Background: Anti-Müllerian Hormone (AMH) and Antral Follicle Count (AFC) are both principally used as markers of ovarian reserve and available in all UK hospitals. The utility of these markers in the binary diagnosis of Polycystic Ovarian Syndrome (PCOS) by published criteria, such as Rotterdam, has been previously reported. We evaluated their utility in the evaluation of oligo/amenorrhoea in healthy young non-obese women.
Methods: Women with both ovaries in situ, under the age of 35 years, with BMI <30 kg/m2, seeking fertility treatment at Imperial College Healthcare NHS Trust were included in the study. 186 women were screened with menstrual cycle history, follicular-phase AFC on ultrasound, ovarian morphology (normal, multicystic ovaries MCO, or polycystic ovaries PCO), serum AMH level (pmol/l; Beckman-Coulter 3rd generation assay), and other reproductive hormones. Oligo/amenorrhoea was defined as average menstrual cycle length (ACL) greater than 35 days.
Results: There was a linear correlation between serum AMH and AFC on ultrasound, with the following equation describing the relationship (AFC = AMH X0.5+12). Rather than AMH and AFC being elevated only in women with oligo/amenorrhoea, there was a gradual increase in these markers with increasing ACL even in eumenorrhoeic women (median AMH 20 pmol/l in ACL <27 days, 28 pmol/l in ACL 2829 days, 47 pmol/l in ACL 3034 days, 66 pmol/l in ACL >35 days). There was an increased prevalence of oligo/amenorrhoea with increasing AMH, or AFC, (5% oligo/amenorrhoea in AMH <15 pmol/l, 24% oligo/amenorrhoea in AMH 3045 pmol/l, 61% oligo/amenorrhoea in AMH >60 pmol/l). Oligo/amenorrhoea was less prevalent in those with at least one normal ovary (07%) when compared with those with those with 2 MCO (11%), or 2 PCO (47%) ovaries.
Conclusion: AMH and AFC are reliable predictive markers of menstrual cyclicity, even in women currently regarded as being eumenorrhoeic. Thus, AMH and AFC are useful adjuncts in the clinical assessment of patients with menstrual disturbance.
07 Nov 2016 - 09 Nov 2016