Increased anti-Mullerian hormone serum concentrations in prepubertal daughters of women with polycystic ovary syndrome

Context: Anti-Mullerian hormone (AMH) is produced by the granulosa cells and reflects follicular development. Adult women with polycystic ovary syndrome ( PCOS) have increased levels of AMH associated with an excessive number of growing follicles. However, it is not known whether these abnormalities are present before the clinical onset of PCOS. Objective: Our objective was to investigate whether prepubertal daughters of women with PCOS have increased AMH levels. Design: Fourteen female infants (2-3 months old) and 25 prepubertal girls (4-7 yr old) born to PCOS mothers were studied. As a control group, we studied 21 female infants and 24 prepubertal girls born to mothers with regular menses and without hyperandrogenism. The group with PCOS mothers and the control group had normal birth weight and were born from spontaneous singleton pregnancies. Circulating concentrations of gonadotropins, testosterone, androstenedione, estradiol, 17-OH-progesterone, SHBG, inhibin B, and AMH were determined by specific assays. Results: Serum concentrations of AMH were significantly higher in the PCOS group compared with the control group during early infancy (20.4 +/- 15.6 vs. 9.16 +/- 8.6 pmol/liter; P = 0.024) and during childhood (14.8 +/- 7.7 vs. 9.61 +/- 4.4 pmol/liter; P = 0.007). Gonadotropin and serum sex steroid concentrations were similar in both groups during the two study periods, except for FSH, which was lower during childhood in girls born to PCOS mothers. Conclusions: We conclude that serum AMH concentrations are increased in prepubertal daughters of PCOS women, suggesting that these girls appear to show evidence of an altered follicular development during infancy and childhood.