A Glimpse Into the Relationship Between Anti-Mullerian Hormone and Polycystic Ovary Syndrome and its Diagnostic Accuracy

The article was conducted to evaluate the diagnostic utility of Anti-Mullerian Hormone (AMH) in detecting Polycystic Ovary Syndrome (PCOS) using an advanced marginal beta-binomial statistical model. The research also seeks to establish optimal AMH cut-off values across various age groups, geographic locations, body mass index (BMI), and other significant factors.

A comprehensive literature review was performed across several databases and included epidemiological studies that used the diagnostic criteria for PCOS as defined by either the Androgen Excess Society (AES), the National Institute of Health (NIH), or the Rotterdam criteria. Studies were eligible if they provided information on the sensitivity and specificity of AMH or related data enabling the calculation of these parameters, and/or data on odds ratios and means.

The diagnostic role of AMH was evaluated using the marginal beta-binomial statistical model and the summary receiver operating characteristics (SROC) method. This assessment focused on pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with a 95% confidence interval (CI). Pooled weighted mean difference (WMD) and pooled odds ratios (ORs) with 95% CI were calculated using a random effects model.

The results revealed that a total of 202 observational studies were incorporated into the pooled analysis.

• Of these, 106 studies (19,465 cases and 29,318 controls) were used for meta-analysis of sensitivity and specificity, while 186 studies (30,656 cases and 34,360 controls) were utilized for meta-analysis of mean difference.
• The pooled sensitivity, specificity, and DOR for AMH were found to be 0.79, 0.82, and 17.12, respectively. 
• The area under the curve (AUC) according to the SROC model was 0.90. AMH levels were significantly elevated in women with PCOS compared to control subjects (WMD = 4.91). 
• Furthermore, individuals with higher AMH levels had a greater likelihood of being affected by PCOS. 
• An AMH serum concentration greater than 5.39 ng/mL was related to PCOS (sensitivity = 88.6%; specificity = 92.75%; likelihood ratio for a positive test result (LR+) = 12.21; and likelihood ratio for a negative test result (LR-) = 0.12).

Thus, this meta-analysis confirmed that serum AMH concentration is a crucial biomarker for diagnosing PCOS. However, the cut-off points identified in the study should be further evaluated and validated through future research before being implemented in clinical practice.

Source: Barghi M et al. New insights into the relationship between Anti-Mullerian Hormone and Polycystic ovary syndrome and its diagnostic accuracy: An updated and extended meta-analysis using marginal beta-binomial model. American Journal of Obstetrics & Gynecology. 2024, Oct 10. DOI: 10.1016/j.ajog.2024.10.004