Serum AMH, FSH, and LH levels in PCOS

LETTER TO THE EDITOR Serum AMH, FSH, and LH levels in PCOS To the Editor: We read with great interest the study by Singer et al. (1), and we would like to comment on the relationships among antim€ullerian hormone (AMH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels in polycystic ovary syndrome (PCOS). In women undergoing in vitro fertilization (IVF), Singer et al. (1) reported a negative association between FSH and AMH serum levels, concluding that the AMH level is highly predictive of the FSH level and can be used as an independent indicator of ovarian reserve. Recently, Dumesic et al. (2) also reported that intrafollicular AMH levels negatively correlated with FSH in follicles of normoandrogenic ovulatory women undergoing IVF, concluding that intrafollicular AMH levels reflect follicle sensitivity to FSH. In an earlier study (3), we noted increased serum AMH levels in women with polycystic ovary syndrome (PCOS). Moreover, AMH levels were negatively correlated to body mass index (BMI) and were independently predicted by the levels of luteinizing hormone (LH) and testosterone and by BMI. We concluded that increased LH levels might be an independent link between PCOS-associated disorders of ovulation and increased serum AMH concentrations. To assess whether the findings of Singer et al. and Dumesic et al., who were working with cohorts of older women undergoing IVF, could be applied to younger women with PCOS, we selected a population of 50 ovulatory women as controls and 200 women with PCOS plus biochemical hyperandrogenemia, oligo-ovulation and/ or anovulation, and/or polycystic ovaries on ultrasound. Serum AMH levels were not correlated with serum FSH levels in women with PCOS or in ovulatory women. On the contrary, serum AMH levels were correlated with LH levels in women with PCOS (r¼0.414, P<.001). Serum AMH levels were also negatively correlated with BMI for both women with PCOS (r¼–0.222, P¼.007) and ovulatory women (r ¼ –0.696, P<.001). Indeed, by dividing

all women according to BMI (limit 25kg/m2), the serum AMH levels were statistically significantly higher in normal-weight women with PCOS (6.88  3.60 ng/mL vs. 4.99  2.16 ng/mL, P<.001) and in normal-weight ovulatory women (4.11  1.29 ng/mL vs. 2.41  0.25 ng/mL, P<.001). We can therefore hypothesize that serum AMH levels are differently modulated in conditions of pure ovarian reserve, such as in women undergoing IVF, compared with young women with hyperandrogenemia. The latter is particularly true for normal-weight hyperandrogenic women with PCOS, which actually represents the more ‘‘pure’’ form of PCOS. In conditions of increased LH and normal to low FSH levels (such as in PCOS), the AMH serum levels are increased and tend to be associated with serum LH levels; whereas in conditions of increased FSH levels (such as in premature ovarian failure), AMH serum levels are decreased and tend to be associated with serum FSH levels. Neoklis A. Georgopoulos, Ph.D. Alexandros D. Saltamavros, Ph.D. George Decavalas, Ph.D. Department of Obstetrics and Gynecology Division of Reproductive Endocrinology University of Patras Medical School Patras, Greece Athanasia Piouka, M.S. Ilias Katsikis, Ph.D. Dimitrios Panidis, Ph.D. Division of Endocrinology and Human Reproduction Second Department of Obstetrics and Gynecology Aristotle University of Thessaloniki Thessaloniki, Greece October 5, 2009 doi:10.1016/j.fertnstert.2009.10.006

REFERENCES 1. Singer T, Barad DH, Weghofer A, Gleicher N. Correlation of antim€ ullerian hormone and baseline folliclestimulating hormone levels. Fertil Steril 2009;91: 2616–9. 2. Dumesic DA, Lesnick TG, Stassart JP, Ball GD, Wong A, Abbott DH. Intrafollicular antimullerian

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hormone levels predict follicle responsiveness to follicle-stimulating hormone (FSH) in normoandrogenic ovulatory women undergoing gonadotropin releasing-hormone analog/recombinant human FSH therapy for in vitro fertilization and embryo transfer. Fertil Steril 2009;92:217–21.

3. Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D. Anti-m€ullerian hormone levels reflect severity of PCOS but are negatively influenced by obesity: relationship with increased luteinizing hormone levels. Am J Physiol Endocrinol Metab 2009;296:E238–43.

Fertility and Sterility Vol. 93, No. 3, February 2010 Copyright ª2010 American Society for Reproductive Medicine, Published by Elsevier Inc.

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