Polycystic ovary syndrome: Cosmetic and dietary approaches

We know that serum AMH levels decline with age, as there is a decline in female reproductive function due to the reduction in the ovarian follicle pool and the quality of the oocytes. Undetectable AMH levels after premature ovarian failure have been reported, and oophorectomy in regularly cycling women is associated with the disappearance of AMH within 3 to 5 days. In contrast, AMH serum levels are normal in women affected by functional hypothalamic (hypogonadotrophic) amenorrhea.

In the past, FSH, inhibin B, and the antral follicle count have been the most reliable markers for investigating ovarian reserve during assisted reproductive treatment and predicting ovarian response to ovulation induction in intrauterine insemination and in vitro fertilization cycles, and are also useful in monitoring other reproductive disorders. However, AMH seems to better reflect the continuous decline of the oocyte/follicle pool with age and may be the best marker of ovarian aging and the menopausal transition. Moreover, serum levels can be drawn at any time of the menstrual cycle, unlike the measurement of FSH, which must be performed on day 3 of the cycle.^8,9

Increased AMH production also has been reported in women with PCOS, compared with controls.¹⁰ The increased production may be the result of aberrant activity of the granulosa cells in polycystic ovaries. AMH production may exert a paracrine negative control on follicle growth sufficient to prevent selection of a dominant follicle. Coupled with higher inhibin B levels, this may lead to a relative deficit of FSH in women with PCOS.

AMH measurement offers high specificity and sensitivity as a marker for PCOS. On this basis, it has been proposed that, in situations in which accurate ultrasonographic data are unavailable, AMH could be used instead of the follicle count as a diagnostic criterion for PCOS. Therapeutic interventions, including metformin administration to improve insulin resistance in women affected by PCOS, are associated with a reduction in both serum AMH levels and antral follicles. This suggests that the measurement of AMH could be used to evaluate treatment efficacy, may be a better predictor of ovarian hyperstimulation syndrome (OHSS) than body mass index, and could help direct the application of mild ovulation induction protocols to avoid moderate and severe OHSS.

There seems to be little doubt that research on AMH will continue in years to come. A clearer understanding of its effects on ovarian physiology may help clinicians find a role for AMH measurement in the field of reproductive medicine, thereby simplifying the diagnosis of PCOS and the evaluation of its treatment efficacy.

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