Diagnostic utility of serum anti-Müllerian hormone in different phenotypes of polycystic ovary syndrome: a case-control study from a tertiary care centre

Abstract

Background: This study aimed to evaluate the diagnostic utility of serum Anti-mullerian hormone (AMH) in polycystic ovary syndrome (PCOS), to establish a cut off value, and to compare AMH levels across different PCOS phenotypes.

Methods: A case-control study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital from July 2022 to June 2023. A total of 100 women aged 16-40 years were enrolled, including 50 PCOS cases diagnosed using the Rotterdam criteria and 50 age-matched controls with regular menstrual cycles. Participants underwent clinical evaluation, anthropometric assessment, transabdominal ultrasonography and serum AMH estimation using an enzyme-linked fluorescent assay. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal AMH cut-off for PCOS diagnosis.

Results: Mean serum AMH levels were significantly higher in women with PCOS compared to controls (7.10±2.70 ng/ml vs. 2.32±1.59 ng/ml; p<0.001). ROC analysis identified an optimal AMH cut-off of 4 ng/ml, yielding 90% sensitivity and 78% specificity, with an area under the curve of 0.895. Women with AMH ≥4 ng/ml had significantly increased odds of PCOS (odds ratio 31.9; 95% confidence interval: 10.2-99.9). Among phenotypes, AMH levels were highest in phenotype A and lowest in phenotype C.

Conclusions: Serum AMH is significantly elevated in PCOS and varies across phenotypes. It demonstrates excellent diagnostic performance and may serve as a useful adjunctive biomarker, particularly in settings where ultrasonography is limited.