Correlation between the anti-Müllerian hormone and endovaginal ultrasound in the predictivity of polycystic ovary syndrome at Chracerh


  • Noa Ndoua C. C. Department of Medicine and Biomedical Sciences, University of Yaounde, Cameroon
  • Ayissi Ngah G. Department of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
  • Mve Koh V. Department of Obstetrics and Gynecology, University Hospital of Yaounde, Cameroon
  • Belinga E. Department of Obstetrics and Gynecology, Hospital Research and Application Centre for Endoscopic Surgery and Human Research, Cameroon
  • Kemfang J. D. Department of Obstetrics and Gynecology, Hospital Research and Application Centre for Endoscopic Surgery and Human Research, Cameroon
  • Kasia J. M. Department of Obstetrics and Gynecology, Hospital Research and Application Centre for Endoscopic Surgery and Human Research, Cameroon



AMH, Follicules antraux, PCOS


Background: Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome posing diagnostic problems in current practice, because of the cumbersomeness associated with the application of the criteria that define it; giving rise to over or under diagnosis of it. Anti-Müllerian hormone (AMH) is an effective alternative in this case, being a stable, reproducible and non-operator dependent marker to diagnose PCOS due to the link that binds it to the multiple pre-antral follicles in the ovaries of PCOS patients. The aim of this study was to determine the threshold value of AMH required to define PCOS in our African population, by revealing the correlation with antral follicles count (AFC) on endovaginal ultrasound.

Methods: We carried out a comparative cross-sectional study, with retrospective data collection in 23 infertile patients diagnosed with PCOS according to the Rotterdam 2003 criteria, and 23 non-PCOS infertile controls having performed the AMH test using the Immunotech technique at CHRACERH. Endovaginal ultrasound (U/S) was performed using a 7.5 mega Hertz (MHz) transvaginal transducer by different qualified operators (radiologists, gynecologists). The comparison of the two independent groups (PCOS and non-PCOS) was performed by the Student t-test; correlations between AMH, age, AFC and ovarian volume obtained by the Pearson test; and the diagnostic power of AMH test in PCOS was evaluated by receiver operating characteristic curves (ROC).

Results: AMH was approximately twice as high in PCOS compared to controls (6.09 versus 3.80, P <0.001) and was inversely correlated with age (r = -0.301; P ˂0.05); significantly correlated antral follicle count (R = 0.85, P <0.0001) and ovarian volume (r = 0.625, P <0.0001). ROC analysis revealed that the AMH test was very informative for the diagnosis of PCOS with an area under the curve (AUC) at 0.90 (0.81-0.99; 95% CI); and the threshold value given by the farthest point of the diagonal representing the nil contribution test was 4.40 ng/L, and predicted PCOS with a sensitivity of 96% and a specificity of 70%.

Conclusions: AMH is a predictive marker for PCOS. It is highly correlated with AFC and ovarian volume and appears to decrease with age. It offers good diagnostic performance in PCOS, with a threshold value of 4.40 ng/L for a sensitivity of 96% and specificity of 70%.


Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. The Lancet. 2007;370(9588):685‑97.

Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. 1935 ;29(2):181-91.

Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19‑25.

Johnson TRB, Kaplan LK, Ouyang P, Rizza RA, Health NI. Evidence-based methodology workshop on polycystic ovary syndrome. Bethesda, Maryland: National Institutes of Health. 2012.

Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen excess and PCOS society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91(2):456‑88.

Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and White women of the Southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83(9):3078‑82.

Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol. 2011;9:39.

Chao KC, Ho CH, Shyong WY, Huang CY, Tsai SC, Cheng HY, et al. Anti-Mullerian hormone serum level as a predictive marker of ovarian function in Taiwanese women. J Chin Med Assoc. 2012;75(2):70‑4.

Homburg R, Ray A, Bhide P, Gudi A, Shah A, Timms P, et al. The relationship of serum anti-Mullerian hormone with polycystic ovarian morphology and polycystic ovary syndrome: a prospective cohort study. Hum Reprod. 2013;28(4):1077-83.

Cook CL, Siow Y, Brenner AG, Fallat ME. Relationship between serum Müllerian-inhibiting substance and other reproductive hormones in untreated women with polycystic ovary syndrome and normal women. Fertil Steril. 2002;77(1):141‑6.

Freeman EW, Gracia CR, Sammel MD, Lin H, Lim LCL, Strauss JF. Association of anti-mullerian hormone levels with obesity in late reproductive-age women. Fertil Steril. 2007;87(1):101‑6.

Dolfing J, Schweitzer D, Wolffenbuttel B. Metabolic and hormonal parameters in lean PCOS women. 2012.

Taylor AE, McCourt B, Martin KA, Anderson EJ, Adams JM, Schoenfeld D, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab.1997;82(7):2248‑56.

Tian X, Ruan X, Mueck AO, Wallwiener D, Wang J, Liu S, et al. Serum anti-Müllerian hormone and insulin resistance in the main phenotypes of non-obese polycystic ovarian syndrome women in China. Gynecol Endocrinol. 2014;30(11):836‑9.

Sahmay S, Atakul N, Aydogan B, Aydın Y, Imamoglu M, Seyisoglu H. Elevated serum levels of anti‐Müllerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2013;92(12):1369‑74.

Iliodromiti S, Kelsey TW, Anderson RA, Nelson SM. Can anti-Müllerian hormone predict the diagnosis of polycystic ovary syndrome? a systematic review and meta-analysis of extracted data. J Clin Endocrinol Metab. 2013;98(8):3332‑40.

Fallat ME, Siow Y, Marra M, Cook C, Carrillo A. Müllerian-inhibiting substance in follicular fluid and serum: a comparison of patients with tubal factor infertility, polycystic ovary syndrome, and endometriosis. Fertil Steril. 1997;67(5):962‑5.

Pierre A, Peigné M, Grynberg M, Arouche N, Taieb J, Hesters L, et al. Loss of LH-induced down-regulation of anti-Müllerian hormone receptor expression may contribute to anovulation in women with polycystic ovary syndrome. Hum Reprod. 2013;28(3):762‑9.

Barbakadze L, Kristesashvili J, Khonelidze N, Tsagareishvili G. The correlations of anti-mullerian hormone, follicle-stimulating hormone and antral follicle count in different age groups of infertile women. Int J Fertil Steril. 2015;8(4):393‑8.

Li R, Gong F, Zhu Y, Fang W, Yang J, Liu J, et al. Anti-Müllerian hormone for prediction of ovarian response in Chinese infertile women undergoing IVF/ICSI cycles: a prospective, multi-centre, observational study. Reprod Biomed Online. 2016;33(4):506‑12.

Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen excess and polycystic ovary syndrome society. Hum Reprod. 2014;20(3):334‑52.

Casadei L, Madrigale A, Puca F, Manicuti C, Emidi E, Piccione E, et al. The role of serum anti-Müllerian hormone (AMH) in the hormonal diagnosis of polycystic ovary syndrome. Gynecol Endocrinol. 2013;29(6):545‑50.






Original Research Articles