Assessment of Anti-mullerian Hormone Level in Polycystic Ovarian Disease Before and After Treatment with Metformin

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women and a major cause of female infertility. Metabolic aspects play important roles in both the pathogenesis and the long-term sequelae of the condition. Insulin resistance and hyperinsulinemia is highly prevalent among PCOS women and are considered the major cause of metabolic syndrome manifestations. Anti-Mullerian hormone (AMH) has gained attention during the recent years and is widely investigated in PCOS. AMH supresses follicle stimulating hormone (FSH) action on growing follicles by inhibiting aromatase and LH receptor expression until the time of follicle selection. Metformin, a biguanide insulin sensitizer improves ovulatory function and hence clinical pregnancy rates in women with PCOS as well as reducing androgen levels and attenuating hyperinsulinemia. We studied the difference in AMH in PCOS and normal control subjects and the impact of the use of metformin (2550 mg 3 times daily for 3 months) on AMH level. This study was conducted on 60 females. They were selected from the outpatient's clinic of Ain Shams University Hospital. The patients were classified into: Group A: included 30 PCOS patients. Group B: included 30 healthy females as control group.

The results of the study showed that: • Anti mullerian hormone was (3.54 + 0.58 ng/ml) in PCO patients before treatment with metformin and was (2.14 + 0.49 ng/ml) in control group with highly significant difference between the two groups. It became (2.79 + 0.39 ng/ml) after treatment with highly significant statistical difference between the two groups. • Body mass index (BMI) was (28.7± 6.2) in PCO patients before metformin treatment and became (27.7± 6.0) after treatment with highly significant difference between the two groups. And was (26.6 + 3.8) in control group with also highly significant statistical difference between the two groups. • Group 1 (PCOS) showed more criteria of metabolic syndrome as obesity, menstrual irregularity, infertility, induction of ovulation, hirsutism, acne. • Our study support the use of metformin in treatment of polycystic ovary disease patients. • Anti mullerian hormone can be used as a marker for treatment efficacy with metformin. • Further large studies are recommended to confirm our results.