Polycystic Ovary Syndrome Diagnosis and Management

Understanding AMH and Its Significance

AMH is a polypeptide secreted by granulosa cells of pre-antral and small antral ovarian follicles, serving as a biomarker of the growing follicular pool 1
Serum AMH levels are significantly higher in women with PCOS compared to those with normal ovulatory function 2
AMH inhibits primordial follicle recruitment and may suppress follicle-stimulating hormone (FSH) action, contributing to ovulatory disturbances seen in PCOS 2

The Endocrine Society recommends that AMH should not yet replace established diagnostic criteria (oligoanovulation, hyperandrogenism, polycystic ovaries on ultrasound) 3
There is significant overlap in AMH levels between women with and without PCOS, limiting its use as a standalone diagnostic test 1

Further evaluation should include assessment of other PCOS diagnostic criteria, including clinical and/or biochemical signs of hyperandrogenism (elevated total testosterone, free testosterone, androstenedione), as recommended by the Endocrine Society 3
Evaluation for oligoanovulation through menstrual history is recommended 1
Ultrasound evaluation for polycystic ovarian morphology (if age-appropriate) is suggested 2
Additional metabolic assessment is recommended due to increased risk of insulin resistance in women with high AMH and PCOS, including a two-hour oral glucose tolerance test and fasting lipid profile, as recommended by the Endocrine Society 3

AMH levels can vary based on assay methods, with no international standard currently established 1
Age-specific reference ranges are important when interpreting AMH levels, as values naturally decline with age 4
AMH measurement should not be used in adolescents within 8 years of menarche for PCOS diagnosis due to significant overlap with normal physiological values 1