Granulosa cell production of anti-Mullerian hormone is increased in polycystic ovaries

Context: There has been renewed interest in anti-Mullerian hormone ( AMH) because of its role in the ovary. Data on its actions are sparse, but it appears to inhibit follicle growth. Interestingly, serum AMH is two to three times higher in women with polycystic ovary ( PCO) syndrome than women with normal ovaries. Objective: We examined the production of AMHby cells from a range of follicle sizes from normal ovaries and compared this with production by ovulatory and anovulatory ( anov) PCOs. Design: Granulosa cells ( GCs) and theca and follicular fluid (ff) were isolated from intact follicles. Cells were cultured for 48 h +/- FSH or LH, and AMH was measured in ff and cell- conditioned media ( CM). Results: AMH levels in ff and GC- CM ranged from 42 to 2240 and 0.025 to 1.7 ng/ ml, respectively, and were low or undetectable in ff and GC- CM from follicles greater than 9 mm, luteinized cells, and theca and stroma. The mean level of AMH was four times higher in GC- CM from ovulatory PCOs [ mean ( range) 1.56 ( 0.025 - 7)] and 75 times higher from anovPCO [ 21.4 ( 17.2 - 43 ng/ ml)] than normal ovaries [ 0.37 ( 0.025 - 1.7)]. Neither LH nor FSH had an effect on AMH production by GCs from normal ovaries, but in cells from PCOs, FSH significantly decreased AMH, and in contrast, LH increased AMH. Conclusions: The reduction of AMH in follicles greater than 9 mm from normal ovaries appears to be an important requirement for the selection of the dominant follicle. AMH production per GC was 75 times higher in anovPCOs, compared with normal ovaries. This increase in AMH may contribute to failure of follicle growth and ovulation seen in polycystic ovary syndrome.