The Relationship of Antimullerian Hormone with Severity of Clinical Symptoms in Polycystic Ovary Syndrome

The Relationship of Antimullerian Hormone with Severity of Clinical Symptoms in Polycystic Ovary Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship of Antimullerian Hormone with Severity of Clinical Symptoms in Polycystic Ovary Syndrome CAN ATA, UFUK ATLIHAN, HUSEYIN AYTUG AVSAR, ONUR YAVUZ, SELCUK ERKILINC, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4592805/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Sep, 2025 Read the published version in BMC Women's Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in around 6-8% of women in their reproductive years. The measurement of Anti-Müllerian Hormone (AMH) holds particular promise in discerning both the diagnosis and the extent of severity in PCOS cases. This study aims to evaluate the effectiveness of using AMH as a potential tool for identifying and diagnosing the severity of clinical aspects associated with the syndrome. Material and Methods: A retrospective analysis was performed on 309 female patients who presented for consultation at our hospital's gynecology outpatient clinic and were diagnosed with PCOS based on the Rotterdam criteria, between January 2018 and March 2022. Data were extracted from the hospital database and systematically assessed. Patients were divided into two groups based on AMH level of 7.5 ng/ml.Clinical symptoms and findings were assessed based on AMH values. Results: A statistically significant difference was observed between groups for the mean levels of total testosterone, androstenedione, free androgen index, luteinizing hormone, and follicle-stimulating hormone (p < 0.05). Additionally, a statistically significant difference was noted between AMH groups and the presence of oligomenorrhea (p < 0.05). Conclusion : Even at the higher end of the spectrum, AMH retains significant value in determining the clinical aspects of PCOS. Anti Mullerian Hormone Polycystic Ovary Syndrome Hyperandrogenism Ovulation dysfuntion Policystic ovarian morphology Introduction Polycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in approximately 6–8% of women of reproductive age ( 1 ). Characterized by oligomenorrhea, hyperandrogenism symptoms, and the identification of polycystic ovaries through ultrasonography, PCOS is intricately linked to insulin resistance and subsequent hyperinsulinemia in its pathophysiology ( 2 ). Research indicates that insulin exerts a direct impact on ovarian function and an indirect influence on the pituitary gland, thereby stimulating androgen production from the ovaries ( 3 ). In the long term, individuals with PCOS, especially those on the severe end of the disease spectrum, are at an increased risk of developing cardiovascular disease, type 2 diabetes, endometrial cancer, ovarian cancer, and breast cancer ( 4 ). This underscores the importance of understanding the comprehensive health implications associated with PCOS beyond its immediate reproductive aspects ( 5 , 6 ). Hyperinsulinemia, increased luteinizing hormone (LH) secretion, decreased fecundity, and ovarian hyperandrogenism are also common findings in PCOS. AMH, a glycoprotein belonging to the transforming growth factor family, is synthesized in the Sertoli cells of the testicles in men and the granulosa cells of the ovary in women. In females, AMH secretion initiates around the 36th week of pregnancy and persists until menopause. Although minimal at birth, there is a gradual increase in the first 2–4 years, with negligible secretion until puberty. Throughout a woman's life, AMH levels consistently remain lower than those in men ( 7 , 8 ). The Rotterdam consensus for diagnosing PCOS is based on a combination of symptoms and/or specific laboratory values that indicate hyperandrogenism, oligo and/or anovulation, and the presence of polycystic ovarian morphology (PCOM). While the fulfillment of two of these criteria is adequate for making a diagnosis, it is imperative that hyperandrogenism, a mandatory criterion as per the Androgen Excess Society criteria, is present in the diagnostic assessment. The diagnosis of PCOS traditionally relies on subjective criteria, encompassing clinical and ultrasonographic observations. However, the measurement of AMH has emerged as a valuable tool for enhancing the precision of PCOS diagnosis and assessing its severity ( 2 , 7 , 9 ). Some researchers have proposed that elevated AMH levels may be attributed to the stimulatory impact of increased androgens on early follicular growth. Notably, studies have observed that AMH measurements, commonly employed to assess ovarian reserve, are higher than normal in instances of hyperandrogenism. This elevation may be attributed to the excessive accumulation of preantral and small antral follicles ( 10 , 11 ). Recognizing the intricate relationship between androgens, follicular growth, and AMH levels provides valuable insights into the potential utility of AMH measurements in the diagnostic framework for PCOS. The objective of this study is to assess the importance of AMH in identifying the severity of sympoms for PCOS. Material and Method A retrospective analysis was performed on 309 female patients who presented for consultation at our hospital's gynecology outpatient clinic and were diagnosed with PCOS based on the Rotterdam criteria, between January 2018 and March 2022. As part of the evaluation process, baseline hormone levels and sonographic assessments were carried out on the 2nd – 5th day of menstrual cycle. As AMH values are known to exhibit little variability throughout the menstrual cycle, their measurements were obtained without consideration of the specific day of the cycle. Oligomenorrhea is characterized by having fewer than eight menstrual cycles within the past year or experiencing menstrual intervals exceeding 35 days, which is indicative of clinical ovulatory dysfunction. Clinical hyperandrogenism is defined as Ferriman Gallway score more than or equal to 8 which is seemed to be appropriate for a middle-eastern european population. The presence of ≥ 12 follicles with a diameter of 2–8 mm in each ovary and/or an increased ovarian volume of > 10 mL was defined as PCOM ( 12 ). PCOS phenotypes were identified and incorporated into subsequent analyses alongside AMH values. Phenotype A is characterized by the presence of PCOM, hyperandrogenism, and ovulatory dysfunction. Phenotype C exhibits PCOM and hyperandrogenism, while Phenotype D displays PCOM and ovulatory dysfunction. During the early follicular phase of the menstrual cycle, whether spontaneous or induced, venous blood samples were obtained from each participant. Subsequently, the collected serum samples underwent analysis for follicular stimulating hormone (FSH), LH, estradiol (E2), total testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), 17-OH progesterone (17-OHP), free androgen index (FAI), and insulin resistance index (HOMA-IR). The analysis was conducted using a human enzyme-linked immunosorbent assay (ELISA)(Elecsys and cobas e411 analyzers from Roche, Switzerland). All samples were processed in the same laboratory immediately following collection. The assessment of the ovaries through ultrasonography was conducted (Voluson-E10 eM6C-G2) employing either an abdominal or gynecological probe. To mitigate the impact of user-dependent factors on the ultrasound diagnosis of PCOM, individuals without PCOM and those with antral follicule counts falls within the uncertainty regarding PCOM diagnosis are excluded from the study. Patients currently undergoing hormonal therapy for PCOS were excluded from the study, unless they had discontinued treatment for at least 3 months prior to enrollment. Additional exclusion criteria included patients diagnosed with congenital adrenal hyperplasia, the presence of androgen-secreting tumors, residual ovarian cysts on the day of the ultrasound examination, use of medications for major medical conditions such as diabetes or hypertension, women aged older than 40 years, hyperprolactinemia, and individuals with a BMI categorized as morbid obese, defined as exceeding 35. Statistical analysis of the research data was conducted using SPSS 20.0 software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The study adhered to the principles outlined in the Declaration of Helsinki and commenced after obtaining approval from the ethics committee. Appropriate statistical analyses, including independent samples Student's t-test and the chi-square test, one way ANOVA as well as pearson correlation tests were employed in this study. A significance level of P < 0.05 was utilized to define statistical significance. Results The mean AMH value for all participants was 7.47 ± 1.55 (5.01–10.10) ng/ml. To further elucidate the correlation of AMH values with clinical features, participants were categorized into two groups (AMH less or equal than 7.5 ng/ml as group A vs more than 7.5 ng/ml as group B) based on whether their AMH values were higher or lower than the mean of patients in total. This classification enables a more comprehensive investigation into the relationship between AMH levels and different clinical characteristics within a patient cohort that already exhibits higher AMH values compared to the general population. The mean age for Group A was 29.2 ± 5.0, and for Group B, it was 30.1 ± 5.4 (p = 0.074). Additional clinically relevant demographic data are provided in Table 1 . Table 1 Demographic properties and their comparisons for both study groups. Group A n:138 Group B n: 171 Significance (p) Age 29.2 ± 5.0 (20–40) 30.1 ± 5.4 (19–40) .074 BMI 25.28 ± 1.95 (20.3–31.8) 25.75 ± 2.35 (21.4–34.0) .064 Age at menarche 11.96 ± 0.77 11.84 ± 0.74 .969 Interval of two periods (days) 42.60 ± 10.11 (30–65) 55.21 ± 15.98 (32–90) .000 The presence of oligomenorrhea 76 (55.1%) 127 (74.3%) .000* Independent sample T-test used for analyses of means. * Chi-square test is used for comparison of categorical values. Significant values are bolded. The analysis revealed no statistically significant relationship between SHBG means and HOMA-IR means compared to groups of AMH (p > 0.05). However, a statistically significant relationship was observed between the means of DHEAS, 17OH-P, total testosterone, androstenedione, free androgen index, LH, FSH compared to AMH groups (p < 0.05). Details of analyses are presented in Table 2 . Table 2 Comparison of laboratory and clinical findings with both groups. Group A n:138 Group B n: 171 Significance (p) LH (mIU/ml) 8.22 ± 1.29 10.14 ± 1.80 .000 FSH (mIU/ml) 7.29 ± 0.68 7.37 ± 0.61 .040 LH/FSH 1.13 ± 0.19 1.39 ± 0.28 .000 Total Testosterone (nmol/L) 1.97 ± 0.30 2.45 ± 0.52 .000 Androstenedione (nmol/L) 2.37 ± 0.29 2.84 ± 0.51 .000 DHEAS (µg/dl) 193.87 ± 13.58 207.81 ± 10.59 .000 17-OH Progesterone (nmol/L) 1.10 ± 0.06 1.14 ± 0.05 .000 SHBG (nmol/L) 44.38 ± 6.84 45.05 ± 7.43 .415 FAI 7.93 ± 0.77 9.00 ± 1.13 .000 HOMA-IR 2.97 ± 0.54 2.97 ± 0.58 .990 Total Antral Follicule Count 17.44 ± 3.34 21.82 ± 4.63 .000 Ferriman Gallwey Score 8.59 ± 1.67 10.43 ± 1.87 .000 Independent sample T-test used for analyses of means. Significant values are bolded. A significant positive correlation was observed between AMH and various features, including LH, DHEAS, androstenedione, total testosterone, free androgen index, and Ferriman Gallwey score (p < 0.05). The only negative correlation identified was between AMH values and age at menarche (p < 0.05). Further details of these correlations are elaborated in Table 3 . Table 3 Correlation of AMH values to various clinical fetaures. Anti Müllerian Hormone n: 309 Correlation Coefficient (r) Significance (p) FSH .073 .200 LH .676 .000 DHEAS .639 .000 Androstenedione .638 .000 Total Testosterone .632 .000 Ferriman Gallwey Score .572 .000 FAI .619 .000 HOMA-IR .079 .165 17-OH Progesterone .356 .000 SHBG .032 .575 Interval Between Two Consecutive Perioods .548 .000 Total Antral Follicule Count .593 .000 Age at Menarche − .083 .144 Pearson correlation analyses were employed to determine the correlation. Analysis of mean AMH values across different phenotypes of PCOS indicated a significant difference between phenotype A and D, as well as between phenotype C and D (p < 0.05). The specifics of post hoc analyses for phenotypes are presented in Table 4 . Table 4 The comparison of mean AMH values across different phenotypes of PCOS. AMH Values Significance (p) Phenotype A Post Hoc Sig. (p) Phenotype C Post Hoc Sig. (p) Phenotype D Post Hoc Sig. (p) Phenotype A 7.74 ± 1.54 (5.06–10.10) .000 NA .703 .000 Phenotype C 7.82 ± 1.06 (5.01–9.74) .703 NA .000 Phenotype D 6.12 ± 1.24 (5.01–9.85) .000 .000 NA A one-way ANOVA was utilized to compare groups, followed by LSD post hoc analyses to further clarify the differences between the groups. Discussion In our study, patients were categorized based on their Anti-Müllerian Hormone (AMH) levels to assess serum AMH levels and various factors related to polycystic ovary syndrome (PCOS). Notably, our findings revealed a generally positive correlation between PCOS laboratory findings and AMH levels. These results align with a previously published study, supporting the notion that elevated AMH levels are indicative of the severity of PCOS, which is consistent with our own observations ( 13 ). Consistent with our findings, existing literature also indicates a positive association between AMH levels and total testosterone as well as androstenedione levels. Moreover, publications in the literature have reported an increase in AMH levels correlating with a decrease in the number of menstrual cycles per year ( 14 , 15 ). These concurrences emphasize the robustness of our results in the context of established knowledge in the field. In our study, there was no significant relationship found between age at menarche and AMH levels, a finding consistent with data from another large-scale study in the literature ( 10 ). However, a positive correlation was observed between DHEAS and 17-OHP levels with AMH levels. Conversely, no correlation was identified between SHBG levels and AMH levels. These observations align with the results of another extensive study in the literature, where no significant relationship was reported between AMH levels and DHEAS, 17-OH progesterone, and SHBG levels ( 10 ). In previous studies, a negative correlation was observed between serum AMH levels and BMI ( 16 ). However, in our study, although no significant difference was identified between BMI and AMH levels, this may be attributed to the exclusion of patients with a BMI exceeding 35 from the study. On the other hand a positive but weak correlation was found between AMH levels and the HOMA-IR (r: 0.079). Even though this finding is not statistically significant, it may suggest that increased AMH levels could contribute to the severity of insulin resistance in patients with PCOS, as discussed in previous studies ( 17 ). Analysis of various phenotypes showed that phenotype A and C are more associated with elevated AMH values. Previous in vitro studies have hypothesized that LH may contribute to silencing granulosa cells, leading them to enter a resting state and potentially disrupting their relationship with theca cells, thus creating a hyperandrogenic environment ( 18 , 19 ). Our analyses of phenotypes aling with previous studies where additon of hyperandrogenism makes the difference in AMH values. Consistent with findings in the literature, our study revealed a significant positive relationship between AMH levels and both the FAI and the total number of antral follicles ( 20 ). This further supports the notion that AMH levels are associated with the number of antral follicles and hormonal imbalances, emphasizing the interconnected nature of these variables in women with PCOS. In our study, utilizing a population with already elevated AMH levels and a diagnosis of PCOS for comparison against non-PCOS individuals will create a deficiency in the comparison. However, considering the variations within the PCOS patient group, changes in AMH levels will aid in understanding their significance. While acknowledging that AMH alone may not serve as a definitive tool for the differential diagnosis of hyperandrogenic conditions, we believe it can provide valuable insights. Elevated AMH levels may also indicate a greater need for intensive treatment of hyperandrogenism symptoms. In our experience, AMH measurements emerge as a highly valuable objective and numerical indicator, not only aiding in the diagnosis of PCOS but also offering indications of the severity of the disease. The use of AMH in conjunction with other clinical and laboratory parameters may contribute to a more comprehensive understanding and characterization of PCOS. Declarations Ethical approval: Ethical approval for this study was obtained from the ‘Buca Seyfi Demirsoy Training and Research Hospital’ on August 23, 2023, with the protocol number 2023/8-157. Consent for publication: Not applicable Consent to participate: All participiants were consented with informed consents approved by local ethical board. Competing interests: The authors declare that they have no competing interests. Authors’ information: 1 Demokrasi University, Buca Seyfi Demirsoy Training and Research Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey 2 Private Karataş Hospital, Izmir, Turkey 3 Dokuz Eylul University School of Medicine, Izmir, Turkey All authors reviewed and approved the final version and no other person made a substantial contribution to the paper. Funding: The authors received no fnancial support for the research, authorship, and/or publication of this article. Author Contribution C.A. contributed to study concept and design, interpreting the data and critical revision of the manuscript.U. A. contributed to study concept and design, and interpreting the data, composed the statistical dataset, performed the analyses, and wrote and revised the manuscript.H. A. A. contributed to data analysis and revision of the paper.O. Y. contributed to data analysis and revision of the paper.S. E. contributed to interpreting the data and critical revision of the manuscript.T. B. B.contributed to interpreting the data and critical revision of the manuscript. Acknowledgements: Not applicable Availability of data and materials: The datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request. References Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745–9. Revised 2003 consensus. on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. 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Pellatt L, Hanna L, Brincat M, Galea R, Brain H, Whitehead S, et al. Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2007;92(1):240–5. La Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS. Anti-Mullerian hormone (AMH): what do we still need to know? Hum Reprod. 2009;24(9):2264–75. Lin YH, Chiu WC, Wu CH, Tzeng CR, Hsu CS, Hsu MI. Antimüllerian hormone and polycystic ovary syndrome. Fertil Steril. 2011;96(1):230–5. Wang JG, Nakhuda GS, Guarnaccia MM, Sauer MV, Lobo RA. Müllerian inhibiting substance and disrupted folliculogenesis in polycystic ovary syndrome. Am J Obstet Gynecol. 2007;196(1):e771–5. Ozel S, Alkan M, Tokmak A, Oksuzoglu A, Kaya M, Aktulay A, et al. Relationship Between Polycystic Ovarian Morphology and Ectopic Pregnancy. J Reprod Infertil. 2021;22(1):32–7. Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D. Anti-Mullerian 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(2):E238–43. Pellatt L, Rice S, Mason HD. Anti-Müllerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction. 2010;139(5):825–33. Carlsen SM, Vanky E, Fleming R. Anti-Müllerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome. Hum Reprod. 2009;24(7):1732–8. Chen X, Ni R, Mo Y, Li L, Yang D. Appropriate BMI levels for PCOS patients in Southern China. Hum Reprod. 2010;25(5):1295–302. Park HT, Cho GJ, Ahn KH, Shin JH, Kim YT, Hur JY, et al. Association of insulin resistance with anti-Mullerian hormone levels in women without polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf). 2010;72(1):26–31. Rosenfield RL, Wroblewski K, Padmanabhan V, Littlejohn E, Mortensen M, Ehrmann DA. Antimüllerian hormone levels are independently related to ovarian hyperandrogenism and polycystic ovaries. Fertil Steril. 2012;98(1):242–9. Li Y, Ma Y, Chen X, Wang W, Li Y, Zhang Q, et al. Different diagnostic power of anti-Mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet. 2012;29(10):1147–51. Chen MJ, Yang WS, Chen CL, Wu MY, Yang YS, Ho HN. The relationship between anti-Mullerian hormone, androgen and insulin resistance on the number of antral follicles in women with polycystic ovary syndrome. Hum Reprod. 2008;23(4):952–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Sep, 2025 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Revision requested 24 Jun, 2024 Editor assigned by journal 17 Jun, 2024 Submission checks completed at journal 17 Jun, 2024 First submitted to journal 17 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4592805","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318358852,"identity":"a701e183-5b6c-48e4-90cf-3b0e49e05767","order_by":0,"name":"CAN ATA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDCCA1Can4GBjSQtBgySDSRrMThArBa+24cffi6o+SNvfCP52YMPFQzy/GIH8GuRPJdmLD3jmIHhthtp5oYzzjAYzpydgF+LwRkeBmkeNgPGbTcSzKR52xgSDG4T1sL8m+efgf3mGenfiNbCBlRpkLhBIodIWyTPsJlZ8/YZJ88486ZMcsYZCcJ+4TvD/Pg2zzc52/729G0SHyps5PmlCWhBAAGwSglilYMA/wFSVI+CUTAKRsFIAgAgkT+4O35KXAAAAABJRU5ErkJggg==","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":true,"prefix":"","firstName":"CAN","middleName":"","lastName":"ATA","suffix":""},{"id":318358853,"identity":"5e3a5800-f4a3-46fc-9f0a-d6cb76febe82","order_by":1,"name":"UFUK ATLIHAN","email":"","orcid":"","institution":"Private Karatas Hospital","correspondingAuthor":false,"prefix":"","firstName":"UFUK","middleName":"","lastName":"ATLIHAN","suffix":""},{"id":318358854,"identity":"b3bab1a8-d6a8-4f34-a6ca-bfc1666f6288","order_by":2,"name":"HUSEYIN AYTUG AVSAR","email":"","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":false,"prefix":"","firstName":"HUSEYIN","middleName":"AYTUG","lastName":"AVSAR","suffix":""},{"id":318358855,"identity":"a319bfa5-53e5-4baa-9c35-a24d4b990621","order_by":3,"name":"ONUR YAVUZ","email":"","orcid":"","institution":"Dokuz Eylül University","correspondingAuthor":false,"prefix":"","firstName":"ONUR","middleName":"","lastName":"YAVUZ","suffix":""},{"id":318358856,"identity":"8de5b6ce-3222-41a1-b3f4-8397669d65f6","order_by":4,"name":"SELCUK ERKILINC","email":"","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":false,"prefix":"","firstName":"SELCUK","middleName":"","lastName":"ERKILINC","suffix":""},{"id":318358858,"identity":"66e1b5d3-feb9-402c-94f5-e056ca67ef11","order_by":5,"name":"TEVFIK BERK BILDACI","email":"","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":false,"prefix":"","firstName":"TEVFIK","middleName":"BERK","lastName":"BILDACI","suffix":""}],"badges":[],"createdAt":"2024-06-17 08:31:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4592805/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4592805/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-025-03983-x","type":"published","date":"2025-09-24T15:57:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92430705,"identity":"6e5c16b6-1ef6-45c2-8cca-3d801a5c1785","added_by":"auto","created_at":"2025-09-29 16:07:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":610880,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4592805/v1/c6e55f84-b144-42ff-9d7d-b56d213d067c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship of Antimullerian Hormone with Severity of Clinical Symptoms in Polycystic Ovary Syndrome","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePolycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in approximately 6\u0026ndash;8% of women of reproductive age (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Characterized by oligomenorrhea, hyperandrogenism symptoms, and the identification of polycystic ovaries through ultrasonography, PCOS is intricately linked to insulin resistance and subsequent hyperinsulinemia in its pathophysiology (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Research indicates that insulin exerts a direct impact on ovarian function and an indirect influence on the pituitary gland, thereby stimulating androgen production from the ovaries (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the long term, individuals with PCOS, especially those on the severe end of the disease spectrum, are at an increased risk of developing cardiovascular disease, type 2 diabetes, endometrial cancer, ovarian cancer, and breast cancer (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This underscores the importance of understanding the comprehensive health implications associated with PCOS beyond its immediate reproductive aspects (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Hyperinsulinemia, increased luteinizing hormone (LH) secretion, decreased fecundity, and ovarian hyperandrogenism are also common findings in PCOS.\u003c/p\u003e \u003cp\u003eAMH, a glycoprotein belonging to the transforming growth factor family, is synthesized in the Sertoli cells of the testicles in men and the granulosa cells of the ovary in women. In females, AMH secretion initiates around the 36th week of pregnancy and persists until menopause. Although minimal at birth, there is a gradual increase in the first 2\u0026ndash;4 years, with negligible secretion until puberty. Throughout a woman's life, AMH levels consistently remain lower than those in men (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Rotterdam consensus for diagnosing PCOS is based on a combination of symptoms and/or specific laboratory values that indicate hyperandrogenism, oligo and/or anovulation, and the presence of polycystic ovarian morphology (PCOM). While the fulfillment of two of these criteria is adequate for making a diagnosis, it is imperative that hyperandrogenism, a mandatory criterion as per the Androgen Excess Society criteria, is present in the diagnostic assessment. The diagnosis of PCOS traditionally relies on subjective criteria, encompassing clinical and ultrasonographic observations. However, the measurement of AMH has emerged as a valuable tool for enhancing the precision of PCOS diagnosis and assessing its severity (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome researchers have proposed that elevated AMH levels may be attributed to the stimulatory impact of increased androgens on early follicular growth. Notably, studies have observed that AMH measurements, commonly employed to assess ovarian reserve, are higher than normal in instances of hyperandrogenism. This elevation may be attributed to the excessive accumulation of preantral and small antral follicles (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Recognizing the intricate relationship between androgens, follicular growth, and AMH levels provides valuable insights into the potential utility of AMH measurements in the diagnostic framework for PCOS. The objective of this study is to assess the importance of AMH in identifying the severity of sympoms for PCOS.\u003c/p\u003e"},{"header":"Material and Method","content":"\u003cp\u003eA retrospective analysis was performed on 309 female patients who presented for consultation at our hospital's gynecology outpatient clinic and were diagnosed with PCOS based on the Rotterdam criteria, between January 2018 and March 2022. As part of the evaluation process, baseline hormone levels and sonographic assessments were carried out on the 2nd \u0026ndash; 5th day of menstrual cycle. As AMH values are known to exhibit little variability throughout the menstrual cycle, their measurements were obtained without consideration of the specific day of the cycle. Oligomenorrhea is characterized by having fewer than eight menstrual cycles within the past year or experiencing menstrual intervals exceeding 35 days, which is indicative of clinical ovulatory dysfunction. Clinical hyperandrogenism is defined as Ferriman Gallway score more than or equal to 8 which is seemed to be appropriate for a middle-eastern european population. The presence of \u0026ge;\u0026thinsp;12 follicles with a diameter of 2\u0026ndash;8 mm in each ovary and/or an increased ovarian volume of \u0026gt;\u0026thinsp;10 mL was defined as PCOM (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). PCOS phenotypes were identified and incorporated into subsequent analyses alongside AMH values. Phenotype A is characterized by the presence of PCOM, hyperandrogenism, and ovulatory dysfunction. Phenotype C exhibits PCOM and hyperandrogenism, while Phenotype D displays PCOM and ovulatory dysfunction.\u003c/p\u003e \u003cp\u003eDuring the early follicular phase of the menstrual cycle, whether spontaneous or induced, venous blood samples were obtained from each participant. Subsequently, the collected serum samples underwent analysis for follicular stimulating hormone (FSH), LH, estradiol (E2), total testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), 17-OH progesterone (17-OHP), free androgen index (FAI), and insulin resistance index (HOMA-IR). The analysis was conducted using a human enzyme-linked immunosorbent assay (ELISA)(Elecsys and cobas e411 analyzers from Roche, Switzerland). All samples were processed in the same laboratory immediately following collection. The assessment of the ovaries through ultrasonography was conducted (Voluson-E10 eM6C-G2) employing either an abdominal or gynecological probe.\u003c/p\u003e \u003cp\u003eTo mitigate the impact of user-dependent factors on the ultrasound diagnosis of PCOM, individuals without PCOM and those with antral follicule counts falls within the uncertainty regarding PCOM diagnosis are excluded from the study. Patients currently undergoing hormonal therapy for PCOS were excluded from the study, unless they had discontinued treatment for at least 3 months prior to enrollment. Additional exclusion criteria included patients diagnosed with congenital adrenal hyperplasia, the presence of androgen-secreting tumors, residual ovarian cysts on the day of the ultrasound examination, use of medications for major medical conditions such as diabetes or hypertension, women aged older than 40 years, hyperprolactinemia, and individuals with a BMI categorized as morbid obese, defined as exceeding 35.\u003c/p\u003e \u003cp\u003eStatistical analysis of the research data was conducted using SPSS 20.0 software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The study adhered to the principles outlined in the Declaration of Helsinki and commenced after obtaining approval from the ethics committee. Appropriate statistical analyses, including independent samples Student's t-test and the chi-square test, one way ANOVA as well as pearson correlation tests were employed in this study. A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was utilized to define statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean AMH value for all participants was 7.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55 (5.01\u0026ndash;10.10) ng/ml. To further elucidate the correlation of AMH values with clinical features, participants were categorized into two groups (AMH less or equal than 7.5 ng/ml as group A vs more than 7.5 ng/ml as group B) based on whether their AMH values were higher or lower than the mean of patients in total. This classification enables a more comprehensive investigation into the relationship between AMH levels and different clinical characteristics within a patient cohort that already exhibits higher AMH values compared to the general population. The mean age for Group A was 29.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0, and for Group B, it was 30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4 (p\u0026thinsp;=\u0026thinsp;0.074). Additional clinically relevant demographic data are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic properties and their comparisons for both study groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003en:138\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003en: 171\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance (p)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 (20\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4 (19\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95 (20.3\u0026ndash;31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35 (21.4\u0026ndash;34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at menarche\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.969\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterval of two periods (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.60\u0026thinsp;\u0026plusmn;\u0026thinsp;10.11 (30\u0026ndash;65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.21\u0026thinsp;\u0026plusmn;\u0026thinsp;15.98 (32\u0026ndash;90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe presence of oligomenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (55.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (74.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eIndependent sample T-test used for analyses of means. * Chi-square test is used for comparison of categorical values. Significant values are bolded.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe analysis revealed no statistically significant relationship between SHBG means and HOMA-IR means compared to groups of AMH (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, a statistically significant relationship was observed between the means of DHEAS, 17OH-P, total testosterone, androstenedione, free androgen index, LH, FSH compared to AMH groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Details of analyses are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of laboratory and clinical findings with both groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003en:138\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003en: 171\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance (p)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLH (mIU/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSH (mIU/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLH/FSH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Testosterone (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAndrostenedione (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDHEAS (\u0026micro;g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e193.87\u0026thinsp;\u0026plusmn;\u0026thinsp;13.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e207.81\u0026thinsp;\u0026plusmn;\u0026thinsp;10.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17-OH Progesterone (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSHBG (nmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e44.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e45.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHOMA-IR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Antral Follicule Count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.44\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e21.82\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFerriman Gallwey Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eIndependent sample T-test used for analyses of means. Significant values are bolded.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA significant positive correlation was observed between AMH and various features, including LH, DHEAS, androstenedione, total testosterone, free androgen index, and Ferriman Gallwey score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The only negative correlation identified was between AMH values and age at menarche (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Further details of these correlations are elaborated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of AMH values to various clinical fetaures.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAnti M\u0026uuml;llerian Hormone\u003c/p\u003e \u003cp\u003en: 309\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation Coefficient (r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003cp\u003e(p)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDHEAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAndrostenedione\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Testosterone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFerriman Gallwey Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHOMA-IR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17-OH Progesterone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSHBG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterval Between Two Consecutive Perioods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Antral Follicule Count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at Menarche\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003ePearson correlation analyses were employed to determine the correlation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAnalysis of mean AMH values across different phenotypes of PCOS indicated a significant difference between phenotype A and D, as well as between phenotype C and D (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The specifics of post hoc analyses for phenotypes are presented in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe comparison of mean AMH values across different phenotypes of PCOS.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAMH Values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificance (p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhenotype A\u003c/p\u003e \u003cp\u003ePost Hoc Sig. (p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePhenotype C\u003c/p\u003e \u003cp\u003ePost Hoc Sig. (p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePhenotype D\u003c/p\u003e \u003cp\u003ePost Hoc Sig. (p)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhenotype A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54 (5.06\u0026ndash;10.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhenotype C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06 (5.01\u0026ndash;9.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhenotype D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24 (5.01\u0026ndash;9.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eA one-way ANOVA was utilized to compare groups, followed by LSD post hoc analyses to further clarify the differences between the groups.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, patients were categorized based on their Anti-M\u0026uuml;llerian Hormone (AMH) levels to assess serum AMH levels and various factors related to polycystic ovary syndrome (PCOS). Notably, our findings revealed a generally positive correlation between PCOS laboratory findings and AMH levels. These results align with a previously published study, supporting the notion that elevated AMH levels are indicative of the severity of PCOS, which is consistent with our own observations (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsistent with our findings, existing literature also indicates a positive association between AMH levels and total testosterone as well as androstenedione levels. Moreover, publications in the literature have reported an increase in AMH levels correlating with a decrease in the number of menstrual cycles per year (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). These concurrences emphasize the robustness of our results in the context of established knowledge in the field.\u003c/p\u003e \u003cp\u003eIn our study, there was no significant relationship found between age at menarche and AMH levels, a finding consistent with data from another large-scale study in the literature (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, a positive correlation was observed between DHEAS and 17-OHP levels with AMH levels. Conversely, no correlation was identified between SHBG levels and AMH levels. These observations align with the results of another extensive study in the literature, where no significant relationship was reported between AMH levels and DHEAS, 17-OH progesterone, and SHBG levels (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn previous studies, a negative correlation was observed between serum AMH levels and BMI (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, in our study, although no significant difference was identified between BMI and AMH levels, this may be attributed to the exclusion of patients with a BMI exceeding 35 from the study. On the other hand a positive but weak correlation was found between AMH levels and the HOMA-IR (r: 0.079). Even though this finding is not statistically significant, it may suggest that increased AMH levels could contribute to the severity of insulin resistance in patients with PCOS, as discussed in previous studies (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnalysis of various phenotypes showed that phenotype A and C are more associated with elevated AMH values. Previous in vitro studies have hypothesized that LH may contribute to silencing granulosa cells, leading them to enter a resting state and potentially disrupting their relationship with theca cells, thus creating a hyperandrogenic environment (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Our analyses of phenotypes aling with previous studies where additon of hyperandrogenism makes the difference in AMH values. Consistent with findings in the literature, our study revealed a significant positive relationship between AMH levels and both the FAI and the total number of antral follicles (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This further supports the notion that AMH levels are associated with the number of antral follicles and hormonal imbalances, emphasizing the interconnected nature of these variables in women with PCOS.\u003c/p\u003e \u003cp\u003eIn our study, utilizing a population with already elevated AMH levels and a diagnosis of PCOS for comparison against non-PCOS individuals will create a deficiency in the comparison. However, considering the variations within the PCOS patient group, changes in AMH levels will aid in understanding their significance. While acknowledging that AMH alone may not serve as a definitive tool for the differential diagnosis of hyperandrogenic conditions, we believe it can provide valuable insights. Elevated AMH levels may also indicate a greater need for intensive treatment of hyperandrogenism symptoms. In our experience, AMH measurements emerge as a highly valuable objective and numerical indicator, not only aiding in the diagnosis of PCOS but also offering indications of the severity of the disease. The use of AMH in conjunction with other clinical and laboratory parameters may contribute to a more comprehensive understanding and characterization of PCOS.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthical approval:\u003c/strong\u003e \u003cp\u003e Ethical approval for this study was obtained from the \u0026lsquo;Buca Seyfi Demirsoy Training and Research Hospital\u0026rsquo; on August 23, 2023, with the protocol number 2023/8-157.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate:\u003c/strong\u003e \u003cp\u003eAll participiants were consented with informed consents approved by local ethical board.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthors\u0026rsquo; information:\u003c/h2\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003e Demokrasi University, Buca Seyfi Demirsoy Training and Research Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey\u003c/p\u003e \u003cp\u003e \u003csup\u003e2\u003c/sup\u003e Private Karataş Hospital, Izmir, Turkey\u003c/p\u003e \u003cp\u003e \u003csup\u003e3\u003c/sup\u003e Dokuz Eylul University School of Medicine, Izmir, Turkey\u003c/p\u003e \u003cp\u003eAll authors reviewed and approved the final version and no other person made a substantial contribution to the paper.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors received no fnancial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eC.A. contributed to study concept and design, interpreting the data and critical revision of the manuscript.U. A. contributed to study concept and design, and interpreting the data, composed the statistical dataset, performed the analyses, and wrote and revised the manuscript.H. A. A. contributed to data analysis and revision of the paper.O. Y. contributed to data analysis and revision of the paper.S. E. contributed to interpreting the data and critical revision of the manuscript.T. B. B.contributed to interpreting the data and critical revision of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAzziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRevised 2003 consensus. on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774\u0026ndash;800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(5):748\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDewailly D, Gronier H, Poncelet E, Robin G, Leroy M, Pigny P, et al. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod. 2011;26(11):3123\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaniilidis A, Dinas K. Long term health consequences of polycystic ovarian syndrome: a review analysis. Hippokratia. 2009;13(2):90\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahmay S, Atakul N, Oncul M, Tuten A, Aydogan B, Seyisoglu H. Serum anti-Mullerian hormone levels in the main phenotypes of polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):157\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePellatt L, Hanna L, Brincat M, Galea R, Brain H, Whitehead S, et al. Granulosa cell production of anti-M\u0026uuml;llerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2007;92(1):240\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLa Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS. Anti-Mullerian hormone (AMH): what do we still need to know? Hum Reprod. 2009;24(9):2264\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin YH, Chiu WC, Wu CH, Tzeng CR, Hsu CS, Hsu MI. Antim\u0026uuml;llerian hormone and polycystic ovary syndrome. Fertil Steril. 2011;96(1):230\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang JG, Nakhuda GS, Guarnaccia MM, Sauer MV, Lobo RA. M\u0026uuml;llerian inhibiting substance and disrupted folliculogenesis in polycystic ovary syndrome. Am J Obstet Gynecol. 2007;196(1):e771\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzel S, Alkan M, Tokmak A, Oksuzoglu A, Kaya M, Aktulay A, et al. Relationship Between Polycystic Ovarian Morphology and Ectopic Pregnancy. J Reprod Infertil. 2021;22(1):32\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePiouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D. Anti-Mullerian 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(2):E238\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePellatt L, Rice S, Mason HD. Anti-M\u0026uuml;llerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction. 2010;139(5):825\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlsen SM, Vanky E, Fleming R. Anti-M\u0026uuml;llerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome. Hum Reprod. 2009;24(7):1732\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen X, Ni R, Mo Y, Li L, Yang D. Appropriate BMI levels for PCOS patients in Southern China. Hum Reprod. 2010;25(5):1295\u0026ndash;302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark HT, Cho GJ, Ahn KH, Shin JH, Kim YT, Hur JY, et al. Association of insulin resistance with anti-Mullerian hormone levels in women without polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf). 2010;72(1):26\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenfield RL, Wroblewski K, Padmanabhan V, Littlejohn E, Mortensen M, Ehrmann DA. Antim\u0026uuml;llerian hormone levels are independently related to ovarian hyperandrogenism and polycystic ovaries. Fertil Steril. 2012;98(1):242\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi Y, Ma Y, Chen X, Wang W, Li Y, Zhang Q, et al. Different diagnostic power of anti-Mullerian hormone in evaluating women with polycystic ovaries with and without hyperandrogenism. J Assist Reprod Genet. 2012;29(10):1147\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen MJ, Yang WS, Chen CL, Wu MY, Yang YS, Ho HN. The relationship between anti-Mullerian hormone, androgen and insulin resistance on the number of antral follicles in women with polycystic ovary syndrome. Hum Reprod. 2008;23(4):952\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anti Mullerian Hormone, Polycystic Ovary Syndrome, Hyperandrogenism, Ovulation dysfuntion, Policystic ovarian morphology","lastPublishedDoi":"10.21203/rs.3.rs-4592805/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4592805/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003ePolycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in around 6-8% of women in their reproductive years. The measurement of Anti-Müllerian Hormone (AMH) holds particular promise in discerning both the diagnosis and the extent of severity in PCOS cases. This study aims to evaluate the effectiveness of using AMH as a potential tool for identifying and diagnosing the severity of clinical aspects associated with the syndrome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and Methods:\u003c/strong\u003e A retrospective analysis was performed on 309 female patients who presented for consultation at our hospital's gynecology outpatient clinic and were diagnosed with PCOS based on the Rotterdam criteria, between January 2018 and March 2022. Data were extracted from the hospital database and systematically assessed. Patients were divided into two groups based on AMH level of 7.5 ng/ml.Clinical symptoms and findings were assessed based on AMH values.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eA statistically significant difference was observed between groups for the mean levels of total testosterone, androstenedione, free androgen index, luteinizing hormone, and follicle-stimulating hormone (p \u0026lt; 0.05). Additionally, a statistically significant difference was noted between AMH groups and the presence of oligomenorrhea (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Even at the higher end of the spectrum, AMH retains significant value in determining the clinical aspects of PCOS.\u003c/p\u003e","manuscriptTitle":"The Relationship of Antimullerian Hormone with Severity of Clinical Symptoms in Polycystic Ovary Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-10 15:26:21","doi":"10.21203/rs.3.rs-4592805/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-24T14:02:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-17T23:29:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-17T23:29:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-06-17T08:30:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb8e0895-d752-4326-a955-059a4cd3c167","owner":[],"postedDate":"July 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-29T16:04:57+00:00","versionOfRecord":{"articleIdentity":"rs-4592805","link":"https://doi.org/10.1186/s12905-025-03983-x","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-09-24 15:57:23","publishedOnDateReadable":"September 24th, 2025"},"versionCreatedAt":"2024-07-10 15:26:21","video":"","vorDoi":"10.1186/s12905-025-03983-x","vorDoiUrl":"https://doi.org/10.1186/s12905-025-03983-x","workflowStages":[]},"version":"v1","identity":"rs-4592805","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4592805","identity":"rs-4592805","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}