, Issue 4, Pages 876–884.e2

Authors:

Glenn E. Palomaki, Ph.D., Bhanu Kalra, Ph.D., Tanya Kumar, B.S., Amita S. Patel, M.S., Gopal Savjani, M.S., Laura C. Torchen, M.D., Andrea Dunaif, M.D., Anthony Morrison, M.S., Geralyn M. Lambert-Messerlian, Ph.D., Ajay Kumar, Ph.D.

Abstract:

Objective

To examine whether accounting for a woman’s age and body mass index (BMI) would improve the ability of anti-Müllerian hormone (AMH) to distinguish between women with (cases) and without (controls) polycystic ovarian syndrome (PCOS).

Design

An opportunistic case-control dataset of reproductive age women having evaluations for PCOS as defined by National Institutes of Health criteria.

Setting

Two medical centers in the United States enrolled women. Serum samples were analyzed for relevant analytes.

Patients

Women were between 18 and 39 years of age when samples and clinical information were collected. Residual samples had been stored for 2−17 years. AMH was measured via immunoassay.

Interventions

None; this was an observational study.

Main outcome measures

Detection and false-positive rates for PCOS were computed for AMH results expressed as multiples of the median (MoM) both before and after adjustment for the woman’s age and BMI.

Results

Using unadjusted AMH MoM results, 168 cases (78%) cases were at or beyond the 90th centile of controls (2.47 MoM). After accounting for each woman’s age and BMI, 188 (87%) of those women were beyond the 90th centile of controls (2.20 MoM), a significant increase (P = .015). The adjusted AMH MoM levels fitted logarithmic normal distributions well (mean, standard deviation for controls and cases of 0.0000, 0.2765 and 0.6884, 0.2874, respectively) and this allowed for computation of patient-specific PCOS risks.

Conclusions

Accounting for the woman’s age and BMI resulted in significantly higher AMH-based detection rates for PCOS at a 10% false-positive rate, and patient-specific PCOS risks could be computed.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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