Pnm-27: Anti-Mullerian Hormone As A Predictor of Ovarian Response to Life Style Modification

Background: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age, affecting 7% of this population. Although not entirely understood, the etiology of PCOS is closely linked to obesity and abdominal adiposity that are considered to worsen the clinical presentation, particularly menstrual irregularities and hyperandrogenism. Lifestyle modification programs focusing on weight loss have been shown to be important for improving reproductive function in obese women with PCOS. But some studies have demonstrated that reproductive responsiveness to weight loss (shown by improved menstrual cyclicity or ovulation) is different among PCOS women and is related to the levels of anti mulerian hormone. The aim of this review article is to study whether baseline and/or change in AMH levels with weight loss predict improvements in reproductive function in overweight and obese women with PCOS.Materials and Methods: This review article prepared by studying of articles obtained from Google, pub med sites with key words such as weight loss / anti-Mullerian hormone, reproductive function , menstrual cyclicity. Results: Popova etal. (2012) examined thirty overweight unovulatory women with PCOS (age 25.7 ± 5.9 y, body mass index (BMI) 32.3 + 5.3 kg/m2) followed a 6-month weight loss program. Mean reductions in weight by 9.0 ± 5.9 kg (p<0.001) and BMI by 3.3 ± 2.1 kg/m2 (p<0.001) occurred for the subjects over the study duration. Of 30 subjects, 15 (50%) responded to the intervention with improvements in menstrual cyclicity (responders). Compared to non-responders, responders had lower baseline anti-mullerian hormone (AMH) levels (6.3 ± 3.3 vs. 9.8 ± 4.2 ng/ml; p=0.015.The value of AMH less than 6.5 ng/ ml can predict improvement of menses (sensitivity 73%, specificity 67%) by weight loss in overweight women with PCOS. Thomson etal. (2009) studied fifty-two overweight and obese women with PCOS and reproductive impairment (age 29.8 ± 0.8 years, BMI 36.5 ± 0.7 kg/m2) followed a 20-week weight loss program. Participants who responded with improvements in reproductive function (n=26) had lower baseline AMH levels (23.5 ± 3.7 vs. 32.5 ± 2.9 pmol/l; p = 0.03) and experienced greater weight loss (211.7 ± 1.2 vs. 26.4 ± 0.9 kg; p = 0.001) compared with those who did not respond (n = 26). Logistic regression analysis showed that weight loss and baseline AMH were independently related to improvements in reproductive function (p = 0.002 and p = 0.013, respectively). AMH levels did not change with weight loss in both responders and non-responders. This study shows women with lower AMH levels experienced greater improvements in reproductive function. Moran etal. (2007) studied 26 overweight women with PCOS, (age 32.9 - 5.8 Y, weight 98.9 - 20.8 kg, BMI 36.1 - 7.0 kg/m) followed an 8w weight loss and 6-month weight maintenance program of 26 subjects, 15 (57.7%) responded to the intervention with improvements in menstrual cyclicity (responders). Compared to non-responders, responders had lower AMH levels at baseline (23.6 _12.0 vs. 37.9 - 17.8 pmol/liter; p = 0.021). Only responders had reductions in fasting insulin (6.1 - 5.9 mU/liter; p = 0.001) and homeostasis model assessment (1.3 - 5.9; p= 0.002) with acute weight loss (wk 0-8). Pretreatment AMH is a potential clinical predictor of menstrual improvements with weight loss in PCOS. Franasiak etal. (2012) examined Seventy-one women with PCOS participated in a randomized, double-blind, shamcontrolled clinical trial of acupuncture. Three longitudinal AMH samples over the 5-month protocol were compared with objective ovulation parameters =. AMH was inversely correlated with ovulation and menstrual cycle frequencies in both arms combined (p < 0.001). There was no difference between the true and sham acupuncture arms in the change in AMH longitudinally. Conclusion: These results suggest that AMH measurement can be useful in the pretreatment identification of women with PCOS who will benefit from lifestyle intervention by menstrual improvements.