Anti-Mullerian hormone, an ovarian reserve marker in hypogonadotropic hypogonadism

Objective: To determine the usefulness of Anti-Mullerian Hormone (AMH) and antral follicle count (AFC) as an ovarian reserve marker in hypogonadotropic hypogonadism (HH) patients and to find a limit value for the gonadotropin levels in the diagnosis of HH patients. Study design: It is a retrospective cross-sectional single-center study. One hundred ninety-nine women with HH and 171 healthy controls with no cycle disorders were included into this study. Continuous variables were expressed as mean +/- standard deviation. Statistical comparisons were carried out according to the intention to treat by Student's t-test, Mann-Whitney U test, where appropriate. Receiver operating characteristic curve-ROC was used to represent the sensitivity and specificity pair corresponding to decision threshold of FSH and LH levels in HH diagnosis. P < 0.05 was accepted to be statistically significant. Results: There was not any statistically significant difference between HH and control group regarding the age (23.94 +/- 6.56 vs. 23.92 +/- 3.01, respectively; p = 0.09). Serum AMH levels didn't show statistically significant difference between HH and control group (3.26 +/- 2.61 ng/mL vs. 3.15 +/- 1.46 ng/mL, respectively; p = 0.11). The difference of AFC between HH and control group was statistically significant (6.67 +/- 6.33 vs. 10.91 +/- 2.92, respectively; p < 0.001). Follicle-stimulating hormone (FSH), Luteinizing-hormone (LH) and Estradiol (E2) levels between the groups were found to be significantly different. Area under the receiver operating characteristic curve-ROC for FSH was 0.98 and for LH was 0.96. For the diagnosis of HH, FSH levels lower than 3.05 IU/L (with a sensitivity of 92% and specificity of 94%) and LH levels lower than 1.55 IU/L (with a sensitivity of 91% and specificity of 92%) can be used. Conclusion: In conclusion, serum AMH levels reflect the follicle cohort in HH cases validly with negligible underestimation of ovarian reserve. FSH < 3.05 IU/L and LH < 1.55 IU/L could be used with high sensitivity and specificity for the diagnosis of HH.

Automated summary

This study aimed to evaluate the usefulness of AMH and AFC as ovarian reserve markers in HH patients and to find cutoff values for gonadotropin levels in the diagnosis of HH. The results showed that serum AMH levels reflect the follicle cohort in HH cases, while AFC was significantly different between HH and control group. FSH and LH levels can be used with high sensitivity and specificity for the diagnosis of HH.